European Spine Journal

, Volume 25, Issue 8, pp 2668–2675

Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection

  • Jung-Hee Lee
  • Ki-Tack Kim
  • Sang-Hun Lee
  • Kyung-Chung Kang
  • Hyun-Seok Oh
  • Young-Jun Kim
  • Hyuk Jung
Original Article

Abstract

Purpose

To determine the correlation of the difference between postoperative lumbar lordosis (LL) and ideal LL with the sagittal vertical axis (SVA) at the final follow-up in patients with adult spinal deformity (ASD).

Methods

Fifty-one patients with degenerative lumbar kyphosis (DLK) (mean age 66.5 years) who underwent surgical correction with a minimum 2-year follow-up were evaluated. Based on the difference between postoperative LL and ideal LL using the Korean version of Legaye’s formula, we divided the 51 patients into two groups: overcorrection (degree of postoperative LL > ideal LL) and undercorrection (degree of postoperative LL < ideal LL).

Results

Our clinical series of patients comprised 24 in the overcorrection and 27 in the undercorrection group. No significant differences were found in preoperative pelvic incidence (PI 52.6° vs. 57.3°), sacral slope (SS 23.3° vs. 18.3°), LL (−6.9° vs. −2.3°), thoracic kyphosis (TK 4.7° vs. 4.9°) and SVA (140 vs. 139 mm) except pelvic tilt (PT 29.4° vs. 39.0°), between the two groups. All the patients in the overcorrection group and 16 in the undercorrection group achieved postoperative optimal sagittal balance based on SVA ≤ 50 mm. In addition, significant differences in PT (10.5° vs. 26.7°), SS (42.1° vs. 30.6°), LL (−64.3° vs. −37.1°), TK (22.6° vs. 15.8°), and SVA (−1 vs. 41 mm) between the two groups were observed postoperatively. Furthermore, four patients (16.7 %) in the overcorrection group and eight (50 %) in the undercorrection group had sagittal decompensation at the final follow-up. Our results showed that the difference between postoperative LL and ideal LL had a significant correlation with postoperative and final follow-up SVA in our clinical series.

Conclusion

Overcorrection of LL is an effective treatment modality to maintain optimal sagittal alignment in patients with DLK; this suggests that it should be considered in preoperative planning for patients with ASD with sagittal imbalance.

Keywords

Adult spinal deformity Degenerative lumbar kyphosis Sagittal imbalance Pelvic incidence Overcorrection 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Jung-Hee Lee
    • 1
  • Ki-Tack Kim
    • 1
  • Sang-Hun Lee
    • 1
  • Kyung-Chung Kang
    • 1
  • Hyun-Seok Oh
    • 1
  • Young-Jun Kim
    • 1
  • Hyuk Jung
    • 1
  1. 1.Department of Orthopaedic Surgery, Graduate SchoolKyung Hee UniversitySeoulKorea

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