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European Spine Journal

, Volume 28, Issue 9, pp 1937–1947 | Cite as

Thoracolumbar junction orientation: its impact on thoracic kyphosis and sagittal alignment in both asymptomatic volunteers and symptomatic patients

  • Hong Joo Moon
  • Keith H. Bridwell
  • Alekos A. Theologis
  • Micheal P. Kelly
  • Thamrong Lertudomphonwanit
  • Han Jo Kim
  • Lawrence G. Lenke
  • Munish C. GuptaEmail author
Original Article

Abstract

Purpose

The thoracolumbar junction (TLJ) has not been explored in regard to its contribution to global sagittal alignment. This study aims to define novel sagittal parameters of the TLJ and to assess their roles within global sagittal alignment.

Methods

Included for cross-sectional, retrospective analysis were asymptomatic volunteers and symptomatic patients who had undergone operation for adult spinal deformity. Unique sagittal parameters of the TLJ were measured using the midline of the T12–L1 disk space: The TLJ orientation [TLJO; thoracolumbar tilt (TLT) and slope (TLS)]. Thoracic kyphosis (TK; T5–12), C7–S1 sagittal vertical axis (SVA), lumbar lordosis (LL; L1–S1), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured. Continuous variables were compared using the independent t test. Pearson correlations examined relationships between the parameters in each group. The asymptomatic TK was calculated using the measurement of the asymptomatic volunteer’s TLJO by linear regression.

Results

One hundred fifteen asymptomatic volunteers and 127 symptomatic patients were included. Only LL among the lumbopelvic parameters correlated with TK (asymptomatic volunteers: r = − 0.42; symptomatic patients: r = − 0.40). All the pelvic parameters have no direct correlation with TK in both groups. TLJO had stronger correlation with TK [asymptomatic volunteers: r = − 0.68 (TLS), r = 0.41 (TLT); symptomatic patients: r = − 0.56 (TLS), r = 0.44 (TLT)] than the lumbopelvic parameters. TLS correlated with LL (asymptomatic volunteers: r = 0.78; symptomatic patients: r = 0.73). Most pelvic parameters correlated with TLJO except for PI. The asymptomatic TK was estimated by the derived formula: 20.847 + TLS × (− 1.198).

Conclusion

The TLJO integrates the status of the lumbopelvic sagittal parameters and simultaneously correlates with thoracic and global sagittal alignment.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Thoracolumbar junction Thoracolumbar junction orientation Thoracic kyphosis Adult spinal deformity Sagittal balance 

Notes

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.

Supplementary material

586_2019_6078_MOESM1_ESM.pptx (355 kb)
Supplementary file1 (PPTX 354 kb)

References

  1. 1.
    Celestre PC, Dimar JR, Glassman SD (2018) Spinopelvic parameters: lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope—what does a spine surgeon need to know to plan a lumbar deformity correction? Neurosurg Clin N Am 29:323–329.  https://doi.org/10.1016/j.nec.2018.03.003 CrossRefPubMedGoogle Scholar
  2. 2.
    Barrey C, Roussouly P, Perrin G, Le Huec JC (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20(Suppl 5):626–633.  https://doi.org/10.1007/s00586-011-1930-3 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Jang JS, Lee SH, Min JH, Maeng DH (2009) Influence of lumbar lordosis restoration on thoracic curve and sagittal position in lumbar degenerative kyphosis patients. Spine 34:280–284.  https://doi.org/10.1097/BRS.0b013e318191e792 CrossRefPubMedGoogle Scholar
  4. 4.
    Lafage V, Ames C, Schwab F, Klineberg E, Akbarnia B, Smith J, Boachie-Adjei O, Burton D, Hart R, Hostin R, Shaffrey C, Wood K, Bess S (2012) Changes in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy: a comprehensive radiographic analysis. Spine 37:E180–E187.  https://doi.org/10.1097/BRS.0b013e318225b926 CrossRefPubMedGoogle Scholar
  5. 5.
    Dubousset J (1994) Three-dimensional analysis of the scoliotic deformity. The pediatric spine: principles and practice. Raven Press Ltd, New YorkGoogle Scholar
  6. 6.
    Smith HE, Anderson DG, Vaccaro AR, Albert TJ, Hilibrand AS, Harrop JS, Ratliff JK (2010) Anatomy, biomechanics, and classification of thoracolumbar injuries. Semin Spine Surg 22:2–7.  https://doi.org/10.1053/j.semss.2009.10.001 CrossRefGoogle Scholar
  7. 7.
    Liu CJ, Zhu ZQ, Wang KF, Duan S, Xu S, Liu HY (2017) Radiological analysis of thoracolumbar junctional degenerative kyphosis in patients with lumbar degenerative kyphosis. Chin Med J (Engl) 130:2535–2540.  https://doi.org/10.4103/0366-6999.217090 CrossRefGoogle Scholar
  8. 8.
    Cho KJ, Suk SI, Park SR, Kim JH, Jung JH (2013) Selection of proximal fusion level for adult degenerative lumbar scoliosis. Eur Spine J 22:394–401.  https://doi.org/10.1007/s00586-012-2527-1 CrossRefPubMedGoogle Scholar
  9. 9.
    Michael F, O’Brien M, Kuklo TR, Blanke KM, Lenke LG (2008) Spinal deformity study group-radiographic measurement manual. Medtronic Sofamor Danek USA, Inc., MemphisGoogle Scholar
  10. 10.
    Jang JS, Lee SH, Min JH, Han KM (2007) Lumbar degenerative kyphosis: radiologic analysis and classifications. Spine 32:2694–2699.  https://doi.org/10.1097/BRS.0b013e31815a590b CrossRefPubMedGoogle Scholar
  11. 11.
    Iyer S, Lenke LG, Nemani VM, Albert TJ, Sides BA, Metz LN, Cunningham ME, Kim HJ (2016) Variations in sagittal alignment parameters based on age: a prospective study of asymptomatic volunteers using full-body radiographs. Spine 41:1826–1836.  https://doi.org/10.1097/brs.0000000000001642 CrossRefPubMedGoogle Scholar
  12. 12.
    Evans JD (1996) Straightforward statistics for the behavioral sciences. Brooks/Cole Publishing, Pacific GroveGoogle Scholar
  13. 13.
    Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G (2006) Sagittal thoracic decompensation following long adult lumbar spinal instrumentation and fusion to L5 or S1: causes, prevalence, and risk factor analysis. Spine 31:2359–2366.  https://doi.org/10.1097/01.brs.0000238969.59928.73 CrossRefPubMedGoogle Scholar
  14. 14.
    Newton PO, Yaszay B, Upasani VV, Pawelek JB, Bastrom TP, Lenke LG, Lowe T, Crawford A, Betz R, Lonner B (2010) Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine 35:1365–1370.  https://doi.org/10.1097/BRS.0b013e3181dccd63 CrossRefPubMedGoogle Scholar
  15. 15.
    Mac-Thiong JM, Labelle H, Berthonnaud E, Betz RR, Roussouly P (2007) Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J 16:227–234.  https://doi.org/10.1007/s00586-005-0013-8 CrossRefPubMedGoogle Scholar
  16. 16.
    Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40–47CrossRefGoogle Scholar
  17. 17.
    Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Jt Surg Am 87:260–267.  https://doi.org/10.2106/jbjs.D.02043 CrossRefGoogle Scholar
  18. 18.
    Boissiere L, Bourghli A, Vital JM, Gille O, Obeid I (2013) The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery. Eur Spine J 22:1339–1345.  https://doi.org/10.1007/s00586-013-2711-y CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Gottfried ON, Daubs MD, Patel AA, Dailey AT, Brodke DS (2009) Spinopelvic parameters in postfusion flatback deformity patients. Spine J 9:639–647.  https://doi.org/10.1016/j.spinee.2009.04.008 CrossRefPubMedGoogle Scholar
  20. 20.
    Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353CrossRefGoogle Scholar
  21. 21.
    Roussouly P, Nnadi C (2010) Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 19:1824–1836.  https://doi.org/10.1007/s00586-010-1476-9 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hong Joo Moon
    • 1
    • 2
  • Keith H. Bridwell
    • 2
  • Alekos A. Theologis
    • 2
    • 3
  • Micheal P. Kelly
    • 2
  • Thamrong Lertudomphonwanit
    • 4
  • Han Jo Kim
    • 5
  • Lawrence G. Lenke
    • 6
  • Munish C. Gupta
    • 2
    Email author
  1. 1.Department of NeurosurgeryKorea University College of MedicineSeoulSouth Korea
  2. 2.Department of Orthopaedic Surgery, School of MedicineWashington University in St. LouisSt. LouisUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of California – San Francisco (UCSF)San FranciscoUSA
  4. 4.Department of Orthopaedic Surgery, Ramathibodi HospitalMahidol UniversityBangkokThailand
  5. 5.Spine ServiceHospital for Special SurgeryNew YorkUSA
  6. 6.Department of Orthopaedic Surgery, Columbia University Medical CenterThe Spine Hospital at New York PresbyterianNew YorkUSA

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