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Defining threshold for sagittal correction in lumbar fractures

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Abstract

Purpose

Surgical indications for thoraco-lumbar fractures are driven both by neurological status, fractures instability and kyphotic deformity. Regarding kyphotic deformity, an angulation superior to 20° is considered by many surgeons as a surgical indication to reduce the disability induced by post-traumatic kyphosis. However, there is a lack of data reporting the ideal or theoretical lordosis that one must have in a particular lumbar segment on CT-scan. The main goal of this study was to determine the mean value for segmental lumbar lordosis according to pelvic incidence (PI) on a cohort of normal subjects.

Methods

The consecutive CT-scan of 171 normal adult subjects were retrospectively analyzed. The PI and the segmental lordosis (L4S1, L3L5, L2L4, L3L1, L2T12 and T11-L1) were measured on all CT-scan. The mean values were calculated for the global cohort and a sub-group analysis according to IP ranges (< 45°, 45 < IP < 60° and > 60°) was performed.

Results

The mean angular values for the whole cohort were IP: 54, 9°; L4S1: − 38, 1°; L3L5: − 30, 6°; L2L4: − 14, 1°; L1L3: − 4, 9°; T12L2: + 1, 9° and T11L1: + 5, 4°. The segmental values vary significatively with PI ranges, as for L3L5: − 26, 8° (PI < 45°); − 30° (45 < PI < 60°) and − 35, 1° (PI > 60°).

Conclusion

These results provide a referential of theoretical values of segmental lordosis according to PI. This abacus may help spinal surgeon in their decision-making process regarding lumbar fractures, to determine the amount of sagittal correction needed, according to the PI range, to be adapted to the sagittal morphology of the patient.

Level of evidence

III.

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Data availability

The anonymous data are available from the corresponding authors at the editor request.

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Authors and Affiliations

  1. Spine Surgery Unit, Orthopaedic Department, Pitié-Salpétrière Hospital, 43-87 Bd de l’Hôpital, 75013, Paris, France

    Laura Marie-Hardy, Yann Mohsinaly, Raphaël Pietton, Raphaël Bonaccorsi & Hugues Pascal-Moussellard

  2. Pediatric Orthopaedic Department, Trousseau Hospital, 26 Av. du Dr Arnold Netter, 75012, Paris, France

    Raphaël Vialle

Authors
  1. Laura Marie-Hardy
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  2. Yann Mohsinaly
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  3. Raphaël Pietton
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  4. Raphaël Bonaccorsi
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  5. Raphaël Vialle
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  6. Hugues Pascal-Moussellard
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Correspondence to Laura Marie-Hardy.

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethical approval

This study received IRB approval, under the number: 20220630143858. This study has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki.

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Marie-Hardy, L., Mohsinaly, Y., Pietton, R. et al. Defining threshold for sagittal correction in lumbar fractures. Eur Spine J 33, 1550–1555 (2024). https://doi.org/10.1007/s00586-024-08138-4

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