Abstract
Study design
A single-centre retrospective study.
Background and Purpose
Although adult patients spend most of their time in sitting positions, the assessment of spinopelvic parameters in adult deformity surgery is commonly performed in standing X-rays. Our study compares the standing and sitting sagittal alignment parameters in subjects who underwent thoracolumbar fusion.
Methods
Patients who underwent corrective surgery for adult scoliosis with at least five instrumented vertebra were stratified according to the upper instrumented vertebra (UIV) and pelvic fixation. Group A:UIV proximal to T6 with pelvis fixation. B:UIV lower than T6 and pelvic fixation. Group C: thoracolumbar fusion without pelvic fixation. Post-operative spinopelvic sagittal parameters were measured in both standing and sitting X-rays.
Results
A total of 51 patients were enrolled in the study (11:Males and 40:Females). The mean age was 52.3 ± 21.7y/o. The comparison of post-operative standing and sitting X-ray within the group A and B showed that a significant change was observed in terms of JA-Junctional Angle-(Group A 6.3 ± 4.3 vs. 8.1 ± 3.3, p value = 0.03) (Group B 8.5 ± 6.4 vs. 10.9 ± 6.4, p value = 0.02). Group C showed statistically significant difference in terms of PT (15.6 ± 11.2 vs. 19.3 ± 9.2, p value = 0.04), AVA-Acetabular Version Angle-(41.1 ± 5.9 vs. 48.3 ± 6.6, p value < 0.01) and LL (− 51.3 ± 16.0 vs. − 42.6 ± 10.7, p value < 0.01).
Conclusion
In our series, the post-operative sagittal alignment showed peculiar behaviours and adaptations in sitting position, depending on the length and the site of the instrumented area. If the pelvis is included, the JA tends to significantly increase in sitting position. These findings can improve the knowledge of pathologies as proximal junctional kyphosis or specific cases of anterior hip impingement.
Level of evidence
IV.
Similar content being viewed by others
Availability of data and material
The datasets used and/or analyzed in the present study are available from the corresponding author on reasonable request.
References
Reid DBC, Daniels AH, Ailon T et al (2018) Frailty and health-related quality of life improvement following adult spinal deformity surgery. World Neurosurg 112:e548–e554. https://doi.org/10.1016/j.wneu.2018.01.079
Diebo BG, Shah NV, Boachie-Adjei O et al (2019) Adult spinal deformity. Lancet 394:160–172. https://doi.org/10.1016/S0140-6736(19)31125-0
Glattes RC, Bridwell KH, Lenke LG et al (1976) (2005) Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa) 30:1643–1649. https://doi.org/10.1097/01.brs.0000169451.76359.49
Zanirato A, Damilano M, Formica M et al (2018) Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences. Eur Spine J 27:2272–2284. https://doi.org/10.1007/s00586-018-5535-y
Yagi M, Rahm M, Gaines R et al (1976) (2014) Characterization and surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity. Spine (Phila Pa) 39:E607–E614. https://doi.org/10.1097/BRS.0000000000000266
Harvey JA, Chastin SFM, Skelton DA (2015) How sedentary are older people? A systematic review of the amount of sedentary behavior. J Aging Phys Act 23:471–487. https://doi.org/10.1123/japa.2014-0164
Lee ES, Ko CW, Suh SW et al (2014) The effect of age on sagittal plane profile of the lumbar spine according to standing, supine, and various sitting positions. J Orthop Surg Res 9:11. https://doi.org/10.1186/1749-799X-9-11
Hey HWD, Teo AQA, Tan K-A et al (2017) How the spine differs in standing and in sitting-important considerations for correction of spinal deformity. Spine J 17:799–806. https://doi.org/10.1016/j.spinee.2016.03.056
Garg B, Mehta N, Bansal T, Malhotra R (2020) EOS® imaging: concept and current applications in spinal disorders. J Clin Orthop Trauma 11:786–793. https://doi.org/10.1016/j.jcot.2020.06.012
Langella F, Villafañe JH, Damilano M et al (2017) predictive accuracy of surgimap surgical planning for sagittal imbalance: a cohort study. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000002230
Woo RY, Morrey BF (1982) Dislocations after total hip arthroplasty. J Bone Jt Surg Am 64:1295–1306
Suzuki H, Endo K, Mizuochi J et al (2016) Sagittal lumbo-pelvic alignment in the sitting position of elderly persons. J Orthop Sci Off J Jpn Orthop Assoc 21:713–717. https://doi.org/10.1016/j.jos.2016.06.015
Endo K, Suzuki H, Nishimura H et al (2012) Sagittal lumbar and pelvic alignment in the standing and sitting positions. J Orthop Sci Off J Jpn Orthop Assoc 17:682–686. https://doi.org/10.1007/s00776-012-0281-1
Nishida N, Izumiyama T, Asahi R et al (2020) Changes in the global spine alignment in the sitting position in an automobile. Spine J Off J North Am Spine Soc 20:614–620. https://doi.org/10.1016/j.spinee.2019.11.016
Wittenberg RH, Shea M, Edwards WT et al (1992) A biomechanical study of the fatigue characteristics of thoracolumbar fixation implants in a calf spine model. Spine 17:S121–S128. https://doi.org/10.1097/00007632-199206001-00010
Sun Z, Zhou S, Wang W et al (2020) Differences in standing and sitting spinopelvic sagittal alignment for patients with posterior lumbar fusion: important considerations for the changes of unfused adjacent segments lordosis. BMC Musculoskelet Disord 21:760. https://doi.org/10.1186/s12891-020-03777-2
Berjano P, Langella F, Ismael M-F et al (2014) Successful correction of sagittal imbalance can be calculated on the basis of pelvic incidence and age. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 23(Suppl 6):587–596. https://doi.org/10.1007/s00586-014-3556-8
Lamartina C, Berjano P, Petruzzi M et al (2012) Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 21(Suppl 1):S27-31. https://doi.org/10.1007/s00586-012-2236-9
Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J 23:1177–1189. https://doi.org/10.1007/s00586-014-3227-9
Yilgor C, Sogunmez N, Boissiere L et al (2017) Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Jt Surg Am 99:1661–1672. https://doi.org/10.2106/JBJS.16.01594
Healy GN, Clark BK, Winkler EAH et al (2011) Measurement of adults’ sedentary time in population-based studies. Am J Prev Med 41:216–227. https://doi.org/10.1016/j.amepre.2011.05.005
Shiba Y, Taneichi H, Inami S et al (2016) Dynamic global sagittal alignment evaluated by three-dimensional gait analysis in patients with degenerative lumbar kyphoscoliosis. Eur Spine J 25:2572–2579. https://doi.org/10.1007/s00586-016-4648-4
Acknowledgements
This study was funded by the Italian Ministry of Health, Italy (Agreement No. Not Applicable). The funders had no involvement in study design, collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. The data that were used for this study were collected in the SpineReg electronic register (IOG SpineReg version 1.7.4, Deloitte, Milan, Italy)
Funding
This study was supported and funded by the Italian Ministry of Health (Ricerca Corrente 2022. Agreement No. Not Applicable). No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Consent to participate
All patients gave informed consent before inclusion in the study and all procedures were in accordance with the 1964 Helsinki Declaration and its later amendments.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Cecchinato, R., Berjano, P., Compagnone, D. et al. Long spine fusions to the sacrum-pelvis are associated with greater post-operative proximal junctional kyphosis angle in sitting position. Eur Spine J 31, 3573–3579 (2022). https://doi.org/10.1007/s00586-022-07418-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-022-07418-1