Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2002 Jun;9(2):133-142. Korean.
    Published online Jun 30, 2002.
    https://doi.org/10.4184/jkss.2002.9.2.133
    Copyright © 2002 Korean Society of Spine Surgery
    Original Article

    The Relationship between Sagittal Spinal Alignment and Surgical Results in Degenerative Lumbar Scoliosis with Spinal Stenosis

    Whoan Jeang Kim, M.D., Jin Sup Yeom, M.D., Jong Won Kang, M.D.,* Kyou Hyeun Kim, M.D.,** Seung Hun Lee, M.D., Keun Jong Choy, M.D. and Won Sik Choy, M.D.
      • Department of Orthopaedic Surgery, Eulji University, Taejon, Korea.
      • *Department of Orthopaedic Surgery, Cheongju St. Mary's Hospital, Chungju, Korea.
      • **Department of Orthopaedic Surgery, Kon-Kuk University Hospital, Chungju, Korea.
    • Address reprint requests to Jin-Sup Yeom, M.D. Department of Orthopaedic Surgery, Eulji University, 24-14, Mok-Dong, Chung-Ku, Taejon, 301-726, Korea. Tel: 042-259-1286, Fax: 042-252-5498, Email: ortho@hananet.net

    Abstract

    Study Design

    A retrospective study.

    Objectives

    To analyze the correlation between clinical results and sagittal vertical axis, clinical results and total lumbar lordosis in degenerative lumbar scoliosis with spinal stenosis.

    Summary of Literature Review

    There has been no report about the relation between sagittal spinal alignment and surgical outcome of degenerative lumbar scoliosis.

    Materials and Methods

    We reviewed 38 surgical cases of degenerative lumbar scoliosis from February 1997 to February 2001 with an average follow-up of 35 months. In whole spine standing AP and lateral radiographs, scoliotic angle(Cobb method), total lumbar lordosis(L1~S1) and the sagittal vertical axis(C7 plumb line) were measured. In lumbar flexion-extension and standing side bending views, the lateral translation was measured and instability was determined. Clinical results were evaluated based on the Kirkaldy-Willis criteria.

    Results

    The scoliotic angles at preoperative, postoperative and follow-up were 15.0±4.9, 5.3±3.1 and 7.1±3.7 degrees retrospectively. Total lumbar lordosis were 28.7±6.1, 40.6±7.3 and 35.1±10.2 degrees retrospectively. Sagittal vertical axis at preoperative and the last follow-up were 3.3±3.2 and 0.1±3.3 cm retrospectively. According to Kirkaldy-Willis criteria, 6 cases were excellent, 24 cases good, 7 cases fair and 1 case poor. There was no statistical correlation between total lumbar lordosis and the clinical results (r=-0.061, p=0.717). Sagittal vertical axis was significantly correlated with the clinical results (r=0.519, p=0.001).

    Conclusions

    For improvement of surgical outcome of degenerative lumbar scoliosis, the sagittal vertical axis should be used as a parameter of sagittal alignment rather than the total lumbar lordosis.

    Keywords
    Lumbar spine; Degenerative scoliosis; Sagittal spinal alignment; Sagittal vertical axis

    Figures

    Fig. 1
    Method of measurement of various parameters of sagittal spinal alignment. Sagittal vertical axis is the horizontal distance from the C7 plumb line to the anterior superior corner of the sacrum. Positive value indicated a line passing anterior to the front of the sacrum, a neutral value indicated a line passing through of the sacrum and a negative value indicated a line passing behind of the sacrum. The angle A is the total lumbar lordosis measured between a line drawn across the top of the L1 and a similar line drawn across the top of the S1.

    Fig. 2
    A. Preoperative radiographs of a 57-year-old woman with degenerative lumbar kyphoscoliosis show sagittal imbalance of spine (scoliotic angle: 18°, total lumbar lordosis: -10°, sagittal vertical axis: 4 cm).

    B. Follow-up 12 months radiographs after decompression and PLF & PLIF with instrumentation show sagittal balance of spine (scoliotic angle: 7°, total lumbar lordosis: 15°, sagittal vertical axis: 0 cm).

    Fig. 3
    A. Preoperative radiographs of a 59-year-old woman with degenerative lumbar scoliosis show 15° scoliotic angle, 20° total lumbar lordosis and 0 cm sagittal vertical axis.

    B. Follow-up 14 months radiographs after decompression and PLF with instrumentation show sagittal balance of spine (scoliotic angle: 4°, total lumbarlordosis: 25°, sagittal vertical axis: 0 cm).

    Fig. 4
    A. Preoperative radiographs of a 65-year-old male with degenerative lumbar scoliosis show sagittal imbalance of spine (scoliotic angle: 30°, total lumbar lordosis: 30°, sagittal vertical axis: 4 cm).

    B. Follow-up 12 months radiographs after decompression and PLF with instrumentation show sagittal imbalance of spine (scoliotic angle: 8°, total lumbar lordosis: 40°, sagittal vertical axis: 3 cm).

    Tables

    Table 1
    Radiological results

    Table 2
    Correlation of total lumbar lordosis and sagittal vertical axis

    Table 3
    Kirkaldy-Willis criteria

    Table 4
    Clinical results and total lumbar lordosis

    Table 5
    Clinical results and sagittal balance

    Table 6
    Correlation of clinical results

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    MeSH Terms
    Animals
    Axis, Cervical Vertebra
    Follow-Up Studies
    Lordosis
    Retrospective Studies
    Scoliosis*
    Spinal Stenosis*
    Spine
    Metrics
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