Re: New Research of Interest

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Very interesting! Thanks for sharing, !

Kelley

>

> pine. 2006 Sep 15;31(20):2343-52.

> An analysis of sagittal spinal alignment following long adult

> lumbar instrumentation and fusion to L5 or S1: can we predict ideal

> lumbar lordosis?

>

> * Kim YJ,

> * Bridwell KH,

> * Lenke LG,

> * Rhim S,

> * Cheh G.

>

> Washington University Medical Center, St. Louis, MO, USA.

>

> STUDY DESIGN: A retrospective study. OBJECTIVE: To determine

> factors controlling sagittal spinal balance after long adult lumbar

> instrumentation and fusion from the thoracolumbar spine to L5 or S1.

> SUMMARY OF BACKGROUND DATA: To our knowledge, no study on

> postoperative sagittal balance following long adult spinal

> instrumentation and fusion to L5 or S1 has been published. METHODS: A

> clinical and radiographic assessment of 80 patients with adult lumbar

> deformity (average age 53.4 years) who underwent long (average 7.6

> vertebrae, 5-11 vertebrae) segmental posterior spinal instrumentation

> and fusion from the thoracolumbar spine to the L5-S1 (average 4.5

> years, 2-15.8-year follow-up) was performed. We defined the optimal

> sagittal balance (n = 42) group, the distance from C7 plumb to

> superior posterior endplate of S1 < or = 3.0 cm, and the suboptimal

> sagittal balance (n = 38) group, the distance from C7 plumb to

> superior posterior endplate of S1 > 3.0 cm at ultimate follow-up.

> RESULTS: The optimal sagittal balance group (C7 plumb, average -0.6

> +/- 2.5 cm) had the larger average angle differences between lumbar

> lordosis and thoracic kyphosis (P < 0.0001), preoperative smaller

> pelvic incidence (P = 0.007), smaller average thoracolumbar junctional

> angle (T10-L2) increase (P < 0.0001), and bigger lumbar lordosis angle

> increase (P = 0.014) at ultimate follow-up. Patients with optimal

> sagittal balance at ultimate follow-up had significantly higher total

> Scoliosis Research Society 24 outcome scores than those with

> suboptimal sagittal balance (P = 0.015). Risk factors that were

> statistically significant for the suboptimal sagittal balance group

> included pelvic incidence compared with lumbar lordosis (> or = 45

> degrees) before surgery (vs. < 45 degrees, P = 0.009), smaller lumbar

> lordosis compared with thoracic kyphosis (< 20 degrees) at 8 weeks

> postoperatively (vs. > or = 20 degrees, P = 0.013), and older than 55

> years of age at surgery (vs. 55 years or younger, P = 0.024).

> CONCLUSION: A sagittal Cobb angle difference between lumbar lordosis

> and thoracic kyphosis of > 20 degrees (higher lumbar lordosis) is

> advisable in most circumstances to achieve optimal sagittal balance.

>