Analysis of sagittal plane deformity and correction

Ashish Patel, Frank Schwab, Benjamin Ungar, Jean Pierre Farcy, Virginie Lafage

Research output: Contribution to journalReview articlepeer-review

3 Scopus citations

Abstract

Adult spinal deformity is a complex structural musculoskeletal entity with variable presentation. Recent reports have found that pain and disability resulting from spinal deformity are primarily caused by sagittal malalignment. With increasing sagittal plane malalignment, patients typically complain of severe back pain, which is exacerbated with activity and substantially limits functional capacity. Radiographic acquisition of the sagittal plane requires capturing the spinopelvic axis from at least C7 proximally to the femoral heads distally on a single 36'' long standing film. Because of the large range considered "normal", regional alignment values alone are insufficient in assessing patient-specific alignment and the optimal values to strive for during spinal deformity realignment. It is thus important to consider the idea of spinopelvic harmony, which relates to the proportionality of one given regional parameter to another and in practical terms the global spinopelvic alignment of the individual. Several key surgical principles have been developed to optimize clinical outcomes during sagittal spinopelvic realignment surgery. These include obtaining sagittal vertical axis (SVA) <50mm, pelvic tilt (PT) <201 and lumbar lordosis (LL)=PI±91. Many methods for surgical realignment are available; however, to maximize the likelihood of a successful outcome it may be less important exactly what type of realignment technique is applied than to pursue proper analysis and execution of spinopelvic realignment. In many cases, a range of options may exist and the ultimate plan should be tempered by numerous factors, including surgeon expertise and patient co-morbidities. With thorough preoperative clinical and radiographic evaluations, awareness of general and patient-specific alignment objectives, and the surgical skills necessary to complete the task, spinopelvic realignment may then be pursued to optimize standing alignment for the symptomatic adult patient with spinal deformity.

Original languageEnglish
Pages (from-to)356-363
Number of pages8
JournalCurrent Orthopaedic Practice
Volume21
Issue number4
DOIs
StatePublished - Jul 2010
Externally publishedYes

Keywords

  • Pelvic incidence
  • Pelvic tilt
  • Sagittal malalignment
  • Sagittal vertical axis
  • Spinal deformity

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