| Part I A related parameters analysis between curvature and coronal balance inpatients with adult spinal deformityObjectives:To explore the prevalence of coronal imbalance,and to demonstrate the radiological parameters of curvature which correlated to coronal imbalance by investigating the pre-operative radiological parameters in adult spinal deformity(ASD).Methods:The study included 161 patients with ASD who had diagnosis and treatment in our hospital,the medical records were reviewed.The radiological parameters of spine were measured on the pre-operative anteroposterior and lateral radiographs.Coronal plane:the curve angle(Cobb),the compensatory angle(C-Cobb),types of curvature(left or right),the involved vertebras and the subluxation degree of the structural curvature,the degree of apical vertebra rotation(AR),coronal pelvic tilt angle(C-PT),the coronal balance distance(CBD):the coronal offset between C7PL and the center of S1 endplate.Sagittal plane:thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI),sagittal vertical axis(SVA).161 patients were divided into two groups,group A(the imbalance group,CBD>30.00mm),and group B(CBD<30.00mm).Radiological parameters of patients in imbalance and balance groups were compared by using independent samples t-test respectively.The ratio of gender,and the types of curve were compared by using x2-tset.Result:161 patients were included in this study,including 29 males(M)and 132 females(F),the age of all of the patients ranged from 45 to 79 years(63.88±8.42 years).Of 106 patients had left side curve,and right side curve in the other 55 patients.Coronal imbalance occurred in 31 patients(M:F,8:23),and the other 130 patients(M:F,21:109)didn't.The coronal imbalance rate was 19.25%(31/161).The age,the ratio of gender and types of curve in the two groups had no difference(P>0.05).The location of apical vertebra had significant difference between the two groups(x 2=12.692,P<0.001),the apicalvertebras were all located at L2 to L3 segments.Although the degree of the structural and the compensatory curvature had no difference respectively(P>0.05),the involved vertebras were less in group A than those in group B(3.87±0.85 VS 4.36±0.95;t=2.639,P=0.009),and the degree of apical vertebra rotation in group A was much more than that in group B(2.81±0.60 VS 2.32±0.77;t=-3.796,P<0.001).The thoracolumbar kyphosis degrees in group A were much more than those in group B(t=-2.445,P=0.017).121 patients whose apical vertebra locates at L2 to L3 segment were divided into two groups,group A'(the imbalance group,CBD>30.00mm)including 31 patients,and group B'(CBD<30.00mm)including 90 patients.The curve angle(Cobb),the compensatory angle(C-Cobb),the involved vertebras and the subluxation degree of the structural curvature,and the degree of apical vertebra rotation(AR)of the two groups were compared by using independent samples t-test respectively.We found similar results as before:Although the degree of the structural and the compensatory curvature had no difference respectively(P>0.05),the involved vertebras were less in group A' than those in group B'(3.87±0.85 VS 4.23±0.85;t=2.052,P=0.04),and the degree of apical vertebra rotation in group A' was much more than that in group B'(2.81±0.60 VS 2.27±0.68;t=-3.905,P<0.001).Conclusion:The prevalence of pre-operative coronal imbalance in ASD patients is about 20%.The most apical vertebras of the structures curvatures locate at L2 to L3 segments in ASD patients.Patients of ASD who have similar structural curvature degrees,the apical vertebras locate at L2 to L3 segment and have more rotation degrees,however,have less involved vertebras,may more easily suffer coronal imbalance.Part II Coronal imbalance in degenerative lumber scoliosis following posterior spinal fusion with instrument:a radiological analysisObjectives:To investigate the Pre-and Post-Operation radiological parameters in adult spinal deformity(ASD),and to explore the radiological parameters which correlated to coronal imbalance after operation.Methods:The study included 67 patients with ASD who underwent posterior long-segment spinal fixation(at least 4 vertebrae),the medical records of 67 ASD patients were reviewed.The radiological parameters of spine were measured on the Pre-and Post-Operation anteroposterior and lateral radiographs.Coronal plane:the curve Cobb angle,types of curve(left or right),degree of apical vertebra rotation,location of apical vertebra/disc,the coronal balance distance(CBD):the distance between C7PL and CSVL.Sagittal plane:thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI),sagittal vertical axis(SVA).All the patients were divided into two groups according to the post-operational CBD:the treatment group(CBD?30.00mm)and the control group(CBD<30.00mm).Radiological parameters of the two groups were compared by using independent samples t-test,Pre-and Post-Operational radiological parameters were compared by using paired samples t-test respectively.The ratio of gender,the types of curve,and the pre-and post-operational coronal imbalance were compared by using x2-tset.Result:67 patients were included in this study,including 13 males and 54 females,the age ranged from 45 to 79 years(63.93±8.46years).The difference of the pre-CBD of the 2 groups was significant(P=0.002),and so was the post-CBD(P=0.00).The pre-LL of the two groups had significant difference(P=0.007),so did the pre-SS(P=0.028),and the other radiological parameters of the 2 groups had no differences(P>0.05).The results of paired samples t-test showed that the differences of the radiological parameters of the 2 groups between pre-and post-operation,such as curve Cobb angles,degree of apical vertebra rotation,TK,TLK,LL,SS,PT,and SVA were significant(P<0.05),and so were the pre-and post-CBD of the treatment group.The PI of the 2 groups,and the pre-and post-CBD of the control group had no significant differences(P>0.05).The ratio of coronal imbalance of all the patients in pre-and post-operation was 31.34%(21/67)and 40.30%(27/67)respectively,there was significant difference(P<0.05).Conclusion:The coronal and sagittal alignments in ASD patients would be improved significantly after posterior long-segments fixation and fusion operation,patients with pre-operative coronal imbalance may be at the risk for post-operative coronal imbalance.Part III Coronal imbalance in adult spinal deformity following posterior spinal fusion with instrument:A related parameters analysis and prevalenceObjectives:To investigate the Pre-and Post-Operation radiological parameters in adult spinal deformity(ASD),and to explore the radiological parameters which correlated to post-operation coronal imbalance and to investigate whether pre-operation coronal imbalance affects post-operation coronal imbalance following posterior spinal fusion with instrument and osteotomy operation.Methods:The study included 67 patients with ASD who underwent posterior long-segment spinal fixation(at least 4 vertebrae)and osteotomy,the medical records of 67 ASD patients were reviewed.The radiological parameters of spine were measured on the Pre-and Post-Operation anteroposterior and lateral radiographs.Coronal plane:the curve Cobb angle,types of curve(left or right),degree of apical vertebra rotation,location of apical vertebra/disc,the coronal balance distance(CBD):the distance between C7PL and CSVL,the modified degree of the curve=pre-Cobb-post-Cobb,the modified degree of the apical vertebra rotation=pre-rotation degree-post-rotation degree.Sagittal plane:thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI),sagittal vertical axis(SVA).Pre-and Post-Operational radiological parameters were compared by using paired samples t-test respectively.To analyze the relation between post-CBD and other radiological parameters by using linear-regression test.Then,all of the patients were divided into three groups according to the types of the curves and the pre-CBD,A:-30.00mm<CBD<30.00mm;B:CBD>30.00mm or CBD<-30.00mm,and C7PL shifts to the concave side of the curve;C:CBD>30.00mm or CBD<-30.00mm,and C7PL shifts to the convex side of the curve.To analyze the radiological parameters of the three groups by using F test.The ratio of gender,the types of curve,and the pre-and post-operational coronal imbalance were compared by using x2-tset.Result:67 patients were included in this study,containing 13 males and 54 females,the age ranged from 45 to 79 years(63.93± 8.46 years).The results of paired samples t-testshowed that the differences of the radiological parameters between pre-and post-operation,such as curve Cobb angles,degree of apical vertebra rotation,TK,TLK,LL,SS,PT,and SVA were significant(P<0.05).The PI,the pre-and post-CBD had no significant differences(P>0.05).The ratio of coronal imbalance of all the patients in pre-and post-operation was 31.34%(21/67)and 40.30%(27/67)respectively,there was significant difference(x 2=5.31,P=0.02).There were significant correlations among post-CBD,pre-CBD,and dCobb(r=0.569,P=0.00;r=0.649,P=0.002),post-CBD=-2.737-0.924*dCobb+0.356*pre-CBD.The ratio of coronal imbalance of the A?B and C group was 16/51;5/9;6/7 respectively,and C group was significant higher than other two groups(x2=8.561,P=0.01).Conclusion:The sagittal alignments in ASD patients would be improved significantly after posterior spinal fusion with instrument and osteotomy operation.There were significant correlations among post-CBD,pre-CBD,and the modified degree of the coronal curve.Patients of C group may be at greater risk for post-operation coronal imbalance following posterior spinal fusion with instrument and osteotomy operation. |
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