Risk factors analysis of coronal imbalance after posterior long-level fixation and transforaminal lumbar interbody fusion for degenerative lumbar scoliosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

NIU Xiaojian , YANG Sizhen , ZHANG Ying , QIU Hao , CHEN Wugui , ZHOU Chiyu ,  CHU Tongwei

Department of Orthopedics, Second Affiliated Hospital of Army Medical University, Chongqing, 400037, P.R.China;

Corresponding author：

CHU Tongwei, Email: chtw@sina.com

Keywords：

Degenerative lumbar scoliosis; transforaminal lumbar interbody fusion; coronal imbalance; risk factor; complication

DOI：

10.7507/1002-1892.201807149

Video：

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Objective To explore the risk factors of coronal imbalance after posterior long-level fixation and fusion for degenerative lumbar scoliosis.Methods Retrospectivly analyzed the clinical records of 41 patients with degenerative lumbar scoliosis who had received posterior long-level fixation and fusion with selective transforaminal lumbar interbody fusion (TLIF) accompanied by Ponte osteotomy between August 2011 and July 2016. Patients were divided into imbalance group (group A, 11 cases) and balance group (group B, 30 cases) according to state of coronal imbalance measured at last follow-up. The radiographic parameters at preoperation and last follow-up were measured, and the variance of preoperative and last follow-up parameters were calculated. The radiographic parameters included coronal Cobb angle, coronal balance distance (CBD), apical vertebral translation (AVT), apical vertebral rotation (AVR), Cobb angle of lumbar sacral curve (LSC), and L₅ tilt angle (L₅TA). Univariate analysis was performed for the factors including gender, age, preoperative T value of bone mineral density, number of instrumented vertebra, upper and lower instrumented vertebra, segments of TLIF, decompression, and Ponte osteotomy, as well as the continuous variables of preoperative imaging parameters with significant difference were converted into two-category variables, obtained the influence factors of postoperative coronal imbalance. Multivariate logistic regression analysis was performed to verify the risk factors from the preliminary screened influence factors and the variance of imaging parameters with significant difference between the two groups.Results The follow-up time of groups A and B was (3.76±1.02) years and (3.56±1.03) years respectively, there was no significant difference between the two groups (t=0.547, P=0.587). The coronal Cobb angle, AVT, LSC Cobb angle, and L₅TA in group A were significantly higher than those in group B before operation (P<0.05), and all the imaging parameters in group A were significantly higher than those in group B at last follow-up (P<0.05). There was no significant difference between the two groups in parameters including the variance of coronal Cobb angle, AVT, and LSC Cobb angle before and after operation (P>0.05), and there were significant differences between the two groups in parameters including the variance of CBD, L₅TA, and AVR (P<0.05). Univariate analysis showed that preoperative L₅TA was the influencing factor of postoperative coronal imbalance (P<0.05). Multivariate logistic regression analysis showed that preoperative L₅TA≥15° was an independent risk factor of postoperative coronal imbalance, and variance of pre- and post-operative AVR was a protective factor.Conclusion Preoperative L₅TA≥15° is an independent risk factor for coronal imbalance in patients with degenerative lumbar scoliosis after posterior long-level fixation and fusion.

Citation： NIU Xiaojian, YANG Sizhen, ZHANG Ying, QIU Hao, CHEN Wugui, ZHOU Chiyu, CHU Tongwei. Risk factors analysis of coronal imbalance after posterior long-level fixation and transforaminal lumbar interbody fusion for degenerative lumbar scoliosis. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(4): 430-435. doi: 10.7507/1002-1892.201807149 Copy

1.	Xu L, Sun X, Huang S, et al. Degenerative lumbar scoliosis in Chinese Han population: prevalence and relationship to age, gender, bone mineral density, and body mass index. Eur Spine J, 2013, 22(6): 1326-1331.
2.	Koerner JD, Reitman CA, Arnold PM, et al. Degenerative lumbar scoliosis. JBJS Rev, 2015, 3(4): pii: 1874474-201504000.
3.	Zhu Y, Wang B, Wang H, et al. Long-term clinical outcomes of selective segmental transforaminal lumbar interbody fusion combined with posterior spinal fusion for degenerative lumbar scoliosis. ANZ J Surg, 2014, 84(10): 781-785.
4.	张志成, 任大江, 孙天胜, 等. 退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略. 中国修复重建外科杂志, 2011, 25(8): 951-955.
5.	王孝宾, 吕国华, 王冰, 等. 后路长节段固定治疗成人退行性脊柱畸形的疗效及其远端并发症. 中国脊柱脊髓杂志, 2016, 26(8): 689-695.
6.	Lenke LG. Sagittal balance. J Neurosurg Spine, 2014, 20(5): 512-514.
7.	周思宇, 孙卓然, 李危石. 矢状位平衡影像学评价之争议与现状. 中国修复重建外科杂志, 2018, 32(11): 1365-1370.
8.	Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976), 2005, 30(6): 682-688.
9.	Cho W, Mason JR, Smith JS, et al. Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors: clinical article. J Neurosurg Spine, 2013, 19(4): 445-453.
10.	邱勇, 朱泽章, 主译. 成人脊柱畸形. 济南: 山东科学技术出版社, 2017: 78-93.
11.	李明, 王岩, 邱勇, 等. 脊柱侧凸外科学. 上海: 第二军医大学出版社, 2013: 12-13.
12.	Hey HWD, Kim CK, Lee WG, et al. Supra-acetabular line is better than supra-iliac line for coronal balance referencing-a study of perioperative whole spine X-rays in degenerative lumbar scoliosis and ankylosing spondylitis patients. Spine J, 2017, 17(12): 1837-1845.
13.	Ploumis A, Simpson AK, Cha TD, et al. Coronal spinal balance in adult spine deformity patients with long spinal fusions: a minimum 2- to 5-year follow-up study. J Spinal Disord Tech, 2015, 28(9): 341-347.
14.	Bao H, Yan P, Qiu Y, et al. Coronal imbalance in degenerative lumbar scoliosis: Prevalence and influence on surgical decision-making for spinal osteotomy. Bone Joint J, 2016, 98-B(9): 1227-1233.
15.	Swamy G, Berven SH, Bradford DS. The selection of L₅ versus S₁ in long fusions for adult idiopathic scoliosis. Neurosurg Clin N Am, 2007, 18(2): 281-288.
16.	商振国, 李永民. 退变性脊柱侧凸手术融合节段选择的研究进展. 中国修复重建外科杂志, 2016, 30(8): 1044-1048.
17.	Burns CB, Dua K, Trasolini NA, et al. Biomechanical comparison of spinopelvic fixation constructs: iliac screw versus S₂-alar-iliac screw. Spine Deform, 2016, 4(1): 10-15.
18.	Kebaish KM. Sacropelvic fixation: techniques and complications. Spine (Phila Pa 1976), 2010, 35(25): 2245-2251.
19.	Shen FH, Mason JR, Shimer AL, et al. Pelvic fixation for adult scoliosis. Eur Spine J, 2013, 22 Suppl 2: S265-S275.
20.	Yasuda T, Hasegawa T, Yamato Y, et al. Lumbosacral junctional failures after long spinal fusion for adult spinal deformity-which vertebra is the preferred distal instrumented vertebra? Spine Deform, 2016, 4(5): 378-384.

1. Xu L, Sun X, Huang S, et al. Degenerative lumbar scoliosis in Chinese Han population: prevalence and relationship to age, gender, bone mineral density, and body mass index. Eur Spine J, 2013, 22(6): 1326-1331.
2. Koerner JD, Reitman CA, Arnold PM, et al. Degenerative lumbar scoliosis. JBJS Rev, 2015, 3(4): pii: 1874474-201504000.
3. Zhu Y, Wang B, Wang H, et al. Long-term clinical outcomes of selective segmental transforaminal lumbar interbody fusion combined with posterior spinal fusion for degenerative lumbar scoliosis. ANZ J Surg, 2014, 84(10): 781-785.
4. 张志成, 任大江, 孙天胜, 等. 退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略. 中国修复重建外科杂志, 2011, 25(8): 951-955.
5. 王孝宾, 吕国华, 王冰, 等. 后路长节段固定治疗成人退行性脊柱畸形的疗效及其远端并发症. 中国脊柱脊髓杂志, 2016, 26(8): 689-695.
6. Lenke LG. Sagittal balance. J Neurosurg Spine, 2014, 20(5): 512-514.
7. 周思宇, 孙卓然, 李危石. 矢状位平衡影像学评价之争议与现状. 中国修复重建外科杂志, 2018, 32(11): 1365-1370.
8. Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976), 2005, 30(6): 682-688.
9. Cho W, Mason JR, Smith JS, et al. Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors: clinical article. J Neurosurg Spine, 2013, 19(4): 445-453.
10. 邱勇, 朱泽章, 主译. 成人脊柱畸形. 济南: 山东科学技术出版社, 2017: 78-93.
11. 李明, 王岩, 邱勇, 等. 脊柱侧凸外科学. 上海: 第二军医大学出版社, 2013: 12-13.
12. Hey HWD, Kim CK, Lee WG, et al. Supra-acetabular line is better than supra-iliac line for coronal balance referencing-a study of perioperative whole spine X-rays in degenerative lumbar scoliosis and ankylosing spondylitis patients. Spine J, 2017, 17(12): 1837-1845.
13. Ploumis A, Simpson AK, Cha TD, et al. Coronal spinal balance in adult spine deformity patients with long spinal fusions: a minimum 2- to 5-year follow-up study. J Spinal Disord Tech, 2015, 28(9): 341-347.
14. Bao H, Yan P, Qiu Y, et al. Coronal imbalance in degenerative lumbar scoliosis: Prevalence and influence on surgical decision-making for spinal osteotomy. Bone Joint J, 2016, 98-B(9): 1227-1233.
15. Swamy G, Berven SH, Bradford DS. The selection of L₅ versus S₁ in long fusions for adult idiopathic scoliosis. Neurosurg Clin N Am, 2007, 18(2): 281-288.
16. 商振国, 李永民. 退变性脊柱侧凸手术融合节段选择的研究进展. 中国修复重建外科杂志, 2016, 30(8): 1044-1048.
17. Burns CB, Dua K, Trasolini NA, et al. Biomechanical comparison of spinopelvic fixation constructs: iliac screw versus S₂-alar-iliac screw. Spine Deform, 2016, 4(1): 10-15.
18. Kebaish KM. Sacropelvic fixation: techniques and complications. Spine (Phila Pa 1976), 2010, 35(25): 2245-2251.
19. Shen FH, Mason JR, Shimer AL, et al. Pelvic fixation for adult scoliosis. Eur Spine J, 2013, 22 Suppl 2: S265-S275.
20. Yasuda T, Hasegawa T, Yamato Y, et al. Lumbosacral junctional failures after long spinal fusion for adult spinal deformity-which vertebra is the preferred distal instrumented vertebra? Spine Deform, 2016, 4(5): 378-384.

Chinese Journal of Reparative and Reconstructive Surgery

Risk factors analysis of coronal imbalance after posterior long-level fixation and transforaminal lumbar interbody fusion for degenerative lumbar scoliosis

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