The Role of Spinopelvic Parameters in Clinical Outcomes of Spinal Osteotomies in Patients with Sagittal Imbalance

Document Type : RESEARCH PAPER


1 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Department of Forensic Medicine and Toxicology, Iran University of Medical Sciences, Tehran, Iran

3 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.

4 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences


Background: Sagittal imbalance is known as the main radiographic driver of disability in adult spinal deformity (ASD).
In this study, the association of radiological spinopelvic parameters and clinical outcomes was evaluated following the
corrective surgery of sagittal imbalance, in order to explore the predictive ability of each parameter.
Methods: A total of 23 patients, who underwent corrective osteotomy for restoration of sagittal balance, were included in
this study. The mean follow-up period of the patients was 15.5±2.1, ranging from 12 to 18 months. Pre- and postoperative
radiological parameters including pelvic tilt (PT), sagittal vertical axis (SVA) and pelvic incidence minus lumbar lordosis
(PI-LL) were assessed for each patient. Clinical outcomes were evaluated using Oswestry disability Index (ODI).
Results: The mean ODI improved 32% following the corrective osteotomy of sagittal imbalance. Postoperative ODI
was significantly correlated with all preoperative radiological parameters (r=0.608, P=0.002 for PI-LL; r=0.483, P=0.01
for PT; and r=0.464, P=0.02 for SVA). ODI improvement was significantly correlated with PI-LL and SVA change (r=536,
P=0.008 and r=416, P=0.04, respectively), but not with PT change (r=247, P=0.25). The outcome was better in pedicle
subtraction osteotomy (PSO) compared to Smith-Petersen Osteotomy (SPO).
Conclusion: Surgical correction of sagittal imbalance could limit the amount of disability caused by this misalignment.
According to our results, while all the spinopelvic parameters could be used in the prediction of the outcomes of
corrective surgery of sagittal imbalance, PI-LL was the most informative parameter and more attention should be
devoted to this parameter.


Main Subjects

1. Good CR, Auerbach JD, O’Leary PT, Schuler TC. Adult
spine deformity. Curr Rev Musculoskelet Med. 2011;
2. Lu DC, Chou D. Flatback syndrome. Neurosurg Clin
North Am. 2007; 18(2):289-94.
3. Blondel B, Schwab F, Ungar B, Smith J, Bridwell K,
Glassman S, et al. Impact of magnitude and percentage
of global sagittal plane correction on health-related
quality of life at 2-years follow-up. Neurosurgery.
2012; 71(2):341-8.
4. Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI,
Smith JS, et al. Radiographical spinopelvic parameters
and disability in the setting of adult spinal deformity:
a prospective multicenter analysis. Spine. 2013;
5. Hyun SJ, Rhim SC. Clinical outcomes and complications
after pedicle subtraction osteotomy for fixed sagittal
imbalance patients: a long-term follow-up data. J
Korean Neurosurg Soc. 2010; 47(2):95-101.
6. Kim YJ, Bridwell KH, Lenke LG, Cheh G, Baldus C.
Results of lumbar pedicle subtraction osteotomies for
fixed sagittal imbalance: a minimum 5-year follow-up
study. Spine. 2007; 32(20):2189-97.
7. Roussouly P, Nnadi C. Sagittal plane deformity: an
overview of interpretation and management. Eur
Spine J. 2010; 19(11):1824-36.
8. Le Huec JC, Faundez A, Dominguez D, Hoffmeyer
P, Aunoble S. Evidence showing the relationship
between sagittal balance and clinical outcomes in
surgical treatment of degenerative spinal diseases: a
literature review. Int Orthop. 2015; 39(1):87-95.
9. Jang JS, Lee SH, Min JH, Maeng DH. Changes in sagittal
alignment after restoration of lower lumbar lordosis
in patients with degenerative flat back syndrome. J
Neurosurg Spine. 2007; 7(4):387-92.
10. Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill
C, Horton W, et al. Operative versus nonoperative
treatment of leg pain in adults with scoliosis: a
retrospective review of a prospective multicenter
database with two-year follow-up. Spine. 2009;
11. Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill
C, Horton W, et al. Improvement of back pain with
operative and nonoperative treatment in adults with
scoliosis. Neurosurgery. 2009; 65(1):86-93.
12. Coutinho MA, Pratali RD, Motta MM, Hoffman CB,
Barsotti CE, Santos FP, et al. Influence of the sagittal
balance on the clinical outcome in spinal fusion.
Coluna/Columna. 2016; 15(1):52-6.
13. Berjano P, Bassani R, Casero G, Sinigaglia A, Cecchinato
R, Lamartina C. Failures and revisions in surgery for
sagittal imbalance: analysis of factors influencing
failure. Eur Spine J. 2013; 22(6):853-8.