Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

European spine journal

article

Ibrahim Obeid¹  Pedro Berjano²  Claudio Lamartina²  Daniel Chopin³  Louis Boissière¹  Anouar Bourghli⁴ 

[1] Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital;IRCCS Istituto Ortopedico Galeazzi;Neuro-Orthopedic Spine Unit, Lille University Hospital;Orthopedic and Spinal Surgery Department, Kingdom Hospital

关键词: Coronal malalignment;    Coronal imbalance;    Adult spinal deformity;    Adult scoliosis;    Three-column osteotomy;    Classifcation;    Surgical planning;    Treatment guideline;   

DOI  :  10.1007/s00586-018-5826-3

来源: Springer

【 摘 要 】

In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. This is an expert’s opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction. These slides can be retrieved under Electronic Supplementary Material.

【 授权许可】

Unknown