A pilot study of surgery tactics in the treatment of lumbosacral deformity in degenerative lumbar scoliosis with coronal global imbalance

English Keywords:Degenerative lumbar scoliosis  Lumbosacral deformity  Coronal balance

English Abstract:

  【Abstract】 Objectives: To investigate the surgery tactics in the treatment of the degenerative lumbar scoliosis (DLS) with lumbosacral deformity, aiming to restore optimal coronal balance. Methods: From May 2018 to September 2018, orthopedic surgery was performed on 5 patients with degenerative scoliosis with lumbosacral deformity. Marked the midpoint of the heels, the gluteal fold and the spinous process of C7 as three reference points when patients were in prone position intra-operatively, and made thorough release in both concave and convex sides in apical vertebral areas. After corrected the main curve, corrected lumbosacral deformity by moving the posture pad to the opposite side and cooperating with controlling the internal fixation, to obtain the three points three points collinear. Parameters of coronal and sagittal alignments was measured in full-length spinal X-ray pre-and post-operatively. Results: All 5 patients successfully completed the operation without serious complications. The pre-operative coronal balance distance(CBD), lumbar Cobb, lumbosacral Cobb, sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), lumbar lordosis(LL), thoracolumbar kyphosis(TLK), thoracic kyphosis(TK) were respectively 3.9±1.1cm, 35.3°±13.1°, 24.5°±7.3°, 11.0±9.2cm, 49.8°±20.7°, 33.8°±12.8°, 8.7°±16.6°, 11.3°±19.5° and 14.4°±6.8°; the post-operative values were respectively -0.1±1.0cm, 11.5°±10.3°, 3.3°±4.0°, 3.7±6.4cm, 49.8°±19.1°, 22.6°±7.7°, 32.3°±9.0°, 2.2°±18.0° and 23.5°±2.7°. Both coronal and sagittal balance was well after operation, which was obviously improved compared with that pre-operation(P＜0.05). Conclusions: The midpoint of the heels, the gluteal fold and the spinous process of C7 is good reference points to evaluate the global coronal balance in intra-operation. Thorough release in both concave and convex sides and postural reduction cooperating with internal fixation reduction is important to restore global coronal balance.