University of California, Los Angeles, LA, USA.
Spine (Phila Pa 1976). 2013 Mar 15;38(6):476-83. doi: 10.1097/BRS.0b013e3182846eb3.
Retrospective study with prospectively collected outcomes data.
Determine the significance of coronal balance on spinal deformity surgery outcomes.
Sagittal balance has been confirmed as an important radiographic parameter correlating with adult deformity treatment outcomes. The significance of coronal balance on functional outcomes is less clear.
Eighty-five patients with more than 4 cm of coronal imbalance who underwent reconstructive spinal surgery were evaluated to determine the significance of coronal balance on functional outcomes as measured with the Oswestry Disability Index (ODI) and Scoliosis Research Society outcomes questionnaires. Sixty-two patients had combined coronal (>4 cm) and sagittal imbalance (>5 cm), while 23 patients had coronal imbalance alone.
Postoperatively, 85% of patients demonstrated improved coronal balance. The mean improvement in the coronal C7 plumb line was 26 mm for a mean correction of 42%. The mean preoperative sagittal C7 plumb line in patients with combined coronal and sagittal imbalance was 118 mm (range, 50-310 mm) and improved to a mean 49 mm. The mean preoperative and postoperative ODI scores were 42 (range, 0-90) and 27 (range, 0-78), for a mean improvement of 15 (36%) (P = 0.00001; 95% CI, 12-20). The mean Scoliosis Research Society scores improved by 17 points (29%) (P = 0.00). Younger age (P = 0.008) and improvement in sagittal balance (P = 0.014) were positive predictors for improved ODI scores. Improvement in sagittal balance (P = 0.010) was a positive predictor for improved Scoliosis Research Society scores. In patients with combined coronal and sagittal imbalance, improvement in sagittal balance was the most significant predictor for improved ODI scores (P = 0.009). In patients with preoperative coronal imbalance alone, improvement in coronal balance trended toward, but was not a significant predictor for improved ODI (P = 0.092).
Sagittal balance improvement is the strongest predictor of improved outcomes in patients with combined coronal and sagittal imbalance. In patients with coronal imbalance alone, improvement in coronal balance was not a factor for predicting improved functional outcomes.
回顾性研究，前瞻性收集结果数据。
确定冠状平衡对脊柱畸形手术结果的意义。
矢状平衡已被证实为与成人畸形治疗结果相关的重要影像学参数。冠状平衡对功能结果的意义尚不清楚。
评估了 85 例冠状失平衡超过 4cm 的患者，以确定冠状平衡对 Oswestry 功能障碍指数（ODI）和脊柱侧凸研究协会结果问卷测量的功能结果的意义。62 例患者存在冠状（>4cm）和矢状（>5cm）失平衡，23 例患者仅存在冠状失平衡。
术后，85%的患者冠状平衡得到改善。C7 铅垂线的平均改善为 26mm，平均矫正率为 42%。合并冠状和矢状失平衡患者术前 C7 铅垂线平均为 118mm（范围 50-310mm），改善至平均 49mm。术前和术后 ODI 评分平均分别为 42（范围 0-90）和 27（范围 0-78），平均改善 15（36%）（P=0.00001；95%CI，12-20）。SRS 评分平均改善 17 分（29%）（P=0.00）。年龄较小（P=0.008）和矢状平衡改善（P=0.014）是 ODI 评分改善的正预测因子。矢状平衡改善（P=0.010）是 SRS 评分改善的正预测因子。在合并冠状和矢状失平衡的患者中，矢状平衡改善是 ODI 评分改善的最显著预测因子（P=0.009）。在仅存在冠状失平衡的患者中，冠状平衡的改善趋势，但不是 ODI 评分改善的显著预测因子（P=0.092）。
矢状平衡改善是合并冠状和矢状失平衡患者改善结果的最强预测因子。在仅存在冠状失平衡的患者中，冠状平衡的改善不是预测功能结果改善的因素。
