University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, Singapore 119228, Singapore.
Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gang Dong, (#149 Sangil-dong) #892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Republic of Korea.
Spine J. 2017 Dec;17(12):1837-1845. doi: 10.1016/j.spinee.2017.06.017. Epub 2017 Jun 20.
The aim of spinal deformity correction is to restore the spine's functional alignment by balancing it in both the sagittal and coronal planes. Regardless of posture, the ideal coronal profile is straight, and therefore readily assessable.
This study compares two radiological methods to determine which better predicts postoperative standing coronal balance.
STUDY DESIGN/SETTING: We conducted a single-center, radiographic comparative study between 2011 and 2015.
A total of 199 patients with a mean age of 55.1 years were studied. Ninety patients with degenerative lumbar scoliosis (DLS) and 109 ankylosing spondylitis (AS) were treated with posterior surgery during this period.
Baseline clinical and radiographic parameters (sagittal and coronal) were recorded. Comparison was performed between the new supra-acetabular line (central sacral vertical line [CSVL1]) and conventional supra-iliac line (CSVL2) perpendicular methods of coronal balance assessment. These methods were also compared with the gold standard standing C7 plumb line.
Each patient underwent standardized operative procedures and had perioperative spine X-rays obtained for assessment of spinal balance. Adjusted multivariate analysis was used to determine predictors of coronal balance.
Significant differences in baseline characteristics (age, gender, and radiographic parameters) were found between patients with DLS and AS. CSVL1, CSVL2, and C7 plumb line differed in all the perioperative measurements. These three radiological methods showed a mean right coronal imbalance for both diagnoses in all pre-, intra-, and postoperative radiographs. The magnitude of imbalance was the greatest for CSVL2 followed by CSVL1 and subsequently the C7 plumb line. A larger discrepancy between CSVL and C7 plumb line measurements intraoperatively than those postoperatively suggests a postural effect on these parameters, which is greater for CSVL2. Multivariate analysis identified that in DLS, the preoperative C7 plumb line was predictive of its postoperative value. CSVL1, but not CSVL2, was predictive of the postoperative C7 plumb line in patients with AS.
The supra-acetabular line (CSVL1) is better, although not ideal, as compared with the supra-iliac line (CSVL2) in determining coronal balance. Because CSVL1 still cannot be relied on with a high predictive value, it is imperative that future studies continue to identify better intraoperative markers for achieving coronal balance.
脊柱畸形矫正的目的是通过在矢状面和冠状面平衡脊柱来恢复脊柱的功能排列。无论姿势如何，理想的冠状面轮廓都是直的，因此很容易评估。
本研究比较了两种放射学方法，以确定哪种方法能更好地预测术后站立时的冠状面平衡。
研究设计/地点：我们进行了一项单中心、放射学比较研究，时间为 2011 年至 2015 年。
共研究了 199 名平均年龄为 55.1 岁的患者。在此期间，90 名退行性腰椎侧凸（DLS）患者和 109 名强直性脊柱炎（AS）患者接受了后路手术治疗。
记录基线临床和放射学参数（矢状面和冠状面）。比较了新的骼前上棘线（中矢状面垂直线[CSVL1]）和传统的骼嵴线（CSVL2）两种冠状面平衡评估的垂直方法。这两种方法也与站立 C7 铅垂线的金标准进行了比较。
每位患者均接受标准化手术治疗，并在围手术期拍摄脊柱 X 线片评估脊柱平衡。采用多变量调整分析确定冠状面平衡的预测因素。
DLS 和 AS 患者的基线特征（年龄、性别和放射学参数）存在显著差异。CSVL1、CSVL2 和 C7 铅垂线在所有围手术期测量中均存在差异。这三种影像学方法在所有术前、术中、术后的 X 线片上均显示出右冠状面不平衡。CSVL2 的不平衡程度最大，其次是 CSVL1，其次是 C7 铅垂线。术中 CSVL 与 C7 铅垂线测量值的差异大于术后，表明这些参数存在姿势影响，CSVL2 的影响更大。多变量分析发现，在 DLS 中，术前 C7 铅垂线可预测术后值。CSVL1，但不是 CSVL2，可预测 AS 患者术后 C7 铅垂线。
与骼嵴线（CSVL2）相比，骼前上棘线（CSVL1）在确定冠状面平衡方面更好，尽管并非理想。由于 CSVL1 仍然不能具有较高的预测价值，因此未来的研究必须继续确定更好的术中标记物来实现冠状面平衡。
