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Risk factors for postoperative coronal decompensation in adult lumbar scoliosis after posterior correction with osteotomy

  • Orthopaedic Surgery
  • Published:
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Abstract

Introduction

To determine potential risk factors for postoperative coronal imbalance following posterior osteotomy for adult scoliosis.

Materials and methods

A total of 74 patients underwent osteotomy for rigid adult lumbar scoliosis. A group of 20 patients with postoperative coronal imbalance was identified. Clinical data and surgical strategies were compared to determine the risk factors, including age, gender, etiology, Cobb angle, preoperative coronal balance distance, direction of preoperative imbalance, T1 tilt, tilt of upper instrumented vertebra (UIV), UIV translation, location of UIV (T6 above or below), fusion to L5 or S1, lower instrumented vertebra (LIV) tilt, LIV rotation, screw density, osteotomy procedure (PSO or SPOs) and use of iliac screws.

Results

Comparison between patients with and without postoperative coronal imbalance showed that postoperative coronal imbalance occurred in older patients and those with degenerative scoliosis as the etiology, UIV above T6, preoperative LIV rotation, preoperative LIV tilt and preoperative coronal imbalance towards the convex side and who underwent Smith–Petersen osteotomy. All seven parameters were included in the logistic regression analysis. UIV above T6 (P = 0.010), LIV rotation (P = 0.012) and preoperative coronal imbalance towards the convex side (P = 0.005) were identified as risk factors for postoperative coronal imbalance after osteotomy.

Conclusions

Patients with preoperative coronal imbalance towards the convex side (UIV above T6) and LIV rotation were more likely to develop coronal imbalance than those without risk factors. Older patients and those with degenerative scoliosis were also at a relatively higher risk of postoperative coronal imbalance.

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Funding

This work was funded by the Natural Science Foundation of Jiangsu Province (No. BK20180122); and funded by the Special Funds for Health Science and Technology Development of Nan**g City (No. YKK18092).

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Author notes

  1. Shibin Shu and Wenting **g contributed equally to this article.

Authors and Affiliations

  1. Spine Surgery, Drum Town Hospital of Nan**g University Medical School, Zhongshan Road 321, Nan**g, 210008, China

    Shibin Shu, Wenting **g, Zezhang Zhu, Yong Qiu & Hongda Bao

  2. Geisel School of Medicine, Dartmouth College, Hanover, NH, USA

    Mike Bao

Authors
  1. Shibin Shu
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  2. Wenting **g
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  3. Zezhang Zhu
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  5. Yong Qiu
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  6. Hongda Bao
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by (SS), (WJ). The first draft of the manuscript was written by (SS), (MB) and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hongda Bao.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Drum Tower hospital’s Ethics Committee and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The authors are accountable for all aspects of the work (including full data access, integrity of the data and the accuracy of the data analysis) in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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The informed consent was obtained from all subjects included in this study.

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Shu, S., **g, W., Zhu, Z. et al. Risk factors for postoperative coronal decompensation in adult lumbar scoliosis after posterior correction with osteotomy. Arch Orthop Trauma Surg 142, 211–217 (2022). https://doi.org/10.1007/s00402-020-03633-x

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  • DOI: https://doi.org/10.1007/s00402-020-03633-x

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