New classification of global coronal malalignment in degenerative lumbar scoliosis and priority-matching correction technique
Objective To introduce a new classification of global coronal malalignment(GCM)in degenerative lumbar scoliosis(DLS)and to investigate the effect of priority-matching correction technique on preventing the postoperative coronal decompensation.Methods A retrospective analysis of 382 patients with GCM who underwent correction surgery or not at our center from 2020 was performed.They were 330 females and 52 males,with an average age of(65.3±2.4)years.Two types of GCM pattern were identified.GCMs with lumbar curve as the key curve were classified as Type 1 GCM and those with lumbosacral curve as the key curve were classified as Type 2 GCM.The curve with the greatest contribution to C7PL shifting was determined as the key curve.The fundamental principle of priority-matching correction was to first and aggressively correct the key curve.Patients were assigned to the priority-matching correction surgery or the traditional correction surgery.The reliability of this new classification was analyzed and the clinical and radiographic outcomes were compared between different subgroups.Results Intraclass correlation coefficient(ICC)analysis indicated that this new classification had adequate intra-and inter-rater reliabilities(ICC>0.75).Type 1 GCM occupied 42.4%and Type 2 GCM occupied 57.6%.Compared with Type 1 GCM,Type 2 GCM had greater LS Cobb's angle[(17.9±3.4)° vs.(7.5±3.0)°,P<0.001]and L4 tilt angle[(18.7±4.2)° vs.(11.6±4.4)°,P<0.001].One hundred and eighteen patients received correction surgeries,thereinto 55 patients underwent priority-matching correction and 63 underwent traditional correction.Thirty patients were found to develop coronal imbalance after mean follow-up of(15.0±2.1)months,16.7%of them had Type 1 GCMs and 83.3%had Type 2 GCMs.The incidences of postoperative coronal decompensation were respectively 7.3%and 41.3%in patients who received priority-matching correction and in patients undergoing traditional correction(P<0.001).Conclusions This new classification for GCM in DLS is designed based on the contribution of curves on C7PL shifting.The GCM with TL/L as the key curve is classified as Type 1,and the GCM with LS as the key curve is classified as Type 2.Priority-matching correction inspired by this new classification governs a novel correction sequence that prevents postoperative coronal decompensation in DLS.
万方数据
维普
