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Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection

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Abstract

Purpose

To determine the correlation of the difference between postoperative lumbar lordosis (LL) and ideal LL with the sagittal vertical axis (SVA) at the final follow-up in patients with adult spinal deformity (ASD).

Methods

Fifty-one patients with degenerative lumbar kyphosis (DLK) (mean age 66.5 years) who underwent surgical correction with a minimum 2-year follow-up were evaluated. Based on the difference between postoperative LL and ideal LL using the Korean version of Legaye’s formula, we divided the 51 patients into two groups: overcorrection (degree of postoperative LL > ideal LL) and undercorrection (degree of postoperative LL < ideal LL).

Results

Our clinical series of patients comprised 24 in the overcorrection and 27 in the undercorrection group. No significant differences were found in preoperative pelvic incidence (PI 52.6° vs. 57.3°), sacral slope (SS 23.3° vs. 18.3°), LL (−6.9° vs. −2.3°), thoracic kyphosis (TK 4.7° vs. 4.9°) and SVA (140 vs. 139 mm) except pelvic tilt (PT 29.4° vs. 39.0°), between the two groups. All the patients in the overcorrection group and 16 in the undercorrection group achieved postoperative optimal sagittal balance based on SVA ≤ 50 mm. In addition, significant differences in PT (10.5° vs. 26.7°), SS (42.1° vs. 30.6°), LL (−64.3° vs. −37.1°), TK (22.6° vs. 15.8°), and SVA (−1 vs. 41 mm) between the two groups were observed postoperatively. Furthermore, four patients (16.7 %) in the overcorrection group and eight (50 %) in the undercorrection group had sagittal decompensation at the final follow-up. Our results showed that the difference between postoperative LL and ideal LL had a significant correlation with postoperative and final follow-up SVA in our clinical series.

Conclusion

Overcorrection of LL is an effective treatment modality to maintain optimal sagittal alignment in patients with DLK; this suggests that it should be considered in preoperative planning for patients with ASD with sagittal imbalance.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-872, Korea

    Jung-Hee Lee, Ki-Tack Kim, Sang-Hun Lee, Kyung-Chung Kang, Hyun-Seok Oh, Young-Jun Kim & Hyuk Jung

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  1. Jung-Hee Lee
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  2. Ki-Tack Kim
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Correspondence to Jung-Hee Lee.

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Lee, JH., Kim, KT., Lee, SH. et al. Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection. Eur Spine J 25, 2668–2675 (2016). https://doi.org/10.1007/s00586-016-4441-4

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  • DOI: https://doi.org/10.1007/s00586-016-4441-4

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