Background
- Coronal imbalance – 10 degrees
- Sagittal (see preivous) SVA 5cm positive or negative
Coronal Deformity Types
- Residual AIS
- Classic patterns
- More segments
- Degenerative de novo adult scoliosis
- Non classic pattern
- Fewer vertebral segments, smalle curve
Presentation
- Back pain
- Spondylosis, discogenic
- Neurogenic claudication
- Stenosis
- Radicular
- Concave side
Imaging
- PA 3 foot standing
- Lateral
- Sagittal assessment
- DEXA – bone density for surgical planning
- MRI
- Central stenosis
- Trefoil canalxs
- Facet hypertophy
- Pedicular enlargment
- Foraminal encroachment
- Disc degeneration
- Central stenosis
Management
- Weinstein et al 2008 SPORT Trial (one arm of it)
- Surgery > Non Op at 4 years
- Non operative
- Oral meds (NSAIDS)
- PT core strengthening
- Cortiosteroid inj and nerve root block
- Dx and therapeutic
- Operative
- Curve >50
- Sagittal deformity
- Failred non op back pain
- Thoracic >60 pulmonary
- Thoracic >90 mortality
Complication
- 13.5% overall
- 10% major with irreverisible affect
- VTE very bad
- Pseudoarthrosis
- Dural tear
- Infection
- Implant failure (sacrum) low cortical to cancellous bone ratio
- Neurologic (PSO is 18%)
Prognosis
- Convex side symptoms
- Sagittal plan balance is the most reliable predictor of clinical symptoms in adults with spinal deformity
- Worse outcomes
- Post op sagittal imbalance
- Preop obesityy
PMMA inj at top and bottom
- Inc fusion
- Dec junctional failure
TL kyphosis corelated to VAS scores
PI does not correlate with anything but matching LL <10 of PI does
Sagittal imbalance correlated with severity of symptoms
Sagittall imbalance prognosticates surgical success (PI within 10 LL)