Factors associated with postoperative coronal imbalance in adult patients with severe and rigid scoliosis: a retrospective study

Journal of Orthopaedic Surgery and Research, 2024 · DOI: https://doi.org/10.1186/s13018-024-05328-0 · Published: December 1, 2024

Orthopedics Spinal Disorders

Simple Explanation

This study investigates coronal imbalance (CIB) in adult patients with severe rigid scoliosis (SRS) after undergoing spinal surgery. The goal was to identify factors that contribute to CIB following surgery to improve outcomes. The study found that preoperative CIB, limited flexibility of the main scoliotic curve, and immediate postoperative CIB are significantly associated with CIB at follow-up. These findings can help surgeons make better decisions to minimize CIB after surgery, leading to improved patient outcomes and reduced complications.

Study Duration

August 2012 and January 2019

Participants

90 SRS patients

Evidence Level

Not specified

Key Findings

1
Preoperative coronal imbalance (CIB+) is significantly associated with postoperative CIB [OR = 12.414 (95% CI: 2.228, 69.162), P = 0.004].
2
A major curve flexibility index of less than 10% is significantly associated with postoperative CIB [OR = 14.300 (95% CI: 2.200, 92.957), P = 0.005].
3
Immediate postoperative CIB is significantly associated with follow-up CIB [OR = 5.169 (95% CI: 1.387, 19.263), P = 0.014].

Research Summary

This retrospective study analyzed 90 adult patients with severe rigid scoliosis (SRS) who underwent posterior column osteotomy (PCO) and fusion to identify risk factors for postoperative coronal imbalance (CIB). The study found that preoperative CIB+, major curve flexibility index < 10%, and immediate postoperative CIB were significantly associated with postoperative CIB. A nomogram prediction model was constructed and validated, demonstrating good predictive performance for postoperative CIB based on these identified risk factors.

Practical Implications

Surgical Planning

Surgeons should carefully assess preoperative coronal balance, curve flexibility, and strive for optimal immediate postoperative coronal alignment to minimize the risk of persistent CIB.

Risk Assessment

The nomogram prediction model can be used to identify patients at higher risk of postoperative CIB, allowing for tailored surgical strategies and postoperative management.

Osteotomy techniques

Multi-level asymmetric Ponte osteotomy is suggested as a safe and effective osteotomy correction technique that can ensure the correction rate of deformity while reducing operation time, blood loss, and complications.

Study Limitations

1
Small sample size of only 90 SRS patients from a single center in a high-altitude region of China.
2
Patient-specific factors such as lifestyle habits, weight fluctuations, or participation in postoperative rehabilitation programs were not accounted for.
3
Analysis focused predominantly on coronal plane parameters and geometric measurements, without incorporating assessments of axial rotation, trunk asymmetry, or sagittal alignment.

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