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Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms?

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Abstract

Introduction

Aging of the spine is characterized by facet joints arthritis, degenerative disc disease and atrophy of extensor muscles resulting in a progressive kyphosis. Recent studies confirmed that patients with lumbar degenerative disease were characterized by an anterior sagittal imbalance, a loss of lumbar lordosis and an increase of pelvis tilt. The aim of this paper was thus to describe the different compensatory mechanisms which are observed in the spine, pelvis and/or lower limbs areas for patients with severe degenerative spine.

Methods

We reviewed all the compensatory mechanisms of sagittal unbalance described in the literature.

Results

According to the severity of the imbalance, we could identify three different stages: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permitted to limit consequences of lumbar kyphosis on the global sagittal alignment. Reduction of thoracic kyphosis, intervertebral hyperextension, retrolisthesis, pelvis backtilt, knee flessum and ankle extension were the main mechanisms described in the literature. The basic concept of these compensatory mechanisms was to extend adjacent segments of the kyphotic spine allowing for compensation of anterior translation of the axis of gravity.

Conclusions

To avoid underestimate the severity of the degenerative spine disorder, it thus seems important to recognize the different compensatory mechanisms from the upper part of the trunk to the lower limbs. We propose a three steps algorithm to analyse the balance status and determine the presence or not of these compensatory mechanisms: measurement of pelvis incidence, assessment of global sagittal alignment and analysis of compensatory mechanisms successively in the spine, pelvis and lower limbs areas.

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Abbreviations

LL:

Lumbar lordosis

PI:

Pelvic incidence

PT:

Pelvic tilt

SS:

Sacral slope

TK:

Thoracic kyphosis

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Conflict of interest

No funds were received in support of this study.

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Authors and Affiliations

  1. Department of Neurosurgery C and Spine Surgery, Neurological Hospital, 59 boulevard Pinel, 69394, Lyon, France

    Cédric Barrey & Gilles Perrin

  2. Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 151 boulevard de l’Hôpital, 75013, Paris, France

    Cédric Barrey

  3. Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, 92 rue Edmond Locard, 69005, Lyon, France

    Pierre Roussouly

  4. Spine unit 2, Deterca Surg lab, Department of Orthopedic Surgery, University Hospital, Bordeaux, France

    Jean-Charles Le Huec

  5. 11 ter rue Saint-Gervais, 69008, Lyon, France

    Cédric Barrey

Authors
  1. Cédric Barrey
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  2. Pierre Roussouly
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  3. Gilles Perrin
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  4. Jean-Charles Le Huec
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Correspondence to Cédric Barrey.

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Barrey, C., Roussouly, P., Perrin, G. et al. Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms?. Eur Spine J 20 (Suppl 5), 626 (2011). https://doi.org/10.1007/s00586-011-1930-3

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  • DOI: https://doi.org/10.1007/s00586-011-1930-3

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