Article Figures & Data
Figures
- Figure
Schematic of the measured sagittal alignment parameters for the cervical and global spinopelvic spinal regions. cSVA, cervical sagittal vertical axis; CL, cervical lordosis; CBVA, chin-brow vertical angle; TK, thoracic kyphosis; LL, lumbar lordosis; SVA, sagittal vertical axis; PT, pelvic tilt; PI, pelvic incidence.
Tables
- Table 1
Alignment values measured preoperatively for spinopelvic and lower extremity alignment parameters across increasing patient age groups.
Actual Postoperative Alignment Age Group P <40 y 40–65 y ≥65 y Spinopelvic Sagittal vertical axis (mm) −14 ± 15.6 −1.2 ± 48.3 16.8 ± 46.8 0.050 Pelvic tilt (°) 7.8 ± 4.8 15.7 ± 9.1 24.3 ± 9.5 <0.001 Pelvic Incidence minus lumbar lordosis (°) −9.2 ± 9.8 −3.5 ± 11.9 5.7 ± 14.2 0.002 Lumbar lordosis and thoracic kyphosis (°) 22.1 ± 14.5 15.4 ± 13.4 −1 ± 22 <0.001 Lower extremity Sacrofemoral angle (°) 205.5 ± 12.7 199.3 ± 9.4 198.3 ± 11.4 0.312 Knee angle (°) 0.06 ± 4.2 3.7 ± 6.2 1.3 ± 5.7 0.743 Ankle angle (°) 4.5 ± 2.3 6.6 ± 3.1 5.5 ± 2.9 0.858 Pelvic shift (mm) 20 ± 23.5 21.6 ± 30.3 15.3 ± 36.5 0.617 Note: Boldface indicates statistical significance.
- Table 2
Alignment values measured preoperatively vs 1 y postoperatively for spinopelvic and cervical alignment parameters within the entire cervical deformity cohort.
Radiographic Measure Preoperative 1 y P Pelvic tilt (°) 16 16.8 0.323 Pelvic incidence and lumbar lordosis (°) −3.1 −1.1 0.034 T4-T12 (°) −43.1 −42 0.367 T1SS (°) 29 31.5 0.062 T1 slope minus cervical lordosis (°) 25.9 23.9 0.335 C2-C7 (°) 3 7.7 0.024* Cervical sagittal vertical angle (mm) 26.3 27.7 0.290 C2-T3 (°) 0.74 3.1 0.357 SVA C2-T3 (°) 51.4 55.9 0.026* C2SS (°) 22.7 20 0.245 SVA (mm) 2.5 8.8 0.142 Note: Boldface indicates statistical significance.
C2SS, C2 sacral slope; SVA, sagittal vertical axis; T1SS, T1 sacral slope.
- Table 3
Measured 1 y postoperative (ACTUAL) and age-adjusted (IDEAL) values for sagittal global and spinopelvic alignment parameters for age cohorts.
AgeGroup, y Mean Age, y Sagittal Vertical Axis (mm) Pelvic Tilt (°) Pelvic Incidence-Lumbar Lordosis (°) Lumbar Lordosis-Thoracic Kyphosis (°) ACTUAL IDEAL ACTUAL IDEAL ACTUAL IDEAL ACTUAL IDEAL <40 24.9 ± 6.6 1.7 ± 20.5 −12.9 ± 9 7.5 ± 4 13.7 ± 1.5 −8 ± 6.4 −6.5 ± 2.3 23.7 ± 16.3 5.5 ± 2.3 0.181 0.010 0.499 0.022 40–65 55.9 ± 6.9 4 ± 46.4 17.6 ± 17 15.7 ± 8 18.8 ± 2.1 −3.4 ± 12 1.2 ± 3.1 13.8 ± 18 13.2 ± 3.1 0.045 0.002 0.004 0.801 ≥65 74.1 ± 6.0 27.5 ± 45.4 60.9 ± 11 25.5 ± 11.7 26 ± 1.8 8.9 ± 14 12 ± 2.7 −0.47 ± 25.4 24 ± 2.7 0.005 0.846 0.311 <0.001 Note: Boldface indicates statistical significance (P < 0.05).
- Table 4
Measured 1 y postoperative (ACTUAL) and age-adjusted (IDEAL) values for sagittal global and spinopelvic alignment parameters for entire cohort.
Radiographic Measure ACTUAL IDEAL P Pelvic tilt (°) 17.1 20.1 0.001 Mismatch between pelvic incidence and lumbar lordosis (°) −1.8 3.1 <0.001 Sagittal vertical axis (mm) 1.9 25.3 <0.001 Mismatch between lumbar lordosis and thoracic kyphosis (°) 12.1 15.1 0.177 Note: Boldface indicates statistical significance (P < 0.0).
- Table 5
Percentages of patients within each age cohort and overall who matched age-adjusted ideals (MATCH), those that undercorrected (UNDER) and those that overcorrected (OVER), based upon a ±10-y interval of age-adjusted values calculated with Renaud et al’s established formulas.Differences in lower extremity compensatory mechanisms (SFA, KA, AA, PS, GSA) by age group.
Age Adjustment Ideals UNDER Under Overall MATCH Match Overall OVER Over Overall Pelvic tilt (°) <40 y 0% 24.40% 28.6% 24.40% 71.4% 51.10% 40–65 y 19.4% 27% 53.2% ≥65 y 47.6% 14.3% 38.1% Mismatch between pelvic tilt-lumbar lordosis (°) <40 y 25% 23.00% 0% 27.60% 75% 49.40% 40–65 y 22.6% 27.4% 50% ≥65 y 23.8% 33.3% 42.9% Sagittal vertical axis (mm) <40 y 42.9% 18.80% 57.1% 40.00% 0% 41.30% 40–65 y 18.5% 40.7% 40.7% ≥65 y 10.5% 31.6% 57.9% Mismatch between lumbar lordosis and thoracic kyphosis (°) <40 y 85.7% 42.90% 14.3% 18.70% 0% 38.50% 40–65 y 46.0% 25.4% 28.6% ≥65 y 19% 0% 81% - Table 6
Differences in lower extremity compensatory mechanisms (SFA, KA, AA, PS, GSA) by age group.
Compensatory Mechanism and Age Group, y Pre- to Postoperative Change P TK <40 –1.8 0.410 40–65 –0.79 0.502 ≥65 –2.0 0.676 SFA <40 5.5 0.075 40–65 6.5 0.275 ≥65 –2.3 0.088 KA <40 –2.5 0.264 40–65 5.4 0.275 ≥65 –0.12 0.931 AA <40 –0.44 0.757 40–65 1.14 0.002a ≥65 –0.74 0.241 PS <40 –6.4 0.517 40–65 –4.9 0.149 ≥65 6.5 0.521 GSA <40 –0.48 0.004a 40–65 –2.8 0.224 ≥65 0.37 0.629 ↵a Statistically significant.
AA, ankle angle; CD, cervical deformity; GSA, global sagittal angle; KA, knee angle; PS, pelvic shift; SFA, sacrofemoral angle; TK, thoracic kyphosis.
- Table 7
Pre- to Postoperative differences in lower extremity compensatory mechanisms (SFA, KA, AA, PS, GSA) for overall, worsened (increase in TS-CL and cSVA), and improved (decrease in TS-CL and cSVA) CD cohorts.
Compensatory Mechanism and Cohort Preoperative Postoperative P TK Overall –42.1 –43 0.535 Worsen –41.1 –45.3 0.106 Improve –42.7 –41.4 0.415 SFA Overall 199.6 195.6 0.286 Worsen 197.5 196.4 0.225 Improve 199.8 194.6 0.36 KA Overall 2.7 –1 0.27 Worsen 3.1 2.8 0.691 Improve 2.6 –2.4 0.33 AA Overall 6.1 5.5 0.036a Worsen 5.9 5.4 0.161 Improve 6.1 5.6 0.19 PS Overall 20.9 21.9 0.742 Worsen 22.7 23.1 0.921 Improve 21.9 24.7 0.55 GSA Overall 1 2.8 0.261 Worsen 0.79 1 0.593 Improve 1.2 4 0.258 ↵a Statistically significant.
AA, ankle angle; CD, cervical deformity; cSVA, cervical sagittal vertical angle; GSA, global sagittal angle; KA, knee angle; PS, pelvic shift; SFA, sacrofemoral angle; TK, thoracic kyphosis; TS-CL, T1 slope minus cervical lordosis.
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