Evolution of Sagittal Imbalance Following Corrective Surgery for Sagittal Plane Deformity

Neurosurgery 81:129–134, 2017

Sagittal balance in adult spinal deformity is a major predictor of quality of life. A temporary loss of paraspinalmuscle force and somatic pain following spine surgery may limit a patient’s ability to maintain posture.

OBJECTIVE: To assess the evolution of sagittal balance and clinical outcomes during recovery from adult spinal deformity surgery.

METHODS: Retrospective review of a prospective observational database identified a consecutive series of patients with sagittal vertical axis (SVA) > 40mm undergoing adult deformity surgery. Radiographic parameters and clinical outcomes were measured out to 2 yr after surgery.

RESULTS: A total of 113 consecutive patients met inclusion criteria. Mean preoperative SVA was 90.3 mm, increased to 104.6mm in the first week, then gradually reduced at each follow-up interval to 59.2mm at 6wk, 45.0mm at 3mo, 38.6mm at 6mo, and 34.1mm at 1 yr (all P < .05). SVA did not change between 1 and 2 yr. Pelvic incidence-lumbar lordosis (PI-LL) corrected immediately from 25.3◦ to 8.5◦ (16.8◦ change; P < .01) and a decreased pelvic tilt from 27.6◦ to 17.6◦ (10◦ change; P < .01). No further change was noted in PILL. Pelvic tilt increased to 20.2◦ (P = .01) at 6wk and held steady through 2 yr. Mean Visual Analog Scale, Oswestry Disability Index, and Short Form-36 scores all improved; pain rapidly improved, whereas disability measures improved as SVA improved.

CONCLUSION: Radiographic assessment of global sagittal alignment did not fully reflect surgical correction of sagittal balance until 6 months after adult deformity surgery. Sagittal balance initially worsened then steadily improved at each interval over the first year postoperatively. At 1 yr, all clinical and radiographic measures outcomes were significantly improved.