Secondary Logo

Institutional members access full text with Ovid®

A Multicenter Radiographic Evaluation of the Rates of Preoperative and Postoperative Malalignment in Degenerative Spinal Fusions

Leveque, Jean-Christophe A., MD; Segebarth, Bradley, MD; Schroerlucke, Samuel R., MD; Khanna, Nitin, MD§; Pollina, John Jr., MD; Youssef, Jim A., MD||; Tohmeh, Antoine G., MD∗∗; Uribe, Juan S., MD††,‡‡

doi: 10.1097/BRS.0000000000002500

Study Design. Multicenter, retrospective, institutional-review-board -approved study at 18 institutions in the United States with 24 treating investigators.

Objective. This study was designed to retrospectively assess the prevalence of spinopelvic malalignment in patients who underwent one- or two-level lumbar fusions for degenerative (nondeformity) indications and to assess the incidence of malalignment after fusion surgery as well as the rate of alignment preservation and/or correction in this population.

Summary of Background Data. Spinopelvic malalignment after lumbar fusion has been associated with lower postoperative health-related quality of life and elevated risk of adjacent segment failure. The prevalence of spinopelvic malalignment in short-segment degenerative lumbar fusion procedures from a large sample of patients is heretofore unreported and may lead to an under-appreciation of these factors in surgical planning and ultimate preservation or correction of alignment.

Methods. Lateral preoperative and postoperative lumbar radiographs were retrospectively acquired from 578 one- or two-level lumbar fusion patients and newly measured for lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt. Patients were categorized at preop and postop time points as aligned if PI-LL < 10° or malaligned if PI-LL≥10°. Patients were grouped into categories based on their alignment progression from pre- to postoperative, with preserved (aligned to aligned), restored (malaligned to aligned), not corrected (malaligned to malaligned), and worsened (aligned to malaligned) designations.

Results. Preoperatively, 173 (30%) patients exhibited malalignment. Postoperatively, 161 (28%) of patients were malaligned. Alignment was preserved in 63%, restored in 9%, not corrected in 21%, and worsened in 7% of patients.

Conclusion. This is the first multicenter study to evaluate the preoperative prevalence and postoperative incidence of spinopelvic malalignment in a large series of short-segment degenerative lumbar fusions, finding over 25% of patients out of alignment at both time points, suggesting that alignment preservation/restoration considerations should be incorporated into the decision-making of even degenerative lumbar spinal fusions.

Level of Evidence: 3

Neuroscience Institute, Virginia Mason Hospital and Medical Center, Seattle, WA

OrthoCarolina, Charlotte, NC

Tabor Orthopedics, Memphis, TN

§Orthopaedic Specialists of Northwest Indiana, Munster, IN

University at Buffalo Neurosurgery, Buffalo, NY

||Spine Colorado, Durango, CO

∗∗Northwest Orthopaedic Specialists, Spokane, WA

††University of South Florida, Tampa, FL

‡‡Barrow Neurologic Institute, Phoenix, AZ.

Address correspondence and reprint requests to Jean-Christophe A. Leveque, MD, Neuroscience Institute, Virginia Mason Hospital and Medical Center, 1100 Ninth Avenue, Seattle, WA 98101; E-mail:

Received 15 August, 2017

Revised 25 October, 2017

Accepted 3 November, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

NuVasive, Inc. funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, royalties, grants.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.