Classification of coronal imbalance in adult scoliosis and spine deformity

a treatment-oriented guideline

Ibrahim Obeid, Pedro Berjano, Claudio Lamartina, Daniel Chopin, Louis Boissière, Anouar Bourghli

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. Methods: This is an expert’s opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. Results: Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. Conclusion: Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)94-113
JournalEuropean Spine Journal
Volume28
Issue number1
DOIs
Publication statusPublished - 2019

Fingerprint

Scoliosis
Spine
Guidelines
Expert Testimony
Therapeutics
Surgeons

Keywords

  • Adult scoliosis
  • Adult spinal deformity
  • Classification
  • Coronal imbalance
  • Coronal malalignment
  • Surgical planning
  • Three-column osteotomy
  • Treatment guideline

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Classification of coronal imbalance in adult scoliosis and spine deformity : a treatment-oriented guideline. / Obeid, Ibrahim; Berjano, Pedro; Lamartina, Claudio; Chopin, Daniel; Boissière, Louis; Bourghli, Anouar.

In: European Spine Journal, Vol. 28, No. 1, 2019, p. 94-113.

Research output: Contribution to journalArticle

Obeid, Ibrahim ; Berjano, Pedro ; Lamartina, Claudio ; Chopin, Daniel ; Boissière, Louis ; Bourghli, Anouar. / Classification of coronal imbalance in adult scoliosis and spine deformity : a treatment-oriented guideline. In: European Spine Journal. 2019 ; Vol. 28, No. 1. pp. 94-113.
@article{b7de0fa07a474e9dbf323444f40461fe,
title = "Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline",
abstract = "Introduction: In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. Methods: This is an expert’s opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. Results: Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. Conclusion: Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].",
keywords = "Adult scoliosis, Adult spinal deformity, Classification, Coronal imbalance, Coronal malalignment, Surgical planning, Three-column osteotomy, Treatment guideline",
author = "Ibrahim Obeid and Pedro Berjano and Claudio Lamartina and Daniel Chopin and Louis Boissi{\`e}re and Anouar Bourghli",
year = "2019",
doi = "10.1007/s00586-018-5826-3",
language = "English",
volume = "28",
pages = "94--113",
journal = "European Spine Journal",
issn = "0940-6719",
publisher = "Springer Verlag",
number = "1",

}

TY - JOUR

T1 - Classification of coronal imbalance in adult scoliosis and spine deformity

T2 - a treatment-oriented guideline

AU - Obeid, Ibrahim

AU - Berjano, Pedro

AU - Lamartina, Claudio

AU - Chopin, Daniel

AU - Boissière, Louis

AU - Bourghli, Anouar

PY - 2019

Y1 - 2019

N2 - Introduction: In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. Methods: This is an expert’s opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. Results: Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. Conclusion: Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

AB - Introduction: In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. Methods: This is an expert’s opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. Results: Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. Conclusion: Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

KW - Adult scoliosis

KW - Adult spinal deformity

KW - Classification

KW - Coronal imbalance

KW - Coronal malalignment

KW - Surgical planning

KW - Three-column osteotomy

KW - Treatment guideline

UR - http://www.scopus.com/inward/record.url?scp=85056829255&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056829255&partnerID=8YFLogxK

U2 - 10.1007/s00586-018-5826-3

DO - 10.1007/s00586-018-5826-3

M3 - Article

VL - 28

SP - 94

EP - 113

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

IS - 1

ER -