Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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The Change of Adjacent Segment and Sagittal Balance after Thoracolumbar Spine Surgery

  • Kim, Kang-San (Department of Neurosurgery, College of Medicine, Hallym University) ;
  • Hwang, Hyung-Sik (Department of Neurosurgery, College of Medicine, Hallym University) ;
  • Jeong, Je-Hoon (Department of Neurosurgery, College of Medicine, Hallym University) ;
  • Moon, Seung-Myung (Department of Neurosurgery, College of Medicine, Hallym University) ;
  • Choi, Sun-Kil (Department of Neurosurgery, College of Medicine, Hallym University) ;
  • Kim, Sung-Min (Department of Neurosurgery, East-West Neo Medical Center, Kyung-Hee University)
  • Published : 2009.11.28
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Abstract

Objective : To characterize perioperative biomechanical changes after thoracic spine surgery. Methods : Fifty-eight patients underwent spinal instrumented fusions and simple laminectomies on the thoracolumbar spine from April 2003 to October 2008. Patients were allocated to three groups; namely, the laminectomy without fusion group (group I, n = 17), the thoracolumbar fusion group (group II, n = 27), and the thoracic spine fusion group (group III, n = 14). Sagittal (ADS) and coronal (ADC) angles for adjacent segments were measured from two disc spaces above lesions at the upper margins, to two disc spaces below lesions at the lower margins. Sagittal (TLS) and coronal (TLC) angles of the thoracolumbar junction were measured from the lower margin of the 11th thoracic vertebra body to the upper margin of the 2nd lumbar vertebra body on plane radiographs. Adjacent segment disc heights and disc signal changes were determined using simple spinal examinations and by magnetic resonance imaging. Clinical outcome indices were determined using a visual analog scale. Results : The three groups demonstrated statistically significant differences in terms of angle changes by ANOVA (p<0.05). All angles in group I showed significantly smaller angles changes than in groups II and III by Turkey's multiple comparison analysis. Coronal Cobb's angles of the thoracolumbar spine (TLC) were not significantly different in the three groups. Conclusion : Postoperative sagittal balance is expected to change in the adjacent and thoracolumbar areas after thoracic spine fusion. However, its prevalence seems to be higher when the thoracolumbar spine is included in instrumented fusion.

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References

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