Supra-acetabular line is better than supra-iliac line for coronal balance referencing-a study of perioperative whole spine X-rays in degenerative lumbar scoliosis and ankylosing spondylitis patients.

BACKGROUND CONTEXT: The aim of spinal deformity correction is to restore the spine's functional alignment by balancing it in both the sagittal and coronal planes. Regardless of posture, the ideal coronal profile is straight, and therefore readily assessable. PURPOSE: This study compares two radiological methods to determine which better predicts postoperative standing coronal balance. STUDY DESIGN/SETTING: We conducted a single-center, radiographic comparative study between 2011 and 2015. PATIENT SAMPLE: A total of 199 patients with a mean age of 55.1 years were studied. Ninety patients with degenerative lumbar scoliosis (DLS) and 109 ankylosing spondylitis (AS) were treated with posterior surgery during this period. OUTCOME MEASURES: Baseline clinical and radiographic parameters (sagittal and coronal) were recorded. Comparison was performed between the new supra-acetabular line (central sacral vertical line [CSVL1]) and conventional supra-iliac line (CSVL2) perpendicular methods of coronal balance assessment. These methods were also compared with the gold standard standing C7 plumb line. METHODS: Each patient underwent standardized operative procedures and had perioperative spine X-rays obtained for assessment of spinal balance. Adjusted multivariate analysis was used to determine predictors of coronal balance. RESULTS: Significant differences in baseline characteristics (age, gender, and radiographic parameters) were found between patients with DLS and AS. CSVL1, CSVL2, and C7 plumb line differed in all the perioperative measurements. These three radiological methods showed a mean right coronal imbalance for both diagnoses in all pre-, intra-, and postoperative radiographs. The magnitude of imbalance was the greatest for CSVL2 followed by CSVL1 and subsequently the C7 plumb line. A larger discrepancy between CSVL and C7 plumb line measurements intraoperatively than those postoperatively suggests a postural effect on these parameters, which is greater for CSVL2. Multivariate analysis identified that in DLS, the preoperative C7 plumb line was predictive of its postoperative value. CSVL1, but not CSVL2, was predictive of the postoperative C7 plumb line in patients with AS. CONCLUSIONS: The supra-acetabular line (CSVL1) is better, although not ideal, as compared with the supra-iliac line (CSVL2) in determining coronal balance. Because CSVL1 still cannot be relied on with a high predictive value, it is imperative that future studies continue to identify better intraoperative markers for achieving coronal balance.

The recovery of damaged paraspinal muscles by posterior surgical treatment for patients with lumbar degenerative diseases and its clinical consequence.

BACKGROUND: Posterior lumbar surgery can lead to damage on paraspinal muscles. OBJECTIVE: Our study aimed to examine the recovery in the denervated paraspinal muscles by posterior lumbar surgery and to determine that of improvement in the lower back pain (LBP). METHODS: Depending on surgical treatments, the patients were divided into two groups: The group I (interspinous implantation with decompression) and II (posterior lumbar interbody fusion with decompression). The paraspinal mapping score was recorded for individual muscle. RESULTS: In the group I, there was reinnervation in the denervated multifidus and erector spinae at the upper, surgical and lower levels at 12 months. In the group II, there was reinnervation in the denervated erector spinae at the upper, surgical and lower levels at 12 months. There was significant aggravation in the LBP in both groups at immediate postoperative. But there was significant improvement in it at 6 months in the group I and at 12 months in the group II. CONCLUSION: There was reinnervation in not only denervated multifidus and erector spinae at 12 months following interspinous ligament stabilization but also in denervated erector spinae at 12 months following pedicle screw fixation with fusion.

Filling Index Score of Remplissage (FISOR): a useful measurement tool to evaluate structural outcome after remplissage.

BACKGROUND: The purpose of this study was to evaluate and to grade the extent of filling into the Hill-Sachs lesion quantitatively by use of magnetic resonance arthrography after an arthroscopic remplissage procedure. METHODS: The current study enrolled 23 patients who underwent arthroscopic Bankart repair with a remplissage procedure for a large or engaging Hill-Sachs lesion confirmed by arthroscopic findings. The postoperative filling index was classified into 5 categories by axial and sagittal views of T2-weighted images on magnetic resonance arthrography: complete filling (4 points); partial filling with minor defect (3 points); partial filling with major defect (2 points); minimal filling with significant free fluid level (1 point); and filling failure with dehiscence (0 point). Filling Index Score of Remplissage (FISOR) was also calculated from the total sum of points in the axial and sagittal planes and classified into 5 grades. RESULTS: The FISOR was 8 points in 13 patients, 7 points in 2 patients, 6 points in 3 patients, 5 points in 1 patient, 4 points in 1 patient, 3 points in 1 patient, 2 points in 1 patient, and 0 point in 1 patient. According to the FISOR grades, these results were recorded as excellent in 15 patients (65.2%), good in 4 patients (17.4%), fair in 2 patients (8.7%), poor in 1 patient (4.3%), and no evidence of filling in 1 patient (4.3%). CONCLUSION: The FISOR would be a useful measurement tool for the evaluation of structural outcomes after the remplissage procedure.