ArticleJournal of spine surgery (Hong Kong)2025
The apical vertebral rotational correction of the lumbosacral fractional curve: implications for coronal alignment in degenerative lumbar scoliosis.
Article in Journal of spine surgery (Hong Kong), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Degenerative lumbar scoliosis (DLS) often presents with coronal malalignment due to lumbosacral fractional (LSF) curve deformity. While apical vertebral rotation (AVR) has been recognized as a contributor to spinal deformity, its relationship with global coronal alignment correction remains unclear. This study aimed to investigate the correlation between AVR at the LSF curve and global coronal alignment in DLS patients, both pre- and post-operatively. Methods: This retrospective study included 144 patients with DLS who underwent spinal fusion surgery with a minimum 2-year follow-up. Radiographic software was used to assess coronal balance distance (CBD), fractional apical vertebral rotation (fAVR), spinopelvic parameters, Cobb angles, and L4/L5 tilt angles. Coronal malalignment was categorized, and change in fAVR (ΔfAVR) were analyzed for correlation with changes in global coronal alignment. Subgroup analyses were conducted based on pelvic incidence (PI) and Bao classification (types A, B, and C). Results: A significant correlation was found between ΔfAVR and improvement in coronal alignment (r=0.6; P<0.05), with moderate correlations with coronal Cobb angle (r=0.51), L4 tilt (r=0.417), and L5 tilt (r=0.403) (P<0.05 for all). Subgroup analysis revealed a strong correlation in patients with low PI and moderate correlation in high PI patients. By Bao classification, the correlation between ΔfAVR and global coronal alignment was strongest in type C (r=0.87), followed by type B (r=0.656) and type A (r=0.506; P<0.05). Conclusions: AVR at the LSF curve significantly contributes to the improvement of global coronal alignment in DLS. Axial alignment correction plays a foundational role in restoring coronal balance, emphasizing the importance of precise surgical strategies for matching lumbosacral and lumbar/thoracolumbar curves.
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