+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Clinical and radiographic evaluation of sagittal imbalance: a new radiographic assessment



Clinical and radiographic evaluation of sagittal imbalance: a new radiographic assessment



American Journal of Orthopedics 40(3): E30



In this article, we describe a case series study involving a new radiologic evaluation of sagittal imbalance. We review the current radiologic assessment of sagittal imbalance and introduce a new radiologic evaluation that helps in ruling out hip flexion contracture as the primary cause of sagittal imbalance and the type and level of spinal osteotomy required to regain sagittal balance. Sagittal imbalance is important in spinal deformity assessment. Studies have confirmed that overall clinical outcomes and patient satisfaction with surgery were best in cases that resulted in an increase in lumbar lordosis. For this study, radiologic assessment of sagittal imbalance was conducted on a long, 14 × 51-inch upright lateral plain radiograph that included the proximal femur and the entire spine. The radiograph was taken with the arms at 45° forward flexion and the hips and knees fully extended. The femoral axis line was drawn and extended cephalad. The C7 offset, the perpendicular distance between the femoral axis line and the center of C7, represented the degree of sagittal imbalance. The angle between the femoral axis line and a line extending from the center of C7 to the vertebra at the level of the proposed osteotomy--the Seattle angle--predicted how much correction was required to bring the C7 plumb in line with the femoral axis and to decrease the C7 offset, thus regaining sagittal balance. The proposed method was used to evaluate 10 consecutive patients who required spinal osteotomies to regain sagittal balance. Preoperative and postoperative plain radiographs were assessed twice, at a 6-week interval, by an independent spine surgeon and a musculoskeletal radiologist. Cohen κ correlation coefficients were used to calculate intraobserver and interobserver reliability. The 2 reviewers' intraobserver reliability was excellent (κs = 0.98, 0.93). Interobserver reliability was lower but good (κ = 0.76). Inclusion of the proximal femur on the long upright lateral plain radiograph of the entire spine and identification of the relation between the femoral axis line and the center of C7 are important in evaluating sagittal imbalance. Excellent intraobserver reliability, coupled with good interobserver reliability, suggest that this new radiologic assessment method can be helpful in preoperative assessment of sagittal imbalance.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 052108086

Download citation: RISBibTeXText

PMID: 21720605


Related references

Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. Journal of Neurosurgery. Spine 5(1): 9-17, 2006

Clinical and Radiographic Features of Subtypes of Acute Proximal Junctional Failures Following Correction Surgery for Degenerative Sagittal Imbalance. World Neurosurgery 125: E304, 2019

Sagittal Balance of the Spine--Clinical Importance and Radiographic Assessment. Zeitschrift für Orthopadie und Unfallchirurgie 154(2): 128-133, 2016

Long-term Clinical and Radiographic Outcomes of Pedicle Subtraction Osteotomy for Fixed Sagittal Imbalance: Does Level of Proximal Fusion Affect the Outcome? Minimum 5-Year Follow-up. Spine Deformity 1(2): 123-131, 2013

Is there a difference in sagittal alignment of Blount's disease between radiographic and clinical evaluation?. Clinical Orthopaedics and Related Research 472(12): 3807-3813, 2014

Sagittal split technique 2. radiographic findings during the fixation period a radiographic follow up study. International Journal of Oral Surgery 8(2): 82-88, 1979

Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study. European Spine Journal 24(Suppl. 3): 433-438, 2015

Clinical and radiographic evaluation of a computer-generated guiding device in bilateral sagittal split osteotomies. JournalofCranio-Maxillo-FacialSurgery42(5):E195, 2014

A clinico-radiographic analysis of sagittal condylar guidance determined by protrusive interocclusal registration and panoramic radiographic images in humans. Contemporary Clinical Dentistry 3(4): 383-387, 2012

Radiographic evaluation of the urinary system and the effect of radiographic contrast media (urografin) on clinical parameters, urinalysis and renal function tests in sheep. Journal of the Faculty of Veterinary Medicine, University of Tehran 62(1): 27-31, 2007

Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection. European Spine Journal 25(8): 2668-2675, 2016

Postoperative Radiographic Early-Onset Adjacent Segment Degeneration after Single-Level L4-L5 Posterior Lumbar Interbody Fusion in Patients without Preoperative Severe Sagittal Spinal Imbalance. Asian Spine Journal 12(4): 743-748, 2018

A reflection on radiographic cephalometry: the evaluation of sagittal discrepancy. Journal of Orthodontics 41(3): 208-217, 2014

A study for the prevention of medical accidents for clinical examination in a department of radiology: part 2. Risk cases due to plain radiographic techniques, ward radiographic techniques, contrast radiographic techniques and angiography. Nihon Hoshasen Gijutsu Gakkai Zasshi 60(6): 787-795, 2004

Association between radiographic damage of the spine and spinal mobility for individual patients with ankylosing spondylitis: can assessment of spinal mobility be a proxy for radiographic evaluation?. Annals of the Rheumatic Diseases 64(7): 988-994, 2005