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The Utility of Preoperative Magnetic Resonance Imaging for Determining the Flexibility of Sagittal Imbalance.

Journal:
Neurosurgery


Issue Date:
2018


Abstract(summary):

BACKGROUND: Scoliosis X-rays are the gold standard for assessing preoperative lumbar lordosis; however, particularly for flexible lumbar deformities, it is difficult to predict from these images the extent of correction required, as standing radiographs cannot predict the thoracolumbar alignment after intraoperative positioning.; OBJECTIVE: To determine the utility of preoperative MRI in surgical planning for patients with flexible sagittal imbalance.; METHODS: We identified 138 patients with sagittal imbalance. Radiographic parameters including pelvic incidence and lumbar lordosis were obtained from images preoperatively.; RESULTS: The mean difference was 2.9=C2=B0 between the lumbar lordosis measured on supine MRI as compared to the intraoperative X-rays, as opposed to 5.53=C2=B0 between standing X-rays and intraoperative X-ray. In patients with flexible deformities (n =3D24), the lumbar lordosis on MRI measured a discrepancy of 3.08=C2=B0, as compared to a discrepancy of 11.46=C2=B0 when measured with standing X-ray.; CONCLUSION: MRI adequately determined which sagittal deformities were flexible. Furthermore, with flexible sagittal deformities, lumbar lordosis measured on MRI more accurately predicted the intraoperative lumbar lordosis than that measured on standing X-ray. The ability to preoperatively predict intraoperative lumbar lordosis with positioning helps with surgical planning and patient counseling regarding expectations and risks of surgery.=20


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