Matching thoracic kyphosis, lumbar lordosis, and pelvic incidence in the sagittal plane is central to optimal alignment in adult spinal deformity surgery. The same principle applies in the coronal plane: the fractional lumbosacral curve, lumbar scoliosis, and thoracic scoliosis must be balanced against each other in the surgical plan.
The case below illustrates individualized surgical planning using the MEANS (Multi-Ethnic Alignment Normative Study) framework in a patient with a prior Harrington rod presenting with difficulty standing upright, back pain, and radiculopathy.
Surgical Planning Principles
On preoperative imaging, the patient was compensating using the lower extremities. Considering the pelvic incidence (PI), thoracic kyphosis (TK), and lumbar lordosis (LL) match, a target lumbar lordosis of 31° was planned for this patient with a thoracic kyphosis of only 8° and pelvic incidence of 50°. Partial reduction of the lumbar scoliosis was planned using differently-shaped rods to match the thoracic scoliosis. Screws were planned around the existing rods.
Postoperative X-rays demonstrate a well-aligned spine in both planes with no further lower extremity compensation required.
Related research: Sardar ZM, Cerpa M, Kelly M, et al. Age and Gender Based Spinopelvic and Regional Spinal Alignment in Asymptomatic Adult Volunteers: Results of the MEANS Study. Spine. 2022;47(19):1382–1390. PMID 35797462
About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, specializing in individualized deformity planning, sagittal balance correction, and Harrington rod revision surgery. To schedule a consultation or second opinion, call 212-932-5187 or visit the contact page.
Case shared for educational purposes. This post does not constitute individualized medical advice.