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The Utility of Preoperative Magnetic Resonance Imaging for Determining the Flexibility of Sagittal Imbalance
Akshay Sharma1,2, Sina Pourtaheri1, Jason Savage2,3
1Case Western Reserve University School of Medicine, Cleveland, Ohio.
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° between the lumbar lordosis measured on supine MRI as compared to the intraoperative X-rays, as opposed to 5.53° between standing X-rays and intraoperative X-ray. In patients with flexible deformities (n = 24), the lumbar lordosis on MRI measured a discrepancy of 3.08°, as compared to a discrepancy of 11.46° 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.
