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Updated: Jan 28, 2026

Intraoperative Ultrasound in Spinal Surgery

Intraoperative Ultrasound in Spinal Surgery

Published on: August 17, 2022

Intraoperatively predicting postoperative sagittal balance using intraoperative X-rays.

Adrian J Praeger¹, Yi Yuen Ian Wang², Tony Goldschlager³

¹Department of Neurosurgery, Monash Health, Melbourne, Australia.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia

|March 5, 2019

Summary

Intraoperative measurements of sagittal balance correlate with postoperative results after spinal fusion. A predictive algorithm helps estimate postoperative pelvic mismatch, guiding surgeons to achieve optimal spinal alignment.

Keywords:

Correlation Lateral Lumbar lordosis Pelvic mismatch Prediction Prone Sagittal balance

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Area of Science:

Spine Surgery
Orthopedics
Radiology

Background:

Accurate assessment of sagittal balance is crucial for spinal fusion outcomes.
Intraoperative measurements are often used to guide surgical correction.
Correlation between intraoperative and postoperative sagittal parameters needs further investigation.

Purpose of the Study:

To correlate intraoperative sagittal balance parameters with postoperative standing full spine X-ray results.
To develop a predictive algorithm for intraoperative estimation of postoperative spinal balance.

Main Methods:

Retrospective analysis of 49 patients undergoing thoracolumbar spinal fusion.
Measurement of sagittal parameters (pelvic incidence, lumbar lordosis, spinopelvic mismatch, sagittal vertical axis) from intraoperative and postoperative X-rays.
Statistical analysis including linear regression to develop a predictive algorithm.

Main Results:

Significant correlation found between intraoperative and postoperative sagittal balance parameters.
For prone patients, intraoperative lumbar lordosis averaged 59.9°, compared to 55.4° postoperatively (mean difference -4.5°, p < 0.001).
A predictive algorithm was developed to estimate postoperative spinopelvic mismatch in prone patients.

Conclusions:

Intraoperative measurement of sagittal balance parameters can reliably estimate postoperative standing full spine X-ray results.
In the prone position, surgeons should aim for intraoperative lordosis approximately 4.5° greater than the desired postoperative lordosis.
The developed predictive formula offers a practical tool for intraoperative calculation of postoperative pelvic mismatch.