A novel classification of coronal malalignment in degenerative lumbar scoliosis for predicting postoperative coronal imbalance: a multicenter cohort study

Weipeng Qiu ^1,2,3, Zhuoran Sun ^1,2,3, Ze Chen ^1,2,3

¹1Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
²2Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
³3Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
⁴4Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
⁵5Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China.
⁶6Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, Hebei, China.
⁷7Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁸8Department of Orthopedic Surgery, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China.
⁹9Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China; and.
¹⁰10Department of Orthopaedics, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

⁰1Department of Orthopaedics, Peking University Third Hospital, Beijing, China.

Neurosurgical Focus +

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June 1, 2025

View abstract on PubMed

Summary

A new classification system for degenerative lumbar scoliosis (DLS) surgery predicts postoperative coronal imbalance (CIB). This system helps surgeons assess risks and make informed decisions for better patient outcomes.

Area Of Science

Spine surgery
Orthopedics
Surgical outcomes

Background

Degenerative lumbar scoliosis (DLS) can lead to postoperative coronal imbalance (CIB).
Accurate prediction of CIB is crucial for surgical planning in DLS patients.

Purpose Of The Study

To identify major risk factors for CIB after DLS surgery.
To develop a novel classification system for predicting CIB.

Main Methods

Retrospective cohort study of 269 DLS patients undergoing posterior long-segment fusion.
Comparison of clinical and radiographic data between patients with and without CIB.
Development of a classification system based on multivariate logistic regression analysis.

Main Results

Postoperative CIB occurred in 38.7% of patients.
C7 plumb line (C7PL) orientation and L4 coronal tilt were significant predictors of CIB.
The novel 4-type classification system demonstrated strong predictive performance (AUC 0.788).

Conclusions

A new coronal classification system aids in preoperative risk stratification for CIB in DLS.
This system can assist surgical decision-making for coronal realignment during DLS surgery.

Keywords:

classification coronal imbalance coronal malalignment deformity degenerative lumbar scoliosis