caa a22 4500 44583465X CHVBK 20180317145326.0 cr unu---uuuuu 170323e20110901xx s 000 0 eng 10.1007/s00586-011-1930-3 doi (NATIONALLICENCE)springer-10.1007/s00586-011-1930-3 Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? [Elektronische Daten] [Cédric Barrey, Pierre Roussouly, Gilles Perrin, Jean-Charles Le Huec] Introduction: Aging of the spine is characterized by facet joints arthritis, degenerative disc disease and atrophy of extensor muscles resulting in a progressive kyphosis. Recent studies confirmed that patients with lumbar degenerative disease were characterized by an anterior sagittal imbalance, a loss of lumbar lordosis and an increase of pelvis tilt. The aim of this paper was thus to describe the different compensatory mechanisms which are observed in the spine, pelvis and/or lower limbs areas for patients with severe degenerative spine. Methods: We reviewed all the compensatory mechanisms of sagittal unbalance described in the literature. Results: According to the severity of the imbalance, we could identify three different stages: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permitted to limit consequences of lumbar kyphosis on the global sagittal alignment. Reduction of thoracic kyphosis, intervertebral hyperextension, retrolisthesis, pelvis backtilt, knee flessum and ankle extension were the main mechanisms described in the literature. The basic concept of these compensatory mechanisms was to extend adjacent segments of the kyphotic spine allowing for compensation of anterior translation of the axis of gravity. Conclusions: To avoid underestimate the severity of the degenerative spine disorder, it thus seems important to recognize the different compensatory mechanisms from the upper part of the trunk to the lower limbs. We propose a three steps algorithm to analyse the balance status and determine the presence or not of these compensatory mechanisms: measurement of pelvis incidence, assessment of global sagittal alignment and analysis of compensatory mechanisms successively in the spine, pelvis and lower limbs areas. Springer-Verlag, 2011 Sagittal balance nationallicence Pelvis nationallicence Spinal alignment nationallicence Lumbar lordosis nationallicence Degenerative disc disease nationallicence Lumbar kyphosis nationallicence LL : Lumbar lordosis nationallicence PI : Pelvic incidence nationallicence PT : Pelvic tilt nationallicence SS : Sacral slope nationallicence TK : Thoracic kyphosis nationallicence Barrey Cédric Department of Neurosurgery C and Spine Surgery, Neurological Hospital, 59 boulevard Pinel, 69394, Lyon, France aut Roussouly Pierre Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, 92 rue Edmond Locard, 69005, Lyon, France aut Perrin Gilles Department of Neurosurgery C and Spine Surgery, Neurological Hospital, 59 boulevard Pinel, 69394, Lyon, France aut Le Huec Jean-Charles Spine unit 2, Deterca Surg lab, Department of Orthopedic Surgery, University Hospital, Bordeaux, France aut European Spine Journal Springer-Verlag 20(2011-09-01), 626-633 0940-6719 20<626 2011 20 586 https://doi.org/10.1007/s00586-011-1930-3 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-011-1930-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Barrey Cédric Department of Neurosurgery C and Spine Surgery, Neurological Hospital, 59 boulevard Pinel, 69394, Lyon, France aut NATIONALLICENCE 700 1- Roussouly Pierre Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, 92 rue Edmond Locard, 69005, Lyon, France aut NATIONALLICENCE 700 1- Perrin Gilles Department of Neurosurgery C and Spine Surgery, Neurological Hospital, 59 boulevard Pinel, 69394, Lyon, France aut NATIONALLICENCE 700 1- Le Huec Jean-Charles Spine unit 2, Deterca Surg lab, Department of Orthopedic Surgery, University Hospital, Bordeaux, France aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20(2011-09-01), 626-633 0940-6719 20<626 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer