INTRAOPERATIVE EVALUATION OF SPINAL CORONAL ALIGNMENT VIA T-SQUARE SHAPED TOOL IN THORACOLUMBAR INSTRUMENTATION

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Sarıgül B., Aydın L., Ramazanoğlu A. F., Dalbayrak S.

Journal of Turkish Spinal Surgery, cilt.36, sa.2, ss.77-82, 2025 (Scopus, TRDizin)

Özet

Objective: Postoperative coronal malalignment (CM) is associated with suboptimal surgical outcomes and a diminished quality of life in spinal deformity patients. Several risk factors for postoperative CM are proposed, including type 2 CM, pelvic obliquity, and lumbosacral fractional curve. Intraoperative assessment of coronal alignment plays a pivotal role in avoiding postoperative CM. A T-square-shaped tool (T-tool) has been proposed as a surgical device to evaluate the coronal balance intraoperatively. In this study, we evaluate the effectiveness of the T-tool in intraoperative coronal alignment correction in patients undergoing thoracolumbar spinal instrumentation. Materials and Methods: The study includes patients who had preoperative coronal spinal deformity and/or sagittal imbalance. The T-tool was used intraoperatively in all patients. Radiological measurements were obtained using pre- and postoperative standing scoliosis X-rays. Pelvic obliquity and leg-length discrepancy were also evaluated. Preoperative and postoperative C7-coronal vertical axis (CVA) and Cobb angle of the coronal curve were measured. CM was classified according to the Obeid-CM classification. The results were compared statistically. Results: Six hundred twenty-nine patients were included in the study. Degenerative deformity was observed in 553 (87.92%) patients, while adolescent idiopathic scoliosis was observed in 76 (12.08%) patients. The preoperative and postoperative C7-CVA were 27.16±11.44 and 8.64±5.21, respectively. The mean coronal Cobb angle decreased from 24.90±21.13° to 14.03±5.68°. No patient demonstrated postoperative worsening of CM. Conclusion: The T-tool is a feasible and cost-effective instrument for intraoperative assessment of the coronal spinal alignment, and it may contribute to the improvement of surgical outcomes and reduced postoperative complications.