Relationship between spinal structural damage and sagittal balance in axial spondyloarthritis: Is the thoracic spine the starting point?

OBJECTIVES: To assess the relationship between spinal structural damage, sagittal balance parameters and spine curvatures in patients with axial spondyloarthritis (axSpA). MATERIAL AND METHODS: In this cross-sectional study, the pelvic and sagittal balance parameters were obtained through EOS® (Biospace, Paris, France). Patients were divided into three groups according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) tertiles (G1 ≤6, n = 36; G2: 6.1-31, n = 36; G3 >31, n = 35) and pelvic and sagittal parameters were compared across them. Multivariable regression analysis was performed to analyze the impact of spinal structural damage and of other factors on sagittal vertical axis (SVA), an important sagittal balance parameter. RESULTS: A total of 107 patients was included. G2 and 3 exhibited higher mean values of thoracic kyphosis T1-T12 when compared to G1 (10.5°(12.3) vs. 22.3°(17.3) vs. 35.2°(14.6), p < 0.001), and G3 demonstrated lumbar L1-S1 straightening compared to the other groups (55.7°(9) and 50.7°(19.8), G1 and G2, respectively, vs. 35.7°(13.2), p < 0.001). Mean SVA values showed an increasing gradient from G1 to G3 (21.6(25.1) vs. 41(44.3) vs. 84.3(47.2)mm, p < 0.001). In the multivariable regression, a one-unit increase in total mSASSS was associated with an average 0.8 mm higher SVA. CONCLUSIONS: Our data showed that more spinal structural damage is associated with a higher SVA, reflecting poorer sagittal balance. Patients with increasing spinal damage have an important increase in thoracic kyphosis suggesting that postural modifications in patients with axSpA might have their origin in the thoracic spine.

Influencia del balance sagital sobre los cambios degenerativos de la columna vertebral (I) / Influence of Sagittal Balance on Degenerative Changes in the Spine (I)

RESUMEN Los estudios han determinado la importancia del balance sagital en el desarrollo de entidades degenerativas de la columna vertebral, fundamentalmente de la región lumbar; así como en los resultados de las intervenciones quirúrgicas de estas afecciones. Es propósito de este trabajo revisar y discutir los conceptos actuales sobre la estabilidad sagital vertebral y lumbar, así como su influencia sobre el proceso degenerativo espinal, de manera fundamental sobre estenosis, espondilolistesis y escoliosis degenerativa. Existen parámetros pélvicos y parámetros espinales que tienen que tomarse en cuenta para la determinación preoperatoria y posoperatoria del equilibrio sagital. El equilibrio sagital se clasifica en: balance normal, balance compensado y desbalance. Esto tiene gran importancia para llegar al diagnóstico correcto y aplicar el tratamiento quirúrgico necesario(AU)

ABSTRACT Studies have determined the importance of sagittal balance in the development of degenerative entities of the spine, mainly in the lumbar region; as well as in the results of the surgical interventions of these affections. The purpose of this paper is to review and discuss current concepts on vertebral and lumbar sagittal stability, as well as its influence on the degenerative spinal process, basically on stenosis, spondylolisthesis and degenerative scoliosis. There are pelvic parameters and spinal parameters that have to be taken into account for the preoperative and postoperative determination of sagittal balance. Sagittal balance is classified into normal balance, compensated balance and imbalance. This is very important to reach the correct diagnosis and apply the necessary surgical treatment(AU)

Calidad de vida y balance sagital en la evolución de los pacientes con mieloma múltiple tratados con vertebroplastia percutánea / Quality of Life and Sagittal Balance in the Evolution of Patients with Multiple Myeloma Who Received Treatment

RESUMEN Introducción: El mieloma múltiple representa el 1 por ciento de las neoplasias y el 10 por ciento de las hemopatías malignas. La edad media de presentación es 65 años. El dolor óseo en columna vertebral y costillas constituye su manifestación inicial. El tratamiento quirúrgico del mieloma múltiple en la columna consiste en descompresión amplia y artrodesis. La vertebroplastia se considera técnica de elección porque restablece el balance sagital y coronal, contribuye al fortalecimiento del cuerpo vertebral, y disminuye el dolor asociado a fracturas. Objetivo: Evaluar el efecto de la vertebroplastia sobre la calidad de vida y el balance sagital, en la disminución del dolor. Métodos: Se estudiaron 192 pacientes con mieloma múltiple con fractura en la columna, 80 tratados con vertebroplastia y 112 en forma conservadora. Se utilizó el cuestionario de Oswestry y la escala de Karnosfky. Resultados: La vertebroplastia disminuyó 0,52 veces el uso de analgésicos opioides. Conclusiones: La vertebroplastia representa un mayor beneficio de la calidad de vida de los pacientes aquejados de mieloma múltiple con fractura vertebral; repercute en el mejoramiento del balance sagital, el nivel de discapacidad y la capacidad para realizar tareas cotidianas(AU)

ABSTRACT Introduction: Multiple myeloma accounts for 1 percent of neoplasms and for 10 percent of malignant hematomas. The mean onset age is 65 years. Bone pain in the spine and ribs is its initial manifestation. Surgical treatment for multiple myeloma in the spine consists in wide decompression and arthrodesis. Vertebroplasty is considered the choice technique because it restores sagittal and coronal balance, contributes to the strengthening of the vertebral body, and reduces pain associated with fractures. Objective: To assess the effect of vertebroplasty on quality of life and the effect of sagittal balance in reducing pain. Methods: 192 patients with multiple myeloma and spinal fracture were studied, 80 treated with vertebroplasty and 112 treated conservatively. The Oswestry questionnaire and the Karnofsky scale were used. Results: Vertebroplasty decreased the use of opioid analgesics by 0.52 times. Conclusions: Vertebroplasty represents a greater benefit for the quality of life of patients suffering from multiple myeloma with vertebral fracture. It affects the improvement of sagittal balance, the level of disability, and the ability to perform daily tasks(AU)

The acromegalic spine: fractures, deformities and spinopelvic balance.

INTRODUCTION: Axial skeleton arthropathy and osteoporotic vertebral fractures are common findings in acromegalic patients and can result in severe spinal deformity. OBJECTIVE: To investigate the presence of spinal fractures and deformities, sagittal imbalances, and spinopelvic compensatory mechanisms in acromegalics. PATIENTS AND METHODS: 58 patients with acromegaly from a referral neuroendocrinology center were prospectively evaluated by panoramic spine radiographs to detect the presence of fractures and scoliosis, to measure thoracic kyphosis, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sagittal vertical axis (SVA). Sagittal imbalance criteria were considered: thoracic kyphosis > 50°, PI-LL > 10°, PT > 20° and SVA > 5 cm. Their medical records were analyzed for clinical and laboratorial data. RESULTS: The prevalence of fractures was 13.8%, predominantly in the thoracic spine, with mild and anterior wedge compressions. Scoliosis was present in 34.5% of the cases, all with degenerative lumbar curve apex. Thoracic kyphosis > 50º occurred in 36.8% of patients, PI-LL > 10° in 48.3%, PT > 20° in 41.4% and SVA > 5 cm in 12.1%. CONCLUSION: Increased number of vertebral fractures and high prevalence of spinal deformities related to sagittal imbalance were detected, indicating the importance of monitoring bone comorbidities in acromegaly, with radiological evaluation of the spine as part of the follow up.

Anatomía de las osteotomías dorsolumbares en fotografías en 3D / Anatomy of thoracolumbar osteotomies in 3D photographs

Introducción y objetivo: Existe evidencia contundente que demuestra la relación entre el balance sagital y la calidad de vida de los pacientes adultos con deformidad espinal, de manera que la corrección y realineación en ese plano se ha transformado en un objetivo primario en el tratamiento quirúrgico de dichas afecciones. Las osteotomías dorsolumbares permiten liberar el raquis para realizar dicha realineación sin el uso de fuerza indebida. Sin embargo, son técnicas complejas y con alta tasa de complicaciones intra y post operatorias. Teniendo en cuenta que el conocimiento anatómico de dichos procedimientos es clave, el objetivo de esta revisión consiste en realizar una descripción de las osteotomías dorsolumbares mediante el uso de fotografías en 3D de un preparado cadavérico de raquis lumbar. Materiales y métodos: Se utilizó un preparado cadavérico formolizado de raquis lumbar. Se realizaron las osteotomías espinales lumbares según la clasificación de Schwab et al., en los segmentos L3 y L4. Se tomaron imágenes fotográficas en 3 dimensiones utilizando equipo Nikon D90, con lente 50 mm Af 1.8G, flash Nikon SB700, y una barra regulable para fotografía 3D. Las imágenes fotográficas obtenidas fueron procesadas con los siguientes softwares con técnica anaglífica: Anaglyph Maker versión 1.08 y StereoPhoto Maker versión 4.54. Resultados: Se realiza una descripción de las osteotomías según la clasificación en 6 grados anatómicos de Schwab y colaboradores. Conclusión: La utilización de la técnica fotográfica 3D permitió demostrar el tipo y magnitud de resección ósea necesaria en cada grado de osteotomía.

Introduction and objective: There is strong evidence that shows the relationship between the sagittal balance and the quality of life of adult patients with spinal deformity. According to that, the correction and realignment of the sagittal plane has become a primary objective in the surgical treatment of these conditions. The dorsolumbar osteotomies allow the spine to be released, in order to perform that realignment without the use of undue force. However, they are complex techniques, with a high rate of intra and post-operative complications. Taking into account that the anatomical knowledge of these procedures is fundamental, the objective of this review was to describe the dorsolumbar osteotomies using 3D photographs of a cadaveric preparation of the lumbar spine. Materials and methods: A cadaveric formolized lumbar spine preparation was used. Lumbar spinal osteotomies were performed according to the classification of Schwab et al. Three-dimensional photographic images were taken using Nikon D90 equipment, with a 50mm AF 1.8G lens, Nikon SB700 flash, and an adjustable bar for 3D photography. The photographic images obtained were processed with the following software with anaglyphic technique: Anaglyph Maker version 1.08 and StereoPhoto Maker version 4.54. Results: A description of the osteotomies was made, according to the 6 anatomic grades classification developed by Schwab et al. Conclusion: The use of the 3D photographic technique allowed to demonstrate the type and magnitude of bone resection needed in each degree of osteotomy.

Is There an Association With Spino-Pelvic Relationships and Clinical Outcome of Type A Thoracic and Lumbar Fractures Treated Non-Surgically?

BACKGROUND: The objective was to evaluate if there is an association of the spino-pelvic relationships and the global spinal alignment with the outcome of AO type A injuries treated nonsurgically. METHODS: This is a retrospective case series. Patients treated nonsurgically for AOSpine type A fractures (T1-L5) with at least 1 year follow-up identified. A standing antero-posterior and lateral 36-inch radiographs and measures of spino-pelvic relationships and sagittal alignment were obtained, as well as clinical assessment using the visual analog scale, the Short-Form 36 (SF-36) questionnaire, the Oswestry Disability Index (ODI), and labor status. RESULTS: Twenty-two patients with 33 fractures were included (L1 was the most injured level with 18.2%). There were 17 men (77.2%) and the mean age was 47.1 years. Follow-up ranged from 12 to 60 months (mean of 27.8 months). There were 22 type A1 (66.7%), 3 type A2 (9%), 6 type A3 (18%), and 2 type A4 (6%) fractures. The ODI ranged from 4% to 58%, with a mean of 24.4%. The SF-36 physical health score ranged from 23 to 82.25 (mean 49.59), and the mental health score ranged from 14.75 to 94.25 (mean 63.28). No association was identified between the spino-pelvic measurements, global alignment, and patient-reported outcomes. CONCLUSIONS: Type A fractures had a clinically relevant amount of long-term disability even when surgical treatment is not required. Spino-pelvic relationships and final global spinal alignment did not associate with outcome measurements.

A Comparative Study of Sagittal Balance in Patients with Neuromuscular Scoliosis

OBJECTIVES: Spinopelvic alignment has been associated with improved quality of life in patients with vertebral deformities, and it helps to compensate for imbalances in gait. Although surgical treatment of scoliosis in patients with neuromuscular spinal deformities promotes correction of coronal scoliotic deformities, it remains poorly established whether this results in large changes in sagittal balance parameters in this specific population. The objective of this study is to compare these parameters before and after the current procedure under the hypothesis is that there is no significant modification. METHODS: Sampling included all records of patients with neuromuscular scoliosis with adequate radiographic records treated at Institute of Orthopedics and Traumatology of Clinics Hospital of University of São Paulo (IOT-HCFMUSP) from January 2009 to December 2013. Parameters analyzed were incidence, sacral inclination, pelvic tilt, lumbar lordosis, thoracic kyphosis, spinosacral angle, spinal inclination and spinopelvic inclination obtained using the iSite-Philips digital display system with Surgimap and a validated method for digital measurements of scoliosis radiographs. Comparison between the pre- and post-operative conditions involved means and standard deviations and the t-test. RESULTS: Based on 101 medical records only, 16 patients met the inclusion criteria for this study, including 7 males and 9 females, with an age range of 9-20 and a mean age of 12.9±3.06; 14 were diagnosed with cerebral palsy. No significant differences were found between pre and postoperative parameters. CONCLUSIONS: Despite correction of coronal scoliotic deformity in patients with neuromuscular deformities, there were no changes in spinopelvic alignment parameters in the group studied.

Global balance in adult spinal deformities. A study of 60 cases / Alinhamento global em deformidades da coluna vertebral do adulto. Um estudo de 60 casos / Balance global en las deformidades espinales del adulto. Un estudio de 60 casos

ABSTRACT Objectives: Determine the most prevalent type of curve in our population, to quantify the radiographic parameters such as PT, IP, SS and compare the physical function according to ODI and SRS-22r. Methods: Retrospective, observational, longitudinal, single-center study, carried out from January 2010 to May 2015 at the Centro Médico ISSEMYM Ecatepec, Spine Surgery Service. Results: A total of 60 patients were obtained, 60% female, with curvatures according to SRS-Schwab, type T (28%), TL (46.6%), D (15%), N (10%), with a mean preoperative VAS of 7 for all curves and post-surgical 2 after 6 months. The SRS-22r preoperative test was 2.1 and postoperatively was 3.75, with p<0.001. Conclusions: Deformities of the adult spine are a growing disease in our country. The surgical management of deformities requires proper clinical and radiographic planning. Patients undergoing surgical treatment in our study showed curvature type TL and demonstrated significant improvement in ODI and SRS-22r.

RESUMO Objetivos: Determinar o tipo de curva mais prevalente em nossa população, quantificar os parâmetros radiográficos, tais como PT, PI, SS e comparar a função física de acordo com ODI e SRS-22r. Métodos: Estudo retrospectivo, observacional, longitudinal, em centro único, realizado no período de janeiro de 2010 a maio de 2015 no Centro Médico ISSEMYM Ecatepec, Serviço de Cirurgia da Coluna. Resultados: Reuniu-se um total de 60 pacientes, 60% do sexo feminino, com curvaturas, de acordo com o SRS-Schwab, tipo T (28%), TL (46,6%), D (15%), N (10%), com EVA média pré-operatória de 7 para todas as curvas e pós-cirúrgica de 2 depois de 6 meses. O teste SRS-22r pré-operatório foi de 2,1 e o pós-operatório foi de 3,75, com p < 0,001. Conclusões: As deformidades da coluna vertebral do adulto são uma doença crescente em nosso país. O tratamento cirúrgico das deformidades requer planejamento clínico-radiográfico adequado. Os pacientes submetidos ao tratamento cirúrgico em nosso estudo mostraram curvatura tipo TL e apresentaram melhora significativa de ODI e SRS-22r.

RESUMEN Objetivos: Determinar el tipo de curva más frecuente en nuestra población, cuantificar los parámetros radiográficos como PT, PI, SS y comparar la función física de acuerdo al test de ODI y SRS-22r. Métodos: Estudio retrospectivo, observacional, longitudinal y unicéntrico, realizado en el periodo entre Enero de 2010 y Mayo de 2015 en el Centro Médico ISSEMYM Ecatepec, Servicio de Cirugía de Columna. Resultados: Se obtuvieron un total de 60 pacientes, 60% mujeres, con curvaturas, de acuerdo a la clasificación SRS-Schwab, tipo T (28%), tipo TL (46,6%), tipo D (15%), tipo N (10%), con una EVA prequirúrgica promedio de 7 para todo tipo de curvas y posquirúrgica de 2 a los 6 meses. El test de SRS-22r prequirúrgico fue de 2,1 y el posquirúrgico de 3,75 con p < 0,001. Conclusiones: Las deformidades espinales del adulto son una patología creciente en nuestro país. El manejo quirúrgico de las deformidades requiere una adecuada planeación clínico-radiográfica. Los pacientes sometidos a tratamiento quirúrgico en nuestro estudio mostraron una curvatura tipo TL y presentaron mejoría significativa del ODI y del SRS-22r.

Modificaciones del plano sagital cervical luego del tratamiento quirúrgico posterior en la escoliosis idiopática del adolescente Lenke 1 / Changes in the cervical alignment after posterior transpedicular instrumentation in Lenke type I adolescent idiopathic scoliosis

Introducción: Como la cifosis toracica y la lordosis cervical son directamente proporcionales, las modificaciones del plano sagital toracico impactarian sobre la columna cervical. Nuestro objetivo fue detectar cambios en el plano sagital cervical, a corto y mediano plazo, durante el tratamiento quirurgico segun una tecnica posterior. Materiales y Métodos: Estudio retrospectivo radiografico de tipo serie de casos, entre enero de 2005 y abril de 2009. Criterios de inclusion: escoliosis idiopatica del adolescente Lenke 1, tratamiento por via posterior con tornillos transpediculares. Seguimiento minimo 2 anos. Parametros analizados: nivel Cobb, nivel de instrumentacion proximal, densidad de implantes, lordosis cervical, cifosis toracica proximal, cifosis toracica principal, inclinacion sagital T1, balance sagital global, balance sagital cervical. Analisis estadistico mediante ANOVA de muestras repetitivas y Tukey, con el programa Graph-Pad-Prism. Resultados: 25 pacientes. Seguimiento promedio 4,3 anos. Cifosis toracica: media preoperatoria 26,8o, posoperatoria 20,6o. Efecto lordotizante despues del tratamiento quirurgico (p ≤0,001). La inclinacion sagital T1 y la cifosis proximal T2-T5 (p ≤0,038) mostraron un incremento hacia el ultimo control. El 72 % presentaba rectificacion o cifosis cervical antes de la cirugia. El 44 % experimento una mejoria hacia el ultimo control. Los niveles de artrodesis mas altos se correlacionaron con los casos que empeoraron su contorno sagital posoperatorio. Conclusiones: Nuestra tecnica de correccion genero un efecto lordotizante toracico. Esto se tradujo, a mediano plazo, en un incremento de la retropulsion del tronco y rectificacion o perdida de la lordosis a nivel cervical...

Background: As thoracic kyphosis and cervical lordosis are proportionally related, every change in the thoracic sagittal plane will impact on the cervical alignment. Our objective was to detect changes in the sagittal cervical plane at short- and medium term follow-up during surgical treatment, according to the posterior technique. Methods: Retrospective, radiographic case series study performed between January 2005 and April 2009. Inclusion criteria: Lenke type 1 adolescent idiopathic scoliosis, and posterior screw fixation surgery. Radiographic parameters: Cobb angle, uppermost instrumented vertebra, implant density, cervical lordosis, proximal thoracic kyphosis, main thoracic kyphosis, T1 sagittal tilt, global sagittal balance and cervical sagittal balance. Statistical analysis: ANOVA of repetitive samples and Tukey, using the Graph-Pad-Prism. Results: 25 patients. Mean follow-up 4.3 years. Thoracic kyphosis (T5-T12): average, preoperative 26.8º and 20.6º postoperative. Lordosing effect after surgical treatment (p ≤0.001). T1 sagittal tilt and T2-T5 proximal thoracic kyphosis (p ≤0.038) tended to increase at last control. Seventy two per cent of our sample showed rectification or even cervical kyphosis before surgery. Only 44 % had certain better alignment at the last follow-up. Higher UIV correlated with a worse cervical plane alignment after surgery. Conclusions: Our derotational concavity technique with poliaxial pedicle screws and titanium 5.5 rod demonstrated a lordosing effect in the thoracic sagittal plane. This was translated into a trunk retropulsion and rectification or lost of lordosis in the sagittal cervical plane in the medium-term follow-up...

Modificaciones del plano sagital cervical luego del tratamiento quirúrgico posterior en la escoliosis idiopática del adolescente Lenke 1 / Changes in the cervical alignment after posterior transpedicular instrumentation in Lenke type I adolescent idiopathic scoliosis

Introducción: Como la cifosis toracica y la lordosis cervical son directamente proporcionales, las modificaciones del plano sagital toracico impactarian sobre la columna cervical. Nuestro objetivo fue detectar cambios en el plano sagital cervical, a corto y mediano plazo, durante el tratamiento quirurgico segun una tecnica posterior. Materiales y Métodos: Estudio retrospectivo radiografico de tipo serie de casos, entre enero de 2005 y abril de 2009. Criterios de inclusion: escoliosis idiopatica del adolescente Lenke 1, tratamiento por via posterior con tornillos transpediculares. Seguimiento minimo 2 anos. Parametros analizados: nivel Cobb, nivel de instrumentacion proximal, densidad de implantes, lordosis cervical, cifosis toracica proximal, cifosis toracica principal, inclinacion sagital T1, balance sagital global, balance sagital cervical. Analisis estadistico mediante ANOVA de muestras repetitivas y Tukey, con el programa Graph-Pad-Prism. Resultados: 25 pacientes. Seguimiento promedio 4,3 anos. Cifosis toracica: media preoperatoria 26,8o, posoperatoria 20,6o. Efecto lordotizante despues del tratamiento quirurgico (p ≤0,001). La inclinacion sagital T1 y la cifosis proximal T2-T5 (p ≤0,038) mostraron un incremento hacia el ultimo control. El 72 % presentaba rectificacion o cifosis cervical antes de la cirugia. El 44 % experimento una mejoria hacia el ultimo control. Los niveles de artrodesis mas altos se correlacionaron con los casos que empeoraron su contorno sagital posoperatorio. Conclusiones: Nuestra tecnica de correccion genero un efecto lordotizante toracico. Esto se tradujo, a mediano plazo, en un incremento de la retropulsion del tronco y rectificacion o perdida de la lordosis a nivel cervical...(AU)

Background: As thoracic kyphosis and cervical lordosis are proportionally related, every change in the thoracic sagittal plane will impact on the cervical alignment. Our objective was to detect changes in the sagittal cervical plane at short- and medium term follow-up during surgical treatment, according to the posterior technique. Methods: Retrospective, radiographic case series study performed between January 2005 and April 2009. Inclusion criteria: Lenke type 1 adolescent idiopathic scoliosis, and posterior screw fixation surgery. Radiographic parameters: Cobb angle, uppermost instrumented vertebra, implant density, cervical lordosis, proximal thoracic kyphosis, main thoracic kyphosis, T1 sagittal tilt, global sagittal balance and cervical sagittal balance. Statistical analysis: ANOVA of repetitive samples and Tukey, using the Graph-Pad-Prism. Results: 25 patients. Mean follow-up 4.3 years. Thoracic kyphosis (T5-T12): average, preoperative 26.8º and 20.6º postoperative. Lordosing effect after surgical treatment (p ≤0.001). T1 sagittal tilt and T2-T5 proximal thoracic kyphosis (p ≤0.038) tended to increase at last control. Seventy two per cent of our sample showed rectification or even cervical kyphosis before surgery. Only 44 % had certain better alignment at the last follow-up. Higher UIV correlated with a worse cervical plane alignment after surgery. Conclusions: Our derotational concavity technique with poliaxial pedicle screws and titanium 5.5 rod demonstrated a lordosing effect in the thoracic sagittal plane. This was translated into a trunk retropulsion and rectification or lost of lordosis in the sagittal cervical plane in the medium-term follow-up...(AU)

Anterior elongation as a minimally invasive alternative for sagittal imbalance-a case series.

BACKGROUND: Degenerative and iatrogenic conditions may lead to flat back or even to kyphotic deformity, and sagittal imbalance can cause significant clinical impairment. Minor imbalance cases are usually treated with conservative care. Among currently popular surgical techniques for the correction of sagittal imbalance are posterior-based procedures, which are associated with access-related risks (mostly neurological) and postoperative morbidity risks. PURPOSE: This study aims to report a minimally invasive lateral approach using hyperlordotic cages in the treatment of mild sagittal imbalance. Radiological correction, clinical improvement, and safety will be analyzed. METHODS: Eight patients (mean age 71.8 years, SD 7.8; mean BMI 27.5, SD 2.3) with symptomatic sagittal imbalance were retrospectively reviewed. Eight cases were treated by anterior interbody fusion with lordotic cages. A minimally invasive lateral retroperitoneal approach was used in the surgical procedures, with or without percutaneous pedicle screw supplementation. RESULTS: No major complications occurred and just one case needed revision for direct decompression. Clinical outcomes Visual Analog Scale score changed from 88 at preoperative visit to 51 at 1-week visit, and Oswestry Disability Index score decreased from 82 at preoperative visit to 44 at 6-week visit. The 6-month radiological assessment revealed improvement in spinopelvic parameters: Focal lordosis improved from 2.3° ± 7.7 to 27.1° ± 6.7. Sagittal vertical alignment improved from 11.7 ± 5.3 to 6.2 ± 4.0 cm. Preoperative sacral slope improved from 20.1° ± 5.8 to 29.4° ± 10.3 and preoperative pelvic tilt improved from 35.2° ± 5.2 to 23.8° ± 4.3. Short-term results indicate that the minimally invasive lateral approach can be applied to the treatment of mild sagittal imbalance, with special advantage in elderly patients or those in which posterior approaches are relatively contraindicated.