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Zhang Y, Lin W, Lian X, Ding L, Song J. Transforaminal Endoscopic Decompression Alone Versus Limited Decompression/Fusion in the Treatment of Adult Degenerative Scoliosis: A Retrospective Study. Global Spine J 2025; 15:2140-2151. [PMID: 39322585 PMCID: PMC11559781 DOI: 10.1177/21925682241288189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
Study DesignA retrospective study.ObjectivesTo investigate and compare the clinical and radiographical outcomes of endoscopic decompression alone and limited decompression/fusion surgery in the treatment of adult degenerative scoliosis (ADS).MethodsFollow-up data of 53 patients with lower limb radiculopathy associated with ADS who underwent focal surgical treatment were collected (endoscope group: 31 patients treated by transforaminal endoscopic decompression alone; fusion group: 22 patients who underwent limited decompression/fusion). The following data were retrospectively analyzed and compared between the two group: the demographics, Lenke-Silva level, radiographic parameters, surgical data, visual analogue scale (VAS) for back/leg pain, the Oswestry disability index (ODI), and the modified MacNab criteria.ResultsThe mean follow-up period was 15.68 ± 3.26 months. The most frequent Lenke-Silva level was I in the endoscope group, and III in the fusion group. Preoperative Cobb angle in the endoscope group was significantly lower than that in the fusion group (23.92 ± 9.06 vs 39.58 ± 13.12, P < 0.05). All patients exhibited improved VAS and ODI scores postoperatively (P < 0.05). At the last follow-up, the Cobb angle had progressed by 1.51° in the endoscope group, whereas radiographic parameters were significantly improved in the fusion group. The reoperation and complication rate in the endoscope group were lower than those in the fusion group. The satisfaction rate post-surgery was comparable between the two groups.ConclusionsFor patients with focal ADS, both limited decompression/fusion and transforaminal endoscopic decompression are viable treatment options. Advanced transforaminal endoscopic techniques enable effective decompression of the symptomatic foramen with minimal complication risk and negligible deformity progression, even in cases of significant scoliosis. While limited fusion surgery can achieve comparable clinical outcomes, it offers inferior deformity correction.
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Affiliation(s)
- Yao Zhang
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Yangfangdian, Beijing, People’s Republic of China
| | - Wancheng Lin
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Yangfangdian, Beijing, People’s Republic of China
| | - Xin Lian
- Department of General Surgery, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Lixiang Ding
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Yangfangdian, Beijing, People’s Republic of China
| | - Jipeng Song
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Yangfangdian, Beijing, People’s Republic of China
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Pluemvitayaporn T, Penrat W, Kunakornsawat S, Surapuchong S, Ratanakoosakul W, Tiracharnvut K, Piyasakulkaew C, Kittithamvongs P. Characteristics of sagittal spinopelvic alignment in Thai population: a cross-sectional study. Spine Deform 2025; 13:617-623. [PMID: 39482459 DOI: 10.1007/s43390-024-00997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Accepted: 10/17/2024] [Indexed: 11/03/2024]
Abstract
BACKGROUND The prevalence of spinal deformity is a significant health concern often associated with the aging process. It is primarily attributed to the thickening of spinal joints, ligament pathologies, or the narrowing of the spinal canal, leading to compression of the spinal cord and nerve roots, and subsequently causing musculoskeletal problems. When considering corrective surgery for adult spinal deformities, it is crucial for spine surgeons to take into account the standard values of sagittal spinopelvic alignment. Notably, there is currently a lack of specific data on this aspect within the Thai population. Therefore, our study was focused on evaluating the alignment in the Thai population. OBJECTIVES To analyze sagittal spinopelvic alignment parameters in the asymptomatic Thai population and compare them with other populations. MATERIALS AND METHODS This study was designed as a cross-sectional analysis involving 194 participants, wherein the sagittal spinopelvic parameters were evaluated utilizing radiographic images. The measurements of the sagittal vertical axis (SVA), pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT) were determined by averaging the assessments conducted by two orthopedic residents and a spine surgeon. In addition, participants' demographic information was obtained through questionnaires, and further analysis was performed on age, gender, and body mass index data. The study also encompassed the determination of correlations between various parameters and the comparison of these parameters with other populations. RESULTS The body mass index (BMI) of the study participants demonstrated significant associations with several spinal parameters. Specifically, BMI showed significant correlations with sagittal vertical axis (SVA) (r = 0.2, p = 0.09), pelvic incidence (PI) (r = 0.4, p < 0.01), lumbar lordosis (LL) (r = 0.2, p = 0.02), sacral slope (SS) (r = -0.2, p = 0.02), and pelvic tilt (PT) (r = 0.2, p = 0.02). The SS exhibited a statistically significant decline with increasing age (p = 0.04). Furthermore, the mean SVA, PI, LL, SS, and PT differed significantly between the study participants and the Indian population. In addition, the SS was notably lower when compared to the European population. CONCLUSION The study revealed the spinopelvic parameters in a cohort of healthy Thai population and observed a correlation between their body mass index (BMI) and pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT). Notably, the average SS among Thai adults was found to be statistically lower than that of individuals from Indian, European Caucasian, Asian, and Mexican populations. These insights hold potential value as a reference when strategizing surgical interventions for Thai patients with spinal deformities.
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Affiliation(s)
- Tinnakorn Pluemvitayaporn
- Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, College of Medicine, Lerdsin Hospital, Rangsit University, 190 Silom Road, Bangkok, 10500, Thailand.
| | - Wachirawit Penrat
- Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, College of Medicine, Lerdsin Hospital, Rangsit University, 190 Silom Road, Bangkok, 10500, Thailand
| | - Sombat Kunakornsawat
- Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, College of Medicine, Lerdsin Hospital, Rangsit University, 190 Silom Road, Bangkok, 10500, Thailand
| | - Suttinont Surapuchong
- Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, College of Medicine, Lerdsin Hospital, Rangsit University, 190 Silom Road, Bangkok, 10500, Thailand
- Research Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, College of Medicine, Lerdsin Hospital, Rangsit University, 190 Silom Road, Bangkok, 10500, Thailand
| | - Warot Ratanakoosakul
- Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, College of Medicine, Lerdsin Hospital, Rangsit University, 190 Silom Road, Bangkok, 10500, Thailand
| | - Kitjapat Tiracharnvut
- Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, College of Medicine, Lerdsin Hospital, Rangsit University, 190 Silom Road, Bangkok, 10500, Thailand
| | - Chaiwat Piyasakulkaew
- Spine Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, College of Medicine, Lerdsin Hospital, Rangsit University, 190 Silom Road, Bangkok, 10500, Thailand
| | - Piyabuth Kittithamvongs
- Research Unit, Institute of Orthopedics, Department of Orthopaedic Surgery, College of Medicine, Lerdsin Hospital, Rangsit University, 190 Silom Road, Bangkok, 10500, Thailand
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Petrosyan E, Fares J, Ahuja CS, Lesniak MS, Koski TR, Dahdaleh NS, El Tecle NE. Genetics and pathogenesis of scoliosis. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 20:100556. [PMID: 39399722 PMCID: PMC11470263 DOI: 10.1016/j.xnsj.2024.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/02/2024] [Accepted: 09/03/2024] [Indexed: 10/15/2024]
Abstract
Background Scoliosis is defined as a lateral spine curvature of at least 10° with vertebral rotation, as seen on a posterior-anterior radiograph, often accompanied by reduced thoracic kyphosis. Scoliosis affects all age groups: idiopathic scoliosis is the most common spinal disorder in children and adolescents, while adult degenerative scoliosis typically affects individuals over fifty. In the United States, approximately 3 million new cases of scoliosis are diagnosed annually, with a predicted increase in part due to global aging. Despite its prevalence, the etiopathogenesis of scoliosis remains unclear. Methods This comprehensive review analyzes the literature on the etiopathogenetic evidence for both idiopathic and adult degenerative scoliosis. PubMed and Google Scholar databases were searched for studies on the genetic factors and etiopathogenetic mechanisms of scoliosis development and progression, with the search limited to articles in English. Results For idiopathic scoliosis, genetic factors are categorized into three groups: genes associated with susceptibility, disease progression, and both. We identify gene groups related to different biological processes and explore multifaceted pathogenesis of idiopathic scoliosis, including evolutionary adaptations to bipedalism and developmental and homeostatic spinal aberrations. For adult degenerative scoliosis, we segregate genetic and pathogenic evidence into categories of angiogenesis and inflammation, extracellular matrix degradation, neural associations, and hormonal influences. Finally, we compare findings in idiopathic scoliosis and adult degenerative scoliosis, discuss current limitations in scoliosis research, propose a new model for scoliosis etiopathogenesis, and highlight promising areas for future studies. Conclusions Scoliosis is a complex, multifaceted disease with largely enigmatic origins and mechanisms of progression, keeping it under continuous scientific scrutiny.
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Affiliation(s)
- Edgar Petrosyan
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Christopher S. Ahuja
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Maciej S. Lesniak
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Tyler R. Koski
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Nader S. Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
| | - Najib E. El Tecle
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, United States
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Pesenti S, Prost S, Solla F, Ilharreborde B, Ferrero E, Obeid I, Riouallon G, Laouissat F, Charles YP, Blondel B. Modern Concepts in Sagittal Curve Measurement: Comparison of Spline-Based and Fixed Landmark Measurements in a Cohort of 1520 Healthy Subjects. Spine (Phila Pa 1976) 2024; 49:1012-1020. [PMID: 38093610 DOI: 10.1097/brs.0000000000004901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 06/25/2024]
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE Our objective was to compare the spline-based measurement of sagittal spinal curvatures to fixed landmarks in a normative population. SUMMARY OF BACKGROUND DATA Recent research has stressed the importance of considering sagittal curvature in its entirety using a spline reconstruction. To date, no data supports the superiority of this method in comparison to classic measurement methods. PATIENTS AND METHODS Full-spine biplanar radiographs of subjects over 20 years old who had normal radiographs were analyzed. Thoracic kyphosis (TK) and lumbar lordosis (LL) were measured following two modalities: either using predefined landmarks (TK T1T12 , TK T5T12 , and LL L1S1 ) or spline-based measurement (TK Spline and LL spline ). RESULTS A total of 1520 subjects were included (mean 54yo). The mean difference between TK spline and TK T1T12 was 1.4° and between TK spline and TK T5T12 was 11.7° ( P <0.001). LL spline was significantly larger than LL L1S1 (55° vs . 54°, P<0.001 ). LL spline and LL L1S1 were correlated ( R =0.950, P <0.001). Pelvic incidence had no influence on the difference between LL spline and LL L1S1 ( R =-0.034, P= 0.184). Using LL L1S1 measurements, LL was underestimated in 17% of the cases. The comparison of outlier distributions according to age groups ( P =0.175), sex ( P =0.937), or pelvic incidence groups ( P =0.662) found no difference. There were significantly more outliers in Roussouly type 1 compared with other types (56%, P <0.001). CONCLUSION Our results suggest that the use of TK T1T12 and LL L1S1 is acceptable to assess spinal sagittal curvatures. However, TK T5T12 is not accurate for the thoracic curve and should be used with caution. LL L1S1 can be used to accurately assess the lumbar curve, except in Roussouly type 1.
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Affiliation(s)
- Sébastien Pesenti
- Orthopédie Pédiatrique, CHU Timone Enfants, AP-HM, Aix-Marseille Université, Marseille, France
| | - Solene Prost
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, Marseille, France
| | | | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Île-de-France, France
| | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, Marseille, France
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Akbik OS, Al-Adli N, Pernik MN, Hicks WH, Hall K, Aoun SG, Bagley CA. A Comparative Analysis of Frailty, Disability, and Sarcopenia With Patient Characteristics and Outcomes in Adult Spinal Deformity Surgery. Global Spine J 2023; 13:2345-2356. [PMID: 35384776 PMCID: PMC10538316 DOI: 10.1177/21925682221082053] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective case series study. OBJECTIVES This study aims to compare preoperative indices, including the modified frailty index-11 (mFI-11), modified frailty index-5 (mFI-5), Oswestry Disability Index (ODI), and psoas muscle index (PMI), as they relate to outcomes in adult spinal deformity (ASD) surgery. METHODS We identified 235 patients who underwent thoracolumbar ASD surgery (≥4 levels). The mFI-11, mFI-5, ODI, and PMI were determined from preoperative visits and correlated to outcome measures, including perioperative transfusion, duration of anesthesia, hospital and ICU length of stay (LOS), discharge disposition, readmission, change in ODI at last follow-up, revision surgery, and mortality. RESULTS Our cohort had a mean age of 69.6 years and a male:female ratio of 1:2 with 177 undergoing an index surgery and 58 patients presenting after a failed multilevel fusion. The average number of levels fused was 9.3. The mFI-11 and mFI-5 were similar in predicting the need for intraoperative and postoperative transfusion. However, the mFI-11 was able to predict longer ICU and hospital LOS and mortality. The average preoperative ODI was 44.9% with an average decrease of 10.1% at the last follow-up. Preoperative ODI was the most significant predictor of postoperative change of ODI. Sarcopenia, defined as the lowest quartile of PMI values measured at L3 and L4, was not associated with any meaningful outcomes. CONCLUSION The mFI-11 better correlated with outcomes, indicating its increased prognostic value compared to other preoperative indices in ASD surgery. Preoperative ODI remains a significant predictor of postoperative change in ODI when evaluating ASD patients.
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Affiliation(s)
- Omar S. Akbik
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nadeem Al-Adli
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mark N. Pernik
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William H. Hicks
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristen Hall
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Salah G. Aoun
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carlos A. Bagley
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Orthopedic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Petrosyan E, Fares J, Lesniak MS, Koski TR, El Tecle NE. Biological principles of adult degenerative scoliosis. Trends Mol Med 2023; 29:740-752. [PMID: 37349248 DOI: 10.1016/j.molmed.2023.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
The global aging population has led to an increase in geriatric diseases, including adult degenerative scoliosis (ADS). ADS is a spinal deformity affecting adults, particularly females. It is characterized by asymmetric intervertebral disc and facet joint degeneration, leading to spinal imbalance that can result in severe pain and neurological deficits, thus significantly reducing the quality of life. Despite improved management, molecular mechanisms driving ADS remain unclear. Current literature primarily comprises epidemiological and clinical studies. Here, we investigate the molecular mechanisms underlying ADS, with a focus on angiogenesis, inflammation, extracellular matrix remodeling, osteoporosis, sarcopenia, and biomechanical stress. We discuss current limitations and challenges in the field and highlight potential translational applications that may arise with a better understanding of these mechanisms.
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Affiliation(s)
- Edgar Petrosyan
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Maciej S Lesniak
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Tyler R Koski
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Najib E El Tecle
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Zhang Y, Song J, Lu Y, Yi M, Lin W, Yao M, Luo Z, Zhang G, Ding L. Modified unilateral iliac screw fixation with partial reduction in the treatment of high-grade spondylolisthesis at L5/S1 in adult patients: introduction of key technique, report of clinical outcomes and analysis of spinopelvic parameters. BMC Musculoskelet Disord 2023; 24:451. [PMID: 37268898 DOI: 10.1186/s12891-023-06552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/19/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Management of high-grade spondylolisthesis (HGS) remains challenging. Spinopelvic fixation such as iliac screw (IS) was developed to deal with HGS. However concerns regarding constructs prominence and increased infection-related revision surgery have complicated it's use. We aim to introduce the modified iliac screw (IS) technique in treating high-grade L5/S1 spondylolisthesis and it's clinical and radiological outcomes. METHODS Patients with L5/S1 HGS who underwent modified IS fixation were enrolled. Pre- and postsurgical upright full spine radiographs were obtained to analyze sagittal imbalance, spinopelvic parameters, pelvic incidence-lumbar lordosis mismatch (PI-LL), slip percentage, slip angle (SA), and lumbosacral angle (LSA). Visual analogue scale (VAS), Oswestry disability index (ODI) were evaluated pre- and postoperatively for clinical outcomes assessment. Estimated blood loss, operating time, perioperative complications and revision surgery were documented. RESULTS From Jan 2018 to March 2020, 32 patients (15 males) with mean age of 58.66 ± 7.77 years were included. The mean follow-up period was 49 months. The mean operation duration was 171.67 ± 36.66 min. At the last follow-up: (1) the VAS and ODI score were significantly improved (p < 0.05), (2) PI increased by an average of 4.3°, the slip percent, SA and LSA were significantly improved (p < 0.05), (3) four patients (16.7%) with global sagittal imbalance recovered a good sagittal alignment, PI-LL within ± 10° was observed in all patients. One patient experienced wound infection. One patient underwent a revision surgery due to pseudoarthrosis at L5/S1. CONCLUSION The modified IS technique is safe and effective in treating L5/S1 HGS. Sparing use of offset connector could reduce hardware prominence, leading to lower wound infection rate and less revision surgery. The long-term clinical affection of increased PI value is unknown.
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Affiliation(s)
- Yao Zhang
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Jipeng Song
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Yuzheng Lu
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Meng Yi
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Wancheng Lin
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Mingtao Yao
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Zhengning Luo
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Genai Zhang
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China
| | - Lixiang Ding
- Department of Spinal Surgery, Beijing Shijitan Hospital, Capital Medical University, No.10, Tieyi Road, Yangfangdian, Haidian District, Beijing, 10038, People's Republic of China.
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Ruffilli A, Barile F, Paolucci A, Manzetti M, Viroli G, Ialuna M, Vita F, Cerasoli T, Faldini C. Independent Risk Factors of Postoperative Coronal Imbalance after Adult Spinal Deformity Surgery. J Clin Med 2023; 12:jcm12103559. [PMID: 37240665 DOI: 10.3390/jcm12103559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of the present study is to elucidate preoperative risk factors for inadequate correction of coronal imbalance and/or creation of new postoperative coronal imbalance (iatrogenic CIB) in patients who undergo surgery for Adult Spinal Deformity (ASD). A retrospective review of adults who underwent posterior spinal fusion (>5 levels) for ASD was performed. Patients were divided into groups according to the Nanjing classification: type A (CSVL < 3 cm), type B (CSVL > 3 cm and C7 plumb line shifted to major curve concavity), and type C (CSVL > 3 cm and C7 plumb line shifted to major curve convexity). They were also divided according to postoperative coronal balance in balanced (CB) vs. imbalanced (CIB) and according to iatrogenic coronal imbalance (iCIB). Preoperative, postoperative, and last follow-up radiographical parameters and intraoperative data were recorded. A multivariate analysis was performed to identify independent risk factors for CIB. A total of 127 patients were included (85 type A, 30 type B, 12 type C). They all underwent long (average levels fused 13.3 ± 2.7) all-posterior fusion. Type C patients were more at risk of developing postoperative CIB (p = 0.04). Multivariate regression analysis indicated L5 tilt angle as a preoperative risk factor for CIB (p = 0.007) and indicated L5 tilt angle and age as a preoperative independent risk factors for iatrogenic CIB (p = 0.01 and p = 0.008). Patients with a preoperative trunk shift towards the convexity of the main curve (type C) are more prone to postoperative CIB and leveling the L4 and L5 vertebrae is the key to achieve coronal alignment preventing the "takeoff phenomenon".
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Affiliation(s)
- Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca Barile
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Azzurra Paolucci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Ialuna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Tosca Cerasoli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Ye J, Yin TC, Gupta S, Farooqi AS, Wan W, Yilgor C, Sides BA, Gupta MC. Use of the Global Alignment and Proportion score to predict postoperative health-related quality of life in adult spinal deformity surgery. J Neurosurg Spine 2023; 38:340-347. [PMID: 36683189 DOI: 10.3171/2022.9.spine22809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/30/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The purpose of this study was to validate the Global Alignment and Proportion (GAP) score as a predictor of health-related quality of life (HRQOL) outcomes for patients undergoing adult spinal deformity (ASD) surgery. METHODS This was a retrospective cohort study of patients with ASD undergoing long-segment spine fusions (≥ 5 vertebrae fused) at a single institution over a 2-year period (n = 85). Radiographic parameters were measured at preoperative, 6-week postoperative, 1-year postoperative, and 2-year postoperative visits. GAP scores were calculated using 4 sagittal parameters: relative pelvic version, relative lumbar lordosis, lordosis distribution index, and relative spinopelvic alignment. Patients were stratified into 3 GAP categories at each time point: proportioned (score 0-2), moderately disproportioned (score 3-6), and severely disproportioned (score ≥ 7). HRQOL outcomes were collected at preoperative, 1-year postoperative, and 2-year postoperative visits; these measures included patient self-reported outcome measures (i.e., PROMIS), Scoliosis Research Society-22 spinal deformity questionnaire (SRS-22), and Oswestry Disability Index (ODI) scores. RESULTS Overall, 42% of cases were revision surgeries and 96.5% of patients underwent fusion to the sacrum. The mean preoperative GAP score significantly improved from preoperative (7.84) to immediate postoperative (3.31) assessment (p < 0.001). Similarly, the percentage of patients categorized as proportioned improved from 9.4% at preoperative to 45.9% at immediate postoperative evaluation. The preoperative GAP score or category was not significantly associated with any preoperative HRQOL outcome metrics. The immediate postoperative GAP score was not correlated with any 1-year HRQOL outcomes. However, the immediate postoperative GAP score was significantly associated with 2-year SRS-22 outcomes, including SRS-22 function (r = -0.35, p < 0.01), self-image (r = -0.27, p = 0.044), and subtotal (r = -0.35, p < 0.01) scores. As compared to severely disproportioned patients, proportioned patients had better SRS-22 pain (4.08 vs 3.17, p = 0.04), satisfaction (4.40 vs 3.50, p = 0.02), and subtotal (4.01 vs 3.27, p = 0.036) scores. The immediate postoperative GAP score was also significantly associated with 2-year PROMIS outcomes, including PROMIS pain (r = 0.31, p = 0.023) and physical function (r = -0.35, p < 0.01) scores. As compared to severely disproportioned patients, proportioned patients had better PROMIS pain (53.18 vs 63.60, p = 0.025) and physical function (41.66 vs 34.18, p = 0.017) scores. Postoperative GAP score or category did not predict any ODI outcomes. CONCLUSIONS The postoperative GAP score is a predictor of long-term HRQOL outcomes following ASD surgery, and proportioned patients are more likely to have less pain and be satisfied with their surgery. However, the postoperative GAP score does not predict outcomes as measured by ODI.
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Affiliation(s)
- Jichao Ye
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tsung-Cheng Yin
- 2Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sachin Gupta
- 3Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ali S Farooqi
- 3Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wenbing Wan
- 4The Second Affiliated Hospital of Nanchang University, Nanchang, Jangxi, China
| | - Caglar Yilgor
- 5Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey; and
| | - Brenda A Sides
- 6Department of Orthopaedic Surgery, Barnes-Jewish Hospital, Washington University in St. Louis, Missouri
| | - Munish C Gupta
- 6Department of Orthopaedic Surgery, Barnes-Jewish Hospital, Washington University in St. Louis, Missouri
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Predicting the Magnitude of Distal Junctional Kyphosis Following Cervical Deformity Correction. Spine (Phila Pa 1976) 2023; 48:232-239. [PMID: 36149856 DOI: 10.1097/brs.0000000000004492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/08/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of a cervical deformity database. OBJECTIVE This study aimed to develop a model that can predict the postoperative distal junctional kyphosis angle (DJKA) using preoperative and postoperative radiographic measurements. SUMMARY OF BACKGROUND DATA Distal junctional kyphosis (DJK) is a complication following cervical deformity correction that can reduce of patient quality of life and functional status. Although researchers have identified the risk factors for DJK, no model has been proposed to predict the magnitude of DJK. MATERIALS AND METHODS The DJKA was defined as the Cobb angle from the lower instrumented vertebra (LIV) to LIV-2 with traditional DJK having a DJKA change >10°. Models were trained using 66.6% of the randomly selected patients and validated in the remaining 33.3%. Preoperative and postoperative radiographic parameters associated with DJK were identified and ranked using a conditional variable importance table. Linear regression models were developed using the factors most strongly associated with postoperative DJKA. RESULTS A total of 131 patients were included with a mean follow-up duration of 14±8 months. The mean postoperative DJKA was 14.6±14° and occurred in 35% of the patients. No significant differences between the training and validation cohort were observed. The variables most associated with postoperative DJK were: preoperative DJKA (DJKApre), postoperative C2-LIV, and change in cervical lordosis (∆CL). The model identified the following equation as predictive of DJKA: DJKA=9.365+(0.123×∆CL)-(0.315×∆C2-LIV)-(0.054×DJKApre). The predicted and actual postoperative DJKA values were highly correlated ( R =0.871, R2 =0.759, P <0.001). CONCLUSIONS The variables that most increased the DJKA were the preoperative DJKA, postoperative alignment within the construct, and change in cervical lordosis. Future studies can build upon the model developed to be applied in a clinical setting when planning for cervical deformity correction.
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Failure in Adult Spinal Deformity Surgery: A Comprehensive Review of Current Rates, Mechanisms, and Prevention Strategies. Spine (Phila Pa 1976) 2022; 47:1337-1350. [PMID: 36094109 DOI: 10.1097/brs.0000000000004435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/22/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Literature review. OBJECTIVE The aim of this review is to summarize recent literature on adult spinal deformity (ASD) treatment failure as well as prevention strategies for these failure modes. SUMMARY OF BACKGROUND DATA There is substantial evidence that ASD surgery can provide significant clinical benefits to patients. The volume of ASD surgery is increasing, and significantly more complex procedures are being performed, especially in the aging population with multiple comorbidities. Although there is potential for significant improvements in pain and disability with ASD surgery, these procedures continue to be associated with major complications and even outright failure. METHODS A systematic search of the PubMed database was performed for articles relevant to failure after ASD surgery. Institutional review board approval was not needed. RESULTS Failure and the potential need for revision surgery generally fall into 1 of 4 well-defined phenotypes: clinical failure, radiographic failure, the need for reoperation, and lack of cost-effectiveness. Revision surgery rates remain relatively high, challenging the overall cost-effectiveness of these procedures. CONCLUSION By consolidating the key evidence regarding failure, further research and innovation may be stimulated with the goal of significantly improving the safety and cost-effectiveness of ASD surgery.
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Im SK, Lee JH, Lee KY, Yoo SJ. Effectiveness and Feasibility of Injectable Escherichia coli-Derived Recombinant Human Bone Morphogenetic Protein-2 for Anterior Lumbar Interbody Fusion at the Lumbosacral Junction in Adult Spinal Deformity Surgery: A Clinical Pilot Study. Orthop Surg 2022; 14:1350-1358. [PMID: 35633034 PMCID: PMC9251273 DOI: 10.1111/os.13303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To explore the effectiveness and feasibility of injectable Escherichia coli‐derived recombinant human bone morphogenetic protein‐2 (injectable E‐rhBMP‐2, a combination of E. coli‐derived recombinant human bone morphogenic protein‐2 and a hydrogel type beta‐tricalcium phosphate carrier) as a bone substitute for anterior lumbar interbody fusion (ALIF) of the lumbosacral junction in adult spinal deformity (ASD) patients. Methods A prospective single‐institution therapeutic exploratory trial was conducted. Twenty patients (average age: 69.1 years; 19 female and one male; average fusion level: 7.95) diagnosed with ASD with sagittal imbalance who underwent surgical treatment including ALIF at the lumbosacral junction from December 2017 to January 2019 were evaluated. Injectable E‐rhBMP‐2 was prepared by dissolving 3 mg of E. coli‐derived recombinant human bone morphogenetic protein‐2 in 1.5 ml H2O and mixing in situ with 9 g hydrogel type beta‐tricalcium phosphate. This bone graft substitute was loaded onto a metal ALIF cage and L5–S1 ALIF was performed in routine manner. Then posterior column osteotomy with multilevel oblique lumbar interbody fusion or pedicle subtraction osteotomy with accessory rod technique was performed to restore sagittal balance. Patients were followed up for 12 months. CT‐based fusion rates were examined at 6 and 12 months after surgery. Also, clinical outcomes (Oswestry Disability Index [ODI], Visual Analog Scale [VAS] score of the back and leg) were evaluated at 6 and 12 months after surgery. All postoperative adverse events were evaluated for the association with injectable E.BMP‐2. Results Of the 20 patients, loss to follow‐up occurred with one patient at 6 months after surgery and one patient at 12 months after surgery, resulting in a total of 18 patients who were available for follow‐up. Six months after surgery, 68.4% patients achieved solid fusion. Twelve months after surgery, 100% fusion rate was achieved. Compared to baseline values, ODI scores improved to 45.8% and 63.7%, VAS (back) improved to 69.2% and 72.8%, and VAS (leg) improved to 49.2% and 64.8%, respectively, at 6 and 12 months after surgery (p < 0.001 for all). Ten cases of adverse events occurred. But no adverse events were associated with injectable E‐rhBMP‐2. Conclusion Injectable E‐rhBMP‐2 will be an effective bone graft substitute when achieving solid interbody fusion in the lumbosacral junction.
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Affiliation(s)
- Sang-Kyu Im
- Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Jung-Hee Lee
- Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Ki Young Lee
- Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Seung-Jin Yoo
- Department of Radiology, College of Medicine, Hanyang University, Seoul, South Korea
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Shestopaloff K, Canizares M, Power JD. A sequential modeling approach for predicting clinical outcomes with repeated measures. COMMUN STAT-THEOR M 2022. [DOI: 10.1080/03610926.2022.2047203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Konstantin Shestopaloff
- Big Data Institute, University of Oxford, Oxford, UK
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mayilee Canizares
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - J. Denise Power
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Hong YG, Kim HC, Jeon H, An SB, Lee JY, Lee JJ, Kim KJ, Kim CO, Shin DA, Yi S, Kim KN, Yoon DH, Kim TW, Ha Y. Association of frailty with regional sagittal spinal alignment in the elderly. J Clin Neurosci 2021; 96:172-179. [PMID: 34836786 DOI: 10.1016/j.jocn.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/14/2021] [Accepted: 10/05/2021] [Indexed: 11/26/2022]
Abstract
The degenerative changes in the spine of the frail elderly gradually exacerbate the alignment of the spine as the degeneration progresses. This study was conducted to assess the relationship between frailty and spine sagittal alignment measured in terms of global, cervical, thoracic, and lumbo-pelvic parameters. In total, 101 patients aged 75 years and older hospitalized for spine surgery were prospectively enrolled. We evaluated spinal sagittal parameters by dividing them into global (C7 sagittal vertical axis [SVA] and T1 pelvic angle [T1PA]), cervical (the C2-7 Cobb angle, Jackson line, and C2-7 plumb line), thoracic (thoracic kyphosis [TK]), and lumbo-pelvic (pelvic tilt [PT] and pelvic incidence minus lumbar lordosis value [PI-LL]). Patient characteristics; the Fatigue, Resistance, Ambulation, Illness, Loss of Weight (FRAIL) scale; and sagittal spinal parameters were included in the analysis. Multiple regression analysis was performed to identify associations between the FRAIL scale and sagittal spinal parameters. The FRAIL scale showed correlations with global sagittal parameters (C7 SVA [β = 0.225, p = 0.029] and T1PA [β = 0.273, p = 0.008]) and lumbo-pelvic parameters (PT [β = 0.294, p = 0.004] and PI-LL [β = 0.323, p = 0.001). Cervical and thoracic parameters were not directly associated with the FRAIL scale. LL and PI-LL were associated with TK, and TK was associated with cervical parameters (the C2-7 Cobb angle, Jackson line and C2-7 plumb line). In conclusion, frailty status could be an important factor that influences sagittal spinal alignment in the elderly. In this study, it was found that frailty mainly affected the balance of lumbo-pelvic alignment, and consequently affected the balance of the whole spine.
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Affiliation(s)
- Yun Gi Hong
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hyung-Cheol Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hyeongseok Jeon
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Seong Bae An
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Ji Yeon Lee
- Division of Geriatrics, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jong Joo Lee
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Kwang Joon Kim
- Division of Geriatrics, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Chang Oh Kim
- Division of Geriatrics, Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Do Heum Yoon
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Tae Woo Kim
- Department of Medicine, Yonsei University Graduate School, Seoul, Republic of Korea; Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, College of Medicine, Yonsei University, Seoul, Republic of Korea.
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15
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Ryan DJ, Stekas ND, Ayres EW, Moawad MA, Balouch E, Vasquez-Montes D, Fischer CR, Buckland AJ, Errico TJ, Protopsaltis TS. Clinical photographs in the assessment of adult spinal deformity: a comparison to radiographic parameters. J Neurosurg Spine 2021; 35:105-109. [PMID: 33990080 DOI: 10.3171/2020.11.spine201732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to reliably predict sagittal and coronal spinal alignment with clinical photographs by using markers placed at easily localized anatomical landmarks. METHODS A consecutive series of patients with adult spinal deformity were enrolled from a single center. Full-length standing radiographs were obtained at the baseline visit. Clinical photographs were taken with reflective markers placed overlying C2, S1, the greater trochanter, and each posterior-superior iliac spine. Sagittal radiographic parameters were C2 pelvic angle (CPA), T1 pelvic angle (TPA), and pelvic tilt. Coronal radiographic parameters were pelvic obliquity and T1 coronal tilt. Linear regressions were performed to evaluate the relationship between radiographic parameters and their photographic "equivalents." The data were reanalyzed after stratifying the cohort into low-body mass index (BMI) (< 30) and high-BMI (≥ 30) groups. Interobserver and intraobserver reliability was assessed for clinical measures via intraclass correlation coefficients (ICCs). RESULTS A total of 38 patients were enrolled (mean age 61 years, mean BMI 27.4 kg/m2, 63% female). All regression models were significant, but sagittal parameters were more closely correlated to photographic parameters than coronal measurements. TPA and CPA had the strongest associations with their photographic equivalents (both r2 = 0.59, p < 0.001). Radiographic and clinical parameters tended to be more strongly correlated in the low-BMI group. Clinical measures of TPA and CPA had high intraobserver reliability (all ICC > 0.99, p < 0.001) and interobserver reliability (both ICC > 0.99, p < 0.001). CONCLUSIONS The photographic measures of spinal deformity developed in this study were highly correlated with their radiographic counterparts and had high inter- and intraobserver reliability. Clinical photography can not only reduce radiation exposure in patients with adult spinal deformity, but also be used to assess deformity when full-spine radiographs are unavailable.
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D’Amico M, Kinel E, D’Amico G, Roncoletta P. A Self-Contained 3D Biomechanical Analysis Lab for Complete Automatic Spine and Full Skeleton Assessment of Posture, Gait and Run. SENSORS 2021; 21:s21113930. [PMID: 34200358 PMCID: PMC8201118 DOI: 10.3390/s21113930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022]
Abstract
Quantitative functional assessment of Posture and Motion Analysis of the entire skeleton and spine is highly desirable. Nonetheless, in most studies focused on posture and movement biomechanics, the spine is only grossly depicted because of its required level of complexity. Approaches integrating pressure measurement devices with stereophotogrammetric systems have been presented in the literature, but spine biomechanics studies have rarely been linked to baropodometry. A new multi-sensor system called GOALS-E.G.G. (Global Opto-electronic Approach for Locomotion and Spine-Expert Gait Guru), integrating a fully genlock-synched baropodometric treadmill with a stereophotogrammetric device, is introduced to overcome the above-described limitations. The GOALS-EGG extends the features of a complete 3D parametric biomechanical skeleton model, developed in an original way for static 3D posture analysis, to kinematic and kinetic analysis of movement, gait and run. By integrating baropodometric data, the model allows the estimation of lower limb net-joint forces, torques and muscle power. Net forces and torques are also assessed at intervertebral levels. All the elaborations are completely automatised up to the mean behaviour extraction for both posture and cyclic-repetitive tasks, allowing the clinician/researcher to perform, per each patient, multiple postural/movement tests and compare them in a unified statistically reliable framework.
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Affiliation(s)
- Moreno D’Amico
- SMART Lab (Skeleton Movement Analysis and Advanced Rehabilitation Technologies)—Bioengineering & Biomedicine Company, 65126 Pescara, Italy; (G.D.); (P.R.)
- Department of Neuroscience, Imaging and Clinical Sciences University G. D’Annunzio, 66100 Chieti, Italy
- Correspondence:
| | - Edyta Kinel
- Department of Rehabilitation, University of Medical Sciences, 61-545 Poznan, Poland;
| | - Gabriele D’Amico
- SMART Lab (Skeleton Movement Analysis and Advanced Rehabilitation Technologies)—Bioengineering & Biomedicine Company, 65126 Pescara, Italy; (G.D.); (P.R.)
| | - Piero Roncoletta
- SMART Lab (Skeleton Movement Analysis and Advanced Rehabilitation Technologies)—Bioengineering & Biomedicine Company, 65126 Pescara, Italy; (G.D.); (P.R.)
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17
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Passias PG, Alas H, Bess S, Line BG, Lafage V, Lafage R, Ames CP, Burton DC, Brown A, Bortz C, Pierce K, Ahmad W, Naessig S, Kelly MP, Hostin R, Kebaish KM, Than KD, Nunley P, Shaffrey CI, Klineberg EO, Smith JS, Schwab FJ. Patient-related and radiographic predictors of inferior health-related quality-of-life measures in adult patients with nonoperative spinal deformity. J Neurosurg Spine 2021; 34:907-913. [PMID: 33799291 DOI: 10.3171/2020.9.spine20519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with nonoperative (N-Op) adult spinal deformity (ASD) have inferior long-term spinopelvic alignment and clinical outcomes. Predictors of lower quality-of-life measures in N-Op populations have yet to be sufficiently investigated. The aim of this study was to identify patient-related factors and radiographic parameters associated with inferior health-related quality-of-life (HRQOL) scores in N-Op ASD patients. METHODS N-Op ASD patients with complete radiographic and outcome data at baseline and 2 years were included. N-Op patients and operative (Op) patients were propensity score matched for baseline disability and deformity. Patient-related factors and radiographic alignment parameters (pelvic tilt [PT], sagittal vertical axis [SVA], pelvic incidence [PI]-lumbar lordosis [LL] mismatch, mismatch between cervical lordosis and T1 segment slope [TS-CL], cervical-thoracic pelvic angle [PA], and others) at baseline and 2 years were analyzed as predictors for moderate to severe 2-year Oswestry Disability Index (ODI > 20) and failing to meet the minimal clinically importance difference (MCID) for 2-year Scoliosis Research Society Outcomes Questionnaire (SRS) scores (< 0.4 increase from baseline). Conditional inference decision trees identified predictors of each HRQOL measure and established cutoffs at which factors have a global effect. Random forest analysis (RFA) generated 5000 conditional inference trees to compute a variable importance table for top predictors of inferior HRQOL. Statistical significance was set at p < 0.05. RESULTS Six hundred sixty-two patients with ASD (331 Op patients and 331 N-Op patients) with complete radiographic and HRQOL data at their 2-year follow-up were included. There were no differences in demographics, ODI, and Schwab deformity modifiers between groups at baseline (all p > 0.05). N-Op patients had higher 2-year ODI scores (27.9 vs 20.3, p < 0.001), higher rates of moderate to severe disability (29.3% vs 22.4%, p = 0.05), lower SRS total scores (3.47 vs 3.91, p < 0.001), and higher rates of failure to reach SRS MCID (35.3% vs 15.7%, p < 0.001) than Op patients at 2 years. RFA ranked the top overall predictors for moderate to severe ODI at 2 years for N-Op patients as follows: 1) frailty index > 2.8, 2) BMI > 35 kg/m2, T4PA > 28°, and 4) Charlson Comorbidity Index > 1. Top radiographic predictors were T4PA > 28° and C2-S1 SVA > 93 mm. RFA also ranked the top overall predictors for failure to reach 2-year SRS MCID for N-Op patients, as follows: 1) T12-S1 lordosis > 53°, 2) cervical SVA (cSVA) > 28 mm, 3) C2-S1 angle > 14.5°, 4) TS-CL > 12°, and 5) PT > 23°. The top radiographic predictors were T12-S1 Cobb angle, cSVA, C2-S1 angle, and TS-CL. CONCLUSIONS When controlling for baseline deformity in N-Op versus Op patients, subsequent deterioration in frailty, BMI, and radiographic progression over a 2-year follow-up were found to drive suboptimal patient-reported outcome measures in N-Op cohorts as measured by validated ODI and SRS clinical instruments.
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Affiliation(s)
- Peter G Passias
- 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Haddy Alas
- 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Shay Bess
- 2Department of Orthopaedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Breton G Line
- 2Department of Orthopaedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Virginie Lafage
- 3Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- 3Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Christopher P Ames
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Douglas C Burton
- 5Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Avery Brown
- 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Cole Bortz
- 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Katherine Pierce
- 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Waleed Ahmad
- 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Sara Naessig
- 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Michael P Kelly
- 6Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Richard Hostin
- 7Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, Texas
| | - Khaled M Kebaish
- 8Department of Orthopaedics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Khoi D Than
- 9Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
| | - Pierce Nunley
- 10Spine Institute of Louisiana, Shreveport, Louisiana
| | - Christopher I Shaffrey
- 11Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and
| | - Eric O Klineberg
- 12Department of Orthopaedic Surgery, University of California, Davis, California
| | - Justin S Smith
- 11Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and
| | - Frank J Schwab
- 3Department of Orthopedics, Hospital for Special Surgery, New York, New York
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KLIMOV VLADIMIRSERGEEVICH, VASILENKO IVANIGOREVICH, RZAEV JAMILAFETOVICH, EVSYUKOV ALEXEYVLADIMIROVICH, KHALEPA ROMANVLADIMIROVICH, AMELINA EVGENIYAVALERYEVNA, RYABYKH SERGEYOLEGOVYCH, SINHA PRIYANK, IVANOV MARCEL. LLIF IN THE CORRECTION OF DEGENERATIVE SCOLIOSIS IN ELDERLY PATIENTS. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201904230798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective The incidence of adult degenerative scoliosis (ADS) among individuals over 50 years old can be as high as 68%. Surgical interventions aimed at correcting the spinal deformity in elderly patients are accompanied by a high risk of complications. The use of lateral lumbar interbody fusion (LLIF) is associated with lower rates of complications when compared with open anterior or posterior fusions. Methods Ninety-three patients with ADS (23 men, 70 women) were operated at the Federal Neurosurgical Center. The average age was 63 (52 to 73 years). Results Back pain, measured according to the Visual Analogue Scale (VAS), decreased from 5.9/6 (4;8) (format – mean/median (1;3 quartile)) to 2.6/3 (1;3) points (p <0.0001). Leg pain according to the VAS decreased from 4.6/4 (3;7) to 1.4/1 (0;2) points (p < 0.0001). Functional adaptation according to the Oswestry Disability Index (ODI) improved from 47.8±17.4 to 38.5±14.5 (p < 0.0273). Pelvic tilt (PT) before the surgery was 23.9±12.2° whereas at 12 months follow-up it was 16.8±5.9° (p < 0.0001). PI-LL mismatch pre surgery was 12.1/13 (9;16)° whereas 12 months later it was 7.9/8 (6;10)° (p = 0.0002). Conclusions Restoration of local sagittal balance in ADS patients by short-segment fixation using LLIF technology leads to a statistically significant improvement in quality of life and increased functional adaptation. A lower incidence of early and late postoperative complications, less intraoperative blood loss and shorter hospital stay makes LLIF, in combination with minimally invasive transpedicular fixation, the method of choice to correct ADS in elderly patients. Level of evidence IV; Case series.
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Mancuso CA, Duculan RB, Cammisa FP, Sama AA, Hughes AP, Girardi FP. Unfulfilled Expectations After Surgery for Adult Lumbar Scoliosis Compared with Other Degenerative Conditions. HSS J 2020; 16:452-460. [PMID: 33380980 PMCID: PMC7749892 DOI: 10.1007/s11420-020-09812-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients' expectations influence their decisions to undergo surgery for scoliosis, and fulfillment of expectations is an important patient-centered outcome. QUESTIONS/PURPOSES In a 2-year cohort study, we compared the proportion of expectations fulfilled based on the number of vertebrae involved in surgery between adult lumbar scoliosis patients and controls with other degenerative conditions. METHODS Patients pre-operatively completed a valid lumbar surgery expectations survey addressing expected improvements for symptoms, function, and psychosocial well-being (scores from 0 to 100; higher score indicates more expectations). Two years post-operatively, the patients completed another survey, this one recording how much improvement they actually experienced; fulfillment was defined as a proportion (i.e., received improvement/expected improvement). The range was 0 (none fulfilled) to > 1 (expectations surpassed). We further analyzed data according to the number of vertebrae involved in the surgery. RESULTS We included 42 scoliosis patients and 134 controls with similar mean ages (66 vs 64 years, respectively) and pre-operative expectations survey scores (72 vs 70, respectively). When we stratified by < 3 or ≥ 3 vertebrae, we found that the proportion of expectations fulfilled differed for scoliosis patients but not for controls. In multivariable analysis, lower proportion of expectations fulfilled was associated with greater pre-operative expectations, less improvement in pre- to post-operative disability, and the composite interaction of scoliosis and number of vertebrae. CONCLUSIONS Compared with controls, scoliosis patients who required surgery to a greater number of vertebrae were more likely to have unfulfilled expectations 2 years post-operatively. Our findings support the importance of addressing expectations pre-operatively with all patients, especially those with scoliosis who require surgery to ≥ 3 vertebrae.
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Affiliation(s)
- Carol A. Mancuso
- Research Division, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA ,Weill Cornell Medicine, New York, NY 10021 USA
| | - Roland B. Duculan
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Frank P. Cammisa
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Andrew A. Sama
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Alexander P. Hughes
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Federico P. Girardi
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
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Bae SH, Son DW, Lee SH, Lee JS, Lee SW, Song GS. Can Supine Magnetic Resonance Imaging Be an Alternative to Standing Lateral Radiographs for Evaluating Cervical Sagittal Alignment? Korean J Neurotrauma 2020; 16:226-234. [PMID: 33163431 PMCID: PMC7607026 DOI: 10.13004/kjnt.2020.16.e18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022] Open
Abstract
Objective Recently, many studies have reported that cervical alignment is related to clinical outcomes. However, poor visibility of anatomical structures during X-ray (XR) imaging limits accurate measurements. In supine magnetic resonance (MR) imaging, the boundary of the anatomical structure is clear, but the correlation to XR images taken in a standing position is problematic. In this study, we evaluated the agreement of sagittal alignment parameters between MR and XR measurements. Methods We retrospectively reviewed 268 patients. Cervical sagittal parameters were measured using XR and MR images, and their relationships were evaluated using Pearson's correlation, paired t-tests, and 2-way random, single score intraclass correlation coefficient (ICCs) (2,1). Using simple linear regression analysis, MR results were converted to the expected value (MR-E). The subsequent comparison of MR-Es with XRs was used to examine whether MR-Es could replace XRs when the measurement difference was less than 2 mm or 2°. Results The correlation between the MR and XR measurements was high, but ICCs showed low reliability. All parameters were significantly different between XR and MR measurements in paired t-tests. Converting the MR values eliminated the t-test differences between MR-Es and XRs, but did not affect correlations and ICCs. The replacement ratio included the Cobb angle: 20.3%, T1: 27.1%, the sagittal vertical axis: 17.6%, C1–2: 29.7%, and C2: 16.0%. Conclusion These results indicate that supine MR measurements could not replace upright XR measurements.
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Affiliation(s)
- Sung Hyun Bae
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
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Lafage R, Beyer G, Schwab F, Klineberg E, Burton D, Bess S, Kim HJ, Smith J, Ames C, Hostin R, Khalife M, Shaffrey C, Mundis G, Lafage V. Risk Factor Analysis for Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery: A New Simple Scoring System to Identify High-Risk Patients. Global Spine J 2020; 10:863-870. [PMID: 32905727 PMCID: PMC7485080 DOI: 10.1177/2192568219882350] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Develop a simple scoring system to estimate proximal junctional kyphosis (PJK) risk. METHODS A total of 417 adult spinal deformity (ASD) patients (80% females, 57.8 years) with 2-year follow-up were included. PJK was defined as a >10° kyphotic angle between the upper-most instrumented vertebra (UIV) and the vertebrae 2 levels above the UIV (UIV+2). Based on a previous literature review, the following point score was attributed to parameters likely to impact PJK development: age >55 years (1 point), fusion to S1/ilium (1 point), UIV in the upper thoracic spine (UIV-UT: 1 point), UIV in the lower thoracic region (UIV-LT: 2 points), flattening of the thoracic kyphosis (TK) relative to the lumbar lordosis (LL; ie, ▵LL - ▵TK) greater than 10° (1 point). RESULTS At 2 years, the overall PJK rate was 43%. The odds ratios for each risk factor were the following: age >55 years (2.52), fusion to S1/ilium (5.17), UIV-UT (6.63), UIV-LT (8.24), and ▵LL - ▵TK >10° (1.59). Analysis by risk factor revealed a significant impact on PJK (no PJK vs PJK): age >55 years (28% vs 51%, P < .001), LIV S1/ilium (16.3% vs 51.4%, P < .001), UIV in lower thoracic spine (12.0% vs 38.7% vs 52.9%, P < .001), and a >10° surgical reduction in TK relative to LL increase (40.0% vs 51.5%, P < .001). The PJK rate by point score was as follows: 1 = 17%, 2 = 29%, 3 = 40%, 4 = 53%, and 5 = 69%. CONCLUSION A pragmatic scoring system was developed that is tied to the increasing risk of PJK. These findings are helpful for surgical planning and preoperative counseling.
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Affiliation(s)
- Renaud Lafage
- Hospital for Special Surgery, New York, NY, USA,Renaud Lafage, Spine Service, Hospital for Special Surgery, 525 E 71st Street, Belaire 4E, New York, NY 10021, USA.
| | - George Beyer
- Hospital for Special Surgery, New York, NY, USA,SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | | | - Douglas Burton
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Shay Bess
- Denver International Spine Center, Denver, CO, USA
| | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, USA
| | - Justin Smith
- University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher Ames
- San Francisco Medical Center, University of California, San Francisco, CA, USA
| | | | - Marc Khalife
- Hopital Europeen Georges Pompidou, Paris, France
| | | | - Gregory Mundis
- San Diego Center for Spinal Disorders, La Jolla, CA, USA
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Lee KY, Lee JH, Kang KC, Shin SJ, Shin WJ, Im SK, Park JH. Strategy for obtaining solid fusion at L5-S1 in adult spinal deformity: risk factor analysis for nonunion at L5-S1. J Neurosurg Spine 2020; 33:323-331. [PMID: 32302980 DOI: 10.3171/2020.2.spine191181] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Maintaining lumbosacral (LS) arthrodesis and global sagittal balance after long fusion to the sacrum remains an important issue in the surgical treatment for adult spinal deformity (ASD). The importance and usefulness of LS fixation have been documented, but the optimal surgical long fusion to the sacrum remains a matter for debate. Therefore, the authors performed a retrospective study to evaluate fusion on CT scans and the risk factors for LS pseudarthrosis (nonunion) after long fusion to the sacrum in ASD. METHODS The authors performed a retrospective study of 59 patients with lumbar degenerative kyphosis (mean age 69.6 years) who underwent surgical correction, including an interbody fusion of the L5-S1, with a minimum 2-year follow-up. Achievement of LS fusion was evaluated by analyzing 3D-CT scans at 3 months, 6 months, 9 months, 1 year, and 2 years after surgery. Patients were classified into a union group (n = 36) and nonunion group (n = 23). Risk factors for nonunion were analyzed, including patient and surgical factors. RESULTS The overall fusion rate was 61% (36/59). Regarding radiological factors, optimal sagittal balance at the final follow-up significantly differed between two groups. There were no significant differences in terms of patient factors, and no significant differences with respect to the use of pedicle subtraction osteotomy, the number of fused segments, the proportion of anterior versus posterior interbody fusion, S2 alar iliac fixation versus conventional iliac fixation, or loosening of sacral or iliac screws. However, the proportion of metal cages to polyetheretherketone cages and the proportion of sacropelvic fixation were significantly higher in the union group (p = 0.022 and p < 0.05, respectively). CONCLUSIONS LS junction fusion is crucial for global sagittal balance, and the use of iliac screws in addition to LS interbody fusion using a metal cage improves the outcomes of long fusion surgery for ASD patients.
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Dietz N, Sharma M, Alhourani A, Ugiliweneza B, Wang D, Drazin D, Boakye M. Evaluation of Predictive Models for Complications following Spinal Surgery. J Neurol Surg A Cent Eur Neurosurg 2020; 81:535-545. [PMID: 32797468 DOI: 10.1055/s-0040-1709709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Complications rates vary across spinal surgery procedures and are difficult to predict due to heterogeneity in patient characteristics, surgical methods, and hospital volume. Incorporation of predictive models for complications may guide surgeon decision making and improve outcomes. METHODS We evaluate current independently validated predictive models for complications in spinal surgery with respect to study design and model generation, accuracy, reliability, and utility. We conducted our search using Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and the Participants, Intervention, Comparison, Outcomes, Study Design model through the PubMed and Ovid Medline databases. RESULTS A total of 18 articles met inclusion criteria including 30 validated predictive models of complications after adult spinal surgery. National registry databases were used in 12 studies. Validation cohorts were used in seven studies for verification; three studies used other methods including random sample bootstrapping techniques or cross-validation. Reported area under the curve (AUC) values ranged from 0.37 to 1.0. Studies described treatment for deformity, degenerative conditions, inclusive spinal surgery (neoplasm, trauma, infection, deformity, degenerative), and miscellaneous (disk herniation, spinal epidural abscess). The most commonly cited risk factors for complications included in predictive models included age, body mass index, diabetes, sex, and smoking. Those models in the deformity subset that included radiographic and anatomical grading features reported higher AUC values than those that included patient demographics or medical comorbidities alone. CONCLUSIONS We identified a cohort of 30 validated predictive models of complications following spinal surgery for degenerative conditions, deformity, infection, and trauma. Accurate evidence-based predictive models may enhance shared decision making, improve rehabilitation, reduce adverse events, and inform best practices.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Ahmad Alhourani
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Doniel Drazin
- Department of Neurosurgery, Pacific Northwest University of Health Sciences, Yakima, Washington, United States
| | - Max Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
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Adult degenerative scoliosis – A literature review. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2020. [DOI: 10.1016/j.inat.2019.100661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jin C, Xie N, Ren Y, Liu X, Tang F, Guo Q, Jia L, Cheng L. How Does Cervical Sagittal Balance Change After Hangman Fracture Treated with Anterior or Posterior Approach Surgery? World Neurosurg 2020; 138:e767-e777. [DOI: 10.1016/j.wneu.2020.03.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
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Cheung JPY. The importance of sagittal balance in adult scoliosis surgery. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:35. [PMID: 32055626 DOI: 10.21037/atm.2019.10.19] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Adult spinal deformity is an important health issue worldwide with our aging population. Understanding ideal sagittal alignment parameters is crucial for planning reconstructive surgery. Despite its variability, sagittal spinopelvic parameters are well recognized as the most crucial factor in predicting postoperative outcomes and risks of revision surgery. Thus, understanding the fundamental concepts of spinopelvic harmony is of utmost importance because they provide useful recommendations for what should be achieved during surgery. The main pathology in degenerative spine disease is the loss of lumbar lordosis (LL), which contributes to lower back pain. The loss of LL may occur as a result of natural history with spinal degeneration or by previous lumbar spine fusion. With adult spinal deformity, understanding the compensatory mechanisms available to patients is important for determining the timing of surgery. The main compensatory mechanisms patients adopt to maintain an upright posture include decreased sacral slope (SS), increased pelvic tilt (PT), decreased thoracic kyphosis (TK). Failure of these compensatory mechanisms leads to recruitment of the lower limbs with flexed hips and knees. At this stage, the patient is decompensated and result in positive sagittal alignment. This sagittal imbalance can be easily measured by the sagittal vertical axis (SVA) and is associated with worse patient-perceived outcome scores. These sagittal parameters also indicate whether surgical reconstruction is required and provides the necessary alignment goals. Depending on the value of pelvic incidence (PI), there are different LL goals. High PI has increased capacity for pelvic retroversion but requires greater lordosis correction. Proper restoration of the LL according to the PI will reduce pelvic retroversion reflected by reduced PT. Without adherence to these surgical goals, complications such as proximal junctional kyphosis (PJK) may occur. It is imperative to restore normal spinopelvic balance to maximize functional outcomes, reduce pain, and avoid complications.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, China
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Lau D, DiGiorgio AM, Chan AK, Dalle Ore CL, Virk MS, Chou D, Bisson EF, Mummaneni PV. Applicability of cervical sagittal vertical axis, cervical lordosis, and T1 slope on pain and disability outcomes after anterior cervical discectomy and fusion in patients without deformity. J Neurosurg Spine 2020; 32:23-30. [PMID: 31628295 DOI: 10.3171/2019.7.spine19437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Understanding what influences pain and disability following anterior cervical discectomy and fusion (ACDF) in patients with degenerative cervical spine disease is critical. This study examines the timing of clinical improvement and identifies factors (including spinal alignment) associated with worse outcomes. METHODS Consecutive adult patients were enrolled in a prospective outcomes database from two academic centers participating in the Quality Outcomes Database from 2013 to 2016. Demographics, surgical details, radiographic data, arm and neck pain (visual analog scale [VAS] scores), and disability (Neck Disability Index [NDI] and EQ-5D scores) were reviewed. Multivariate analysis was used. RESULTS A total of 186 patients were included, and 48.4% were male. Their mean age was 55.4 years, and 45.7% had myelopathy. Preoperative cervical sagittal vertical axis (cSVA), cervical lordosis (CL), and T1 slope values were 24.9 mm (range 0-55 mm), 10.4° (range -6.0° to 44°), and 28.3° (range 14.0°-51.0°), respectively. ACDF was performed at 1, 2, and 3 levels in 47.8%, 42.0%, and 10.2% of patients, respectively. Preoperative neck and arm VAS scores were 5.7 and 5.4, respectively. NDI and EQ-5D scores were 22.1 and 0.5, respectively. There was significant improvement in all outcomes at 3 months (p < 0.001) and 12 months (p < 0.001). At 3 months, neck VAS (3.0), arm VAS (2.2), NDI (12.7), and EQ-5D (0.7) scores were improved, and at 12 months, neck VAS (2.8), arm VAS (2.3), NDI (11.7), and EQ-5D (0.8) score improvements were sustained. Improvements occurred within the first 3-month period; there was no significant difference in outcomes between the 3-month and 12-month mark. There was no correlation among cSVA, CL, or T1 slope with any outcome endpoint. The most consistent independent preoperative factors associated with worse outcomes were high neck and arm VAS scores and a severe NDI result (p < 0.001). Similar findings were seen with worse NDI and EQ-5D scores (p < 0.001). A significant linear trend of worse NDI and EQ-5D scores at 3 and 12 months was associated with worse baseline scores. Of the 186 patients, 171 (91.9%) had 3-month follow-up data, and 162 (87.1%) had 12-month follow-up data. CONCLUSIONS ACDF is effective in improving pain and disability, and improvement occurs within 3 months of surgery. cSVA, CL, and T1 slope do not appear to influence outcomes following ACDF surgery in the population with degenerative cervical disease. Therefore, in patients with relatively normal cervical parameters, augmenting alignment or lordosis is likely unnecessary. Worse preoperative pain and disability were independently associated with worse outcomes.
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Affiliation(s)
- Darryl Lau
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Anthony M DiGiorgio
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Cecilia L Dalle Ore
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael S Virk
- 2Department of Neurological Surgery, Cornell University, New York, New York; and
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Erica F Bisson
- 3Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
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Ding JZ, Kong C, Sun XY, Lu SB. Perioperative Complications And Risk Factors In Degenerative Lumbar Scoliosis Surgery For Patients Older Than 70 Years Of Age. Clin Interv Aging 2019; 14:2195-2203. [PMID: 31908430 PMCID: PMC6924653 DOI: 10.2147/cia.s218204] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022] Open
Abstract
Study design Multivariate analysis of retrospective registry data. Objective To report the perioperative complication in a large cohort of surgery for elderly degenerative lumbar scoliosis (DLS) patients and to analyze the risk factors. Summary of background data The perioperative complication rate and risk factors for patients with DLS remain unclear, especially in elderly population. Methods Between November 2015 and June 2018, 98 patients aged 70 or older with DLS received decompression and intervertebral fusion by one spine surgeon at Beijing Xuanwu Hospital. The medical history and comorbidities of all patients were recorded. Results The perioperative complication rate was 34.7% in all patients, 11.2% of all patients had major complications, and 31.6% had minor complications. The major complication most commonly seen was wound infection, and the most common minor complication was hypoproteinemia. Elderly patients (>75) had longer hospital stays (17.5 ± 7.9) when compared to younger patients. Two risk factors of perioperative complications were chosen after binary logistic regression analysis: lower BMI and longer instrumented segments. The only risk factor for major complications was longer instrumented level (≥3), and the only risk factor for minor complications was lower BMI. Conclusion Our findings indicate that in elderly patients with DLS, lower BMI is a risk factor for minor perioperative complication. Obesity is not a major problem in this population, on the contrary, BMI is a protective factor for perioperative complications. The risk factors for major perioperative complications in elderly patients with DLS are longer instrumented segments but not related to the number of decompression and intervertebral fusion levels. Preoperative comorbidities and advanced age were not associated to a higher perioperative complication rate in elderly patients. The perioperative complication rate in patients with DLS over 70 years of age is found to be acceptable with appropriate perioperative management.
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Affiliation(s)
- Jun-Zhe Ding
- Orthopaedic Department, Xuanwu Hospital, National Center for Clinical Research of Geriatric Diseases, Beijing, People's Republic of China
| | - Chao Kong
- Orthopaedic Department, Xuanwu Hospital, National Center for Clinical Research of Geriatric Diseases, Beijing, People's Republic of China
| | - Xiang-Yao Sun
- Orthopaedic Department, Xuanwu Hospital, National Center for Clinical Research of Geriatric Diseases, Beijing, People's Republic of China
| | - Shi-Bao Lu
- Orthopaedic Department, Xuanwu Hospital, National Center for Clinical Research of Geriatric Diseases, Beijing, People's Republic of China
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Raman T, Passias PG, Kebaish KM. Asymmetric Three-Column Osteotomy for Coronal Malalignment in Adult Patients with Prior Thoracic Fusion for Adolescent Idiopathic Scoliosis: Three-Year Follow-up. World Neurosurg 2019; 131:e441-e446. [PMID: 31382065 DOI: 10.1016/j.wneu.2019.07.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE In the setting of a previous proximal fusion, an asymmetric 3-column osteotomy (3CO) can provide tremendous deformity correction. Our goal was to evaluate outcomes and complications of asymmetric 3CO through the proximal fusion mass, for coronal malalignment in patients with previous long thoracic fusion for adolescent idiopathic scoliosis. METHODS This was a retrospective case series. Thirteen individuals with a history of a long thoracic fusion underwent asymmetric 3CO for persistent coronal malalignment. Clinical chart review was conducted to determine perioperative complications and radiographs evaluated for alignment. RESULTS Thirteen patients (age: 57.8 ± 12.2 years; 0 male, 13 female) completed a mean follow-up of 42.4 months. There was significant improvement in coronal and sagittal alignment, and pelvic incidence-lumbar lordosis postoperatively (P < 0.05). One patient developed lower-extremity weakness requiring revision decompression 72 hours postoperatively; the weakness subsequently resolved. One patient had a foot drop postoperatively. At final follow-up, 12 of 13 patients had grade 1 fusion at the osteotomy site; 1 patient had a grade 2 fusion. None of the patients developed a pseudarthrosis, or superficial or deep infections. CONCLUSIONS Patients with a history of previous thoracic fusion for adolescent idiopathic scoliosis and coronal malalignment may develop painful degeneration of the segments caudal to the fusion as adults. In this setting, extension of fusion to the sacropelvis alone may worsen the patient's coronal alignment. An asymmetric 3CO may be considered at the proximal fusion mass to achieve realignment objectives, with an acceptable complication rate and an expected improvement in outcomes.
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Affiliation(s)
- Tina Raman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA.
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
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Changes in pelvic anatomy after long corrective fusion using iliac screws for adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2103-2111. [DOI: 10.1007/s00586-019-06027-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
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Segreto FA, Passias PG, Lafage R, Lafage V, Smith JS, Line BG, Mundis GM, Bortz CA, Stekas ND, Horn SR, Diebo BG, Brown AE, Ihejirika Y, Nunley PD, Daniels AH, Gupta MC, Gum JL, Hamilton DK, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. Incidence of Acute, Progressive, and Delayed Proximal Junctional Kyphosis Over an 8-Year Period in Adult Spinal Deformity Patients. Oper Neurosurg (Hagerstown) 2019; 18:75-82. [DOI: 10.1093/ons/opz128] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Proximal junctional kyphosis (PJK) is a common radiographic complication of adult spinal deformity (ASD) corrective surgery. Although previous literature has reported a 5 to 61% incidence of PJK, these studies are limited by small sample sizes and short-term follow-up.
OBJECTIVE
To assess the incidence of PJK utilizing a high-powered ASD database.
METHODS
Retrospective review of a prospective multicenter ASD database. Operative ASD patients > 18 yr old from 2009 to 2017 were included. PJK was defined as ≥ 10° for the sagittal Cobb angle between the inferior upper instrumented vertebra (UIV) endplate and the superior endplate of the UIV + 2. Chi-square analysis and post hoc testing assessed annual and overall incidence of acute (6-wk follow-up [f/u]), progressive (increase in degree of PJK from 6 wk to 1 yr), and delayed (1-yr, 2-yr, and 3-yr f/u) PJK development.
RESULTS
A total of 1005 patients were included (age: 59.3; 73.5% F; body mass index: 27.99). Overall PJK incidence was 69.4%. Overall incidence of acute PJK was 48.0%. Annual incidence of acute PJK has decreased from 53.7% in 2012 to 31.6% in 2017 (P = .038). Overall incidence of progressive PJK was 35.0%, with stable rates observed from 2009 to 2016 (P = .297). Overall incidence of 1-yr-delayed PJK was 9.3%. Annual incidence of 1-yr-delayed PJK has decreased from 9.2% in 2009 to 3.2% in 2016 (P < .001). Overall incidence of 2-yr-delayed PJK development was 4.3%. Annual incidence of 2-yr-delayed PJK has decreased from 7.3% in 2009 to 0.9% in 2015 (P < .05). Overall incidence of 3-yr-delayed PJK was 1.8%, with stable rates observed from 2009 to 2014 (P = .594).
CONCLUSION
Although progressive PJK has remained a challenge for physicians over time, significantly lower incidences of acute and delayed PJK in recent years may indicate improving operative decision-making and management strategies.
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Affiliation(s)
- Frank A Segreto
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Peter G Passias
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Renaud Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Breton G Line
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Gregory M Mundis
- Department of Orthopedics, San Diego Center for Spinal Disorders, La Jolla, California
| | - Cole A Bortz
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Nicholas D Stekas
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Samantha R Horn
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Bassel G Diebo
- Department of Orthopedic Surgery, State University of New York Downstate Medical Center, Brooklyn, New York, New York
| | - Avery E Brown
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Yael Ihejirika
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | | | - Alan H Daniels
- Department of Orthopedics, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Munish C Gupta
- Department of Orthopedic Surgery, University of California, Davis, Davis, California
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, Kentucky
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburg School of Medicine, Pittsburgh, Pennsylvania
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California, Davis, Davis, California
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert A Hart
- Department of Orthopedics, Swedish Neuroscience Institute, Seattle, Washington
| | - Frank J Schwab
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Jung JM, Hyun SJ, Kim KJ, Jahng TA, Kim HJ, Choi Y. Anatomic Trajectory Screw Fixation at Upper Instrumented Vertebra Is a Substantial Risk Factor for Proximal Junctional Kyphosis. World Neurosurg 2019; 129:e522-e529. [PMID: 31152888 DOI: 10.1016/j.wneu.2019.05.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to investigate the risk of proximal junction kyphosis (PJK) and proximal junction failure (PJF) associated with screw trajectory (straightforward vs. mixed vs. anatomic) at upper instrumented vertebra (UIV). METHODS A single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥4 levels (the UIV of the thoracolumbar spine, T9-L2, and the lower instrumented vertebra at the sacrum or pelvis) was retrospectively reviewed. Patients were divided into 3 groups according to UIV screw trajectory: group S, 2 straightforward screws; group M, 1 straightforward screw and 1 anatomic trajectory screw; and group A, 2 anatomic trajectory screws. RESULTS A total of 83 patients were included in this study, including 51 in group S, 16 in group M, and 16 in group A. The incidence of PJK in group S (12 patients, 23.5%), group M (7 patients, 43.8%), and group A (9 patients, 56.3%) significantly increased in sequence by group (P = 0.044). Anatomic trajectory screw fixation increased the risk for PJF requiring revision surgery compared with straightforward screw fixation (3 patients [18.8%] vs. 1 patient [2.0%]; P = 0.040). Multivariable analysis identified that anatomic trajectory screw fixation was a significant risk factor for PJK (P = 0.008; adjusted odds ratio = 7.591; 95% confidence interval, 1.69-34.093). CONCLUSION Anatomic trajectory screw fixation at the UIV is a substantial risk factor for PJK and PJF. To reduce PJK and PJF, straightforward screw fixation at the UIV is recommended in adult spinal deformity correction surgery.
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Affiliation(s)
- Jong-Myung Jung
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Yagi M, Hosogane N, Fujita N, Okada E, Suzuki S, Tsuji O, Nagoshi N, Asazuma T, Tsuji T, Nakamura M, Matsumoto M, Watanabe K. Surgical risk stratification based on preoperative risk factors in adult spinal deformity. Spine J 2019; 19:816-826. [PMID: 30537554 DOI: 10.1016/j.spinee.2018.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Corrective surgery for adult spinal deformity (ASD) improves health-related quality of life but has high complication rates. Predicting a patient's risk of perioperative and late postoperative complications is difficult, although several potential risk factors have been reported. PURPOSE To establish an accurate, ASD-specific model for predicting the risk of postoperative complications, based on baseline demographic, radiographic, and surgical invasiveness data in a retrospective case series. STUDY DESIGN/SETTING Multicentered retrospective review and the surgical risk stratification. PATIENT SAMPLE One hundred fifty-one surgically treated ASD at our hospital for risk analysis and model building and 89 surgically treated ASD at 2 other our hospitals for model validation. OUTCOME MEASURES HRQoL measures and surgical complications. METHODS We analyzed demographic and medical data, including complications, for 151 adults with ASD who underwent surgery at our hospital and were followed for at least 2years. Each surgical risk factor identified by univariate analyses was assigned a value based on its odds ratio, and the values of all risk factors were summed to obtain a surgical risk score (range 0-20). We stratified risk scores into grades (A-D) and analyzed their correlations with complications. We validated the model using data from 89 patients who underwent ASD surgery at two other hospitals. RESULTS Complications developed in 48% of the patients in the model-building cohort. Univariate analyses identified 10 demographic, physical, and surgical risk indicators, with odds ratios from 5.4 to 1.4, for complications. Our risk-grading system showed good calibration and discrimination in the validation cohort. The complication rate increased with and correlated well with the risk grade using receiver operating characteristic curves. CONCLUSIONS This simple, ASD-specific model uses readily accessible indicators to predict a patient's risk of perioperative and postoperative complications and can help surgeons adjust treatment strategies for best outcomes in high-risk patients.
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Affiliation(s)
- Mitsuru Yagi
- Department of Orthopedic Surgery, Keio UniversitySchool of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, 2 Chome-37-༑ Gakuen, Musashimurayama, Tokyo 208-0011, Japan; Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan
| | - Naobumi Hosogane
- Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan; Department of Orthopedic Surgery, Kyorin University School of Medicine, 6 Chome-20-2 Shinkawa, Mitaka, Tokyo 181-0004, Japan
| | - Nobuyuki Fujita
- Department of Orthopedic Surgery, Keio UniversitySchool of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan
| | - Eijiro Okada
- Department of Orthopedic Surgery, Keio UniversitySchool of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio UniversitySchool of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio UniversitySchool of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio UniversitySchool of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan
| | - Takashi Asazuma
- Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, 2 Chome-37-༑ Gakuen, Musashimurayama, Tokyo 208-0011, Japan
| | - Takashi Tsuji
- Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan; Department of Orthopedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio UniversitySchool of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio UniversitySchool of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio UniversitySchool of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Keio Spine Research Group, 178-4-4 Wakashiba, Kashiwa, Chiba 277-0871, Japan.
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Bassani T, Casaroli G, Galbusera F. Dependence of lumbar loads on spinopelvic sagittal alignment: An evaluation based on musculoskeletal modeling. PLoS One 2019; 14:e0207997. [PMID: 30883563 PMCID: PMC6422292 DOI: 10.1371/journal.pone.0207997] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 11/10/2018] [Indexed: 12/18/2022] Open
Abstract
Still little is known about how spinopelvic alignment affects spinal load distribution. Musculoskeletal modeling can potentially help to discover associations between spine alignment and risk factors of spinal disorders (e.g. disc herniation, vertebral fracture, spondylolisthesis, low back pain). The present study exploited the AnyBody full-body musculoskeletal model to assess the relation between lumbar loads and spinopelvic alignment in the sagittal plane. The model was evaluated in the standing position. The simulated postures were set using spinopelvic parameters gleaned from the literature and characterizing the healthy adult population. The parameters were: sagittal vertical axis, Roussouly lumbar type, sacral slope, and pelvic incidence. A total of 2772 configurations were simulated based on the following measurements: compression force and anterior shear at levels L4L5 and L5S1; multifidus, longissimus spinae, and rectus abdominis muscle forces. Changes in global sagittal alignment, lumbar typology, and sacral inclination, but not in pelvic incidence, were found to affect intervertebral loads in the lumbar spine and spinal muscle activation. Considering these changes would be advantageous for clinical evaluation, due to the recognized relation between altered loads and risk of disc herniation, vertebral fracture, spondylolisthesis, and low back pain. Musculoskeletal modeling proved to be a valuable biomechanical tool to non-invasively investigate the relation between internal loads and anatomical parameters.
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Affiliation(s)
- Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- * E-mail:
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Loss of Pelvic Incidence Correction After Long Fusion Using Iliac Screws for Adult Spinal Deformity: Cause and Effect on Clinical Outcome. Spine (Phila Pa 1976) 2019; 44:195-202. [PMID: 29975330 DOI: 10.1097/brs.0000000000002775] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational cohort study. OBJECTIVE To determine change in pelvic incidence (PI) and loss of correction after long fusion with iliac screws, the effect of iliac screw loosening, and global alignment according to postoperative PI. SUMMARY OF BACKGROUND DATA Posterior long fixation and fusion of the thoracic to the ilium is one of the most common surgical treatments for adult spinal deformity (ASD). Long fusion to the sacrum with iliac screws decreases the PI by 3.9° after surgery. PI decreases once by long fusion with iliac screws. However, if the iliac screw loosens, PI may cause correction loss and return to the preoperative PI. METHODS We retrospectively reviewed the cases of 69 consecutive patients with ASD. Their mean age (SD) was 70.5 (7.3) years, 12% were male. PI was evaluated preoperatively, early- and 1-year postoperatively. We compared change in PI with and without loosening of iliac screws, spinopelvic parameters according to 1-year-postoperative PI. RESULTS PI decreased significantly from 51.8° (9.3°) to 48.1° (9.5°) early postoperatively (P < 0.01). PI increased significantly from 48.1° (9.5°) to 49.6° (9.7°) within a year postoperatively (P < 0.01). Significant loss of PI correction (2.3°, P < 0.01) occurred within a year after surgery in patients with iliac screw loosening and was significantly different from the PI loss in those without screw loosening (53.9°, 48.2°, P = 0.03). Pelvic tilt, sacral slope, C7 sagittal vertical axis, global tilt, and T1 pelvic angle were significantly smaller in the group with PI <50° postoperatively at 1 year compared with the group with PI >50°. CONCLUSION Although PI decreases after long fusion surgery with iliac screws, significant correction loss appears within a year. Loosening of iliac screws may exacerbate this loss. Patients with PI <50° postoperatively were able to maintain better global alignment. LEVEL OF EVIDENCE 3.
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Predictive model for major complications 2 years after corrective spine surgery for adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:180-187. [DOI: 10.1007/s00586-018-5816-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
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Lewis SJ, Keshen SG, Kato S, Dear TE, Gazendam AM. Risk Factors for Postoperative Coronal Balance in Adult Spinal Deformity Surgery. Global Spine J 2018; 8:690-697. [PMID: 30443478 PMCID: PMC6232708 DOI: 10.1177/2192568218764904] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN A retrospective case-control study. OBJECTIVES To determine factors influencing the ability to achieve coronal balance following spinal deformity surgery. METHODS Following institutional ethics approval, the radiographs of 47 patients treated for spinal deformity surgery with long fusions to the pelvis, were retrospectively reviewed. The postoperative measurements included coronal balance, L4 tilt, and L5 tilt, levels fused, apical vertebral translation and maximum Cobb angle. L4 and L5 tilt angles were measured between the superior endplate and the horizontal. Sagittal parameters including thoracic kyphosis, lumbar lordosis, pelvic incidence, and sagittal vertical axis were recorded. Coronal balance was defined as the distance between the central sacral line and the mid body of C7 being ≤40 mm. Surgical factors, including levels fused, use of iliac fixation with and without connectors, use of S2A1 screws, interbody devices, and osteotomies. Statistical tests were performed to determine factors that contribute to postoperative coronal imbalance. RESULTS Of the 47 patients reviewed, 32 were balanced after surgery and 14 were imbalanced. Coronal balance was 1.30 cm from center in the balanced group compared to 4.83 cm in the imbalanced group (P < .01). Both L4 and L5 tilt were statistically different between the groups. Gender and the use of transverse connectors differed between the groups but not statistically. CONCLUSIONS In adult spinal deformity patients undergoing primary fusions to the pelvis, the ability to level the coronal tilt of L4 and L5 had the greatest impact on the ability to achieve coronal balance in this small series. A larger prospective series can help validate this important finding.
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Affiliation(s)
- Stephen J. Lewis
- University Health Network, Toronto Western Hospital, Toronto,
Ontario, Canada,Stephen J. Lewis, Division of Orthopaedic
Surgery, Toronto Western Hospital, 399 Bathurst Street, Room 442, First Floor,
East Wing, Toronto, Ontario, M5T 2S8, Canada.
| | - Sam G. Keshen
- University Health Network, Toronto Western Hospital, Toronto,
Ontario, Canada
| | - So Kato
- University Health Network, Toronto Western Hospital, Toronto,
Ontario, Canada
| | - Taylor E. Dear
- University Health Network, Toronto Western Hospital, Toronto,
Ontario, Canada
| | - Aaron M. Gazendam
- University Health Network, Toronto Western Hospital, Toronto,
Ontario, Canada
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Diebo BG, Shah NV, Pivec R, Naziri Q, Patel A, Post NH, Assi A, Godwin EM, Lafage V, Schwab FJ, Paulino CB. From Static Spinal Alignment to Dynamic Body Balance: Utilizing Motion Analysis in Spinal Deformity Surgery. JBJS Rev 2018; 6:e3. [DOI: 10.2106/jbjs.rvw.17.00189] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Pratali RDR, Martins SM, Santos FPED, Barsotti CEG, Oliveira CEASD. The use of three-column osteotomy in the treatment of rigid deformities of the adult spine. Rev Bras Ortop 2018; 53:213-220. [PMID: 29911089 PMCID: PMC6001390 DOI: 10.1016/j.rboe.2017.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/06/2017] [Indexed: 11/28/2022] Open
Abstract
Objective To analyze and characterize data about clinical outcome and complication rates in three-column osteotomies (3 CO) for treatment of rigid adult spine deformity (ASD). Methods Baseline and postoperative clinical outcomes, considering the Oswestry Disability Index (ODI) and Scoliosis Research Society-22 (SRS-22) questionnaires, radiographic parameters, and demographic data of patients who underwent 3 CO procedure for fixed ASD treatment were collected. Surgical characteristics and reports of perioperative complications were recorded, as well as those that occurred at a minimum follow-up of 12 months. Results Ten patients underwent 3 CO and had a minimum follow-up of 12 months (mean 24 months). The patients showed significantly improved health-related quality of life scores (ODI, SRS-22 total, function/activity, pain, and appearance). They also presented a significant improvement in all radiographic parameters considered in the study. Taking into account the surgical procedure, the operative time was significantly higher in patients with staged procedure than in patients with single-stage surgery (p = 0.003), with similar estimated blood loss and complication incidence. There were ten complications in six patients (60%), with a mean of 1.0 complication per patient. Conclusions Despite of the high complication rates, 3 CO was an effective technique, considering clinical and radiographic outcomes, to treat complex cases of rigid ASD in a sample of patients operated in a Brazilian spine center, with a minimum follow-up of 12 months.
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Kurra S, Lavelle WF, Silverstein MP, Savage JW, Orr RD. Long-term outcomes of transforaminal lumbar interbody fusion in patients with spinal stenosis and degenerative scoliosis. Spine J 2018; 18:1014-1021. [PMID: 29174460 DOI: 10.1016/j.spinee.2017.10.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients with spinal deformity may present with complaints related to either the deformity itself or the manifestations of the coexisting spinal stenosis. There are reports of successful management of lumbar pathology in the absence of global sagittal or coronal imbalance, with limited decompression and fusion, addressing only the symptomatic segment. PURPOSE Our study examined the long-term outcomes of transforaminal lumbar interbody fusion (TLIF), a less extensive procedure, based on the experience of the senior author over the past 10 years. STUDY DESIGN/SETTING This was a retrospective study of symptomatic lumbar spinal stenosis and spinal deformity managed by one surgeon at The Cleveland Clinic since 2003. PATIENT SAMPLE Forty-one patients were included in the study. OUTCOME MEASURES The present study measures the long-term clinical functional outcomes of these patients through EQ-5D (EuroQol five dimensions questionnaire), PHQ-9 (Patient Health Questionnaire), and PDQ (Pain Disability Questionnaire) forms, along with documented radiographic parameters and Charlson Comorbidity Index (CCI). METHODS There were no funding or potential conflicts of interest associated biases in the present study. Patients with symptomatic lumbar spinal stenosis with neutral global alignment in the sagittal and coronal planes and symptomatic stenosis at the deformity level were treated by limited fusion and TLIF, and had a follow-up period of at least 5 years. Excluded were patients under 18 years of age, had more than three levels of fusion, and had an active spinal malignancy or recent spinal trauma. The grouping variables were curve magnitude, revision surgeries, and TLIF levels. Clinical outcomes were compared in all the grouping variables. Analysis of variance (ANOVA) and chi-square tests were utilized; p<.05 was considered statistically significant. RESULTS The average age and follow-up period were 66±10 and 7.5 years, respectively. There was no statistical difference between patients with curves measuring between 10° and 20° and greater than 20° for EQ-5D, PHQ-9, and PDQ. Patients had worse PDQ data with larger curves compared with smaller curves at both 5 years and final follow-up. Although there was no statistical significance between preoperative coronal curve magnitude and revision surgeries, patients with curves greater than 20° had higher rates of revision surgeries (75%; p=.343) in the global lumbar curve deformity group. Although there was no statistical significance for patients who underwent revision surgeries,those patients had low PHQ-9 values at the final follow-up (p=.09). The revision surgery rate was 48% in one-level TLIF and 18% in two-level TLIF. Moderate pain disability scores were noticed for one-level TLIF patients (mean=75) compared with two-level TLIF patients (mean=27) at the final follow-up, and approached statistical significance in this comparison (p=.06). CONCLUSION Although this topic has a limited audience to spinal deformity surgeons, the prevalence of patients who present with adult spinal deformities has been increasing. Short segment fusion, in the setting of modest spinal deformity, is a reasonable and safe option. Further study on the concept of short segment fusions in the growing patient population is required as more comprehensive fusions do have noted complication rates, and a compromise must be reached between the extent of surgery that is enough to provide pain relief and disability and the degree of surgery that is too much to be tolerated in terms of complication rates.
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Affiliation(s)
- Swamy Kurra
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA
| | - William F Lavelle
- Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210, USA.
| | - Michael P Silverstein
- Department of Orthopaedic Surgery, The Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Jason W Savage
- Center for Spine Health, The Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - R Douglas Orr
- Department of Orthopaedic Surgery, The Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
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Zhao Z, Liu Z, Hu Z, Tseng C, Li J, Pan W, Qiu Y, Zhu Z. Improved accuracy of screw implantation could decrease the incidence of post-operative hydrothorax? O-arm navigation vs. free-hand in thoracic spinal deformity correction surgery. INTERNATIONAL ORTHOPAEDICS 2018; 42:2141-2146. [PMID: 29549400 DOI: 10.1007/s00264-018-3889-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/12/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to analyze the occurrence of PE after intra-operative O-arm navigation-assisted surgery and determine whether the post-operative PE incidence could be decreased by using O-arm navigation as compared to conventional free-hand technique. METHODS A cohort of 27 patients with spinal deformity who were operated upon with an O-arm navigated system (group A) between 2013 and 2016 were enrolled in the study. A total of 27 curve-matched patients treated by conventional free-hand technique were included as the control group (group B). Whole spine posterior-anterior and lateral radiographs, and CT scans were taken pre and post-operation. Radiologic parameters and volume of PE were measured and compared between the two groups. RESULTS There were no significant differences in age, Cobb angle, and sagittal contour between the two groups pre-operatively. The mean total volume of post-operative PE was significantly larger in the free-hand group (p < 0.001). In the O-arm group, 59 malpositioned screws were identified in 22 patients. In the free-hand group, 88 malpositioned screws were found among 26 patients. The screw perforation rate was higher in the free-hand group than in the O-arm group (p = 0.007). In the O-arm group, the mean volume of PE was significantly larger among patients with malpositioned screws than those without malpositioned screws (p < 0.001), as well as in the free-hand group. CONCLUSION The volume of PE after correction surgery can be significantly decreased by application of O-arm navigation system as compared to conventional free-hand technique. We ascribed the improvement to the accuracy of screw implantation navigated by O-arm.
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Affiliation(s)
- Zhihui Zhao
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Zhen Liu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Zongshan Hu
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Changchun Tseng
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Jie Li
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Wei Pan
- Department of Orthopaedics, The Affiliated Huai'an Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yong Qiu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Zezhang Zhu
- Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
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Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE To identify the best indicator for reproducible representation of craniocervical sagittal balance (CCSB). SUMMARY OF BACKGROUND DATA Spinal sagittal balance is considered one of the most critical factors affecting the health-related quality of life. Although standard indicators of spinopelvic balance have been established, these do not include the craniocervical balance and there is no standard parameter for evaluating the CCSB. MATERIALS AND METHODS Six kinds of sagittal vertical axis (SVA) were drawn by a total of 9 spine or orthopedic surgeons, from the anterior margin of the external auditory canal: cranial center of gravity (CCG), C1 (center of the anterior arch), C2 (C2vb: center of the vertebral body, C2e: center of the lower endplate), and C7 (C7vb: center of the vertebral body, C7p: posterosuperior corner). Eight SVA distances were measured by using 30 radiographs; CCG-C7vb, C1-C7vb, C2e-C7vb, C2vb-C7vb, CCG-C7p, C1-C7p, C2e-C7p, and C2bv-C7p.The interobserver and intraobserver reliabilities, and the correlations between CCG and C1, C2e, or C2bv were calculated among the main groups or subgroups. RESULTS In the overall analysis, although the intraclass correlation coefficients (ICC) (1, 1) of all parameters were >0.900, the ICC (2, 1) of CCG-C7p and CCG-C7vb were <0.900. The same trends were noted in the subgroups based on observer's experience. Comparing C7p-related and C7vb-related parameters, ICC (2, 1) showed 0.901 in C7p-related and 0.849 in C7bv-related parameters. In the analysis of the correlation between cranial SVAs, C1-C7p and C2vb-C7p SVAs correlated highly with CCG-C7p SVA (0.905, 0.805, respectively). CONCLUSIONS Although the CCG SVA represents the center of the head, the current results revealed its low reproducibility. The low values were notable in those unfamiliar with craniocervical anatomy. The correlation analysis indicated that C1-C7p and C2vb-C7p SVA parameters are suitable for CCG-C7p SVA. Therefore, these 2 are considered as possible standard parameters in evaluating CCSB. LEVEL OF EVIDENCE Level III.
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Pratali RDR, Martins SM, Santos FPED, Barsotti CEG, Oliveira CEASD. O uso da osteotomia das três colunas no tratamento de deformidades rígidas da coluna vertebral do adulto. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Diebo BG, Shah NV, Stroud SG, Paulino CB, Schwab FJ, Lafage V. Realignment surgery in adult spinal deformity. DER ORTHOPADE 2018; 47:301-309. [DOI: 10.1007/s00132-018-3536-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Passias PG, Jalai CM, Line BG, Poorman GW, Scheer JK, Smith JS, Shaffrey CI, Burton DC, Fu KMG, Klineberg EO, Hart RA, Schwab F, Lafage V, Bess S. Patient profiling can identify patients with adult spinal deformity (ASD) at risk for conversion from nonoperative to surgical treatment: initial steps to reduce ineffective ASD management. Spine J 2018; 18:234-244. [PMID: 28688984 DOI: 10.1016/j.spinee.2017.06.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Non-operative management is a common initial treatment for patients with adult spinal deformity (ASD) despite reported superiority of surgery with regard to outcomes. Ineffective medical care is a large source of resource drain on the health system. Characterization of patients with ASD likely to elect for operative treatment from non-operative management may allow for more efficient patient counseling and cost savings. PURPOSE This study aimed to identify deformity and disability characteristics of patients with ASD who ultimately convert to operative treatment compared with those who remain non-operative and those who initially choose surgery. STUDY DESIGN/SETTING A retrospective review was carried out. PATIENT SAMPLE A total of 510 patients with ASD (189 non-operative, 321 operative) with minimum 2-year follow-up comprised the patient sample. OUTCOME MEASURES Oswestry Disability Index (ODI), Short-Form 36 Health Assessment (SF-36), Scoliosis Research Society questionnaire (SRS-22r), and spinopelvic radiographic alignment were the outcome measures. METHODS Demographic, radiographic, and patient-reported outcome measures (PROMs) from a cohort of patients with ASD prospectively enrolled into a multicenter database were evaluated. Patients were divided into three treatment cohorts: Non-operative (NON=initial non-operative treatment and remained non-operative), Operative (OP=initial operative treatment), and Crossover (CROSS=initial non-operative treatment with subsequent conversion to operative treatment). NON and OP groups were propensity score-matched (PSM) to CROSS for baseline demographics (age, body mass index, Charlson Comorbidity Index). Time to crossover was divided into early (<1 year) and late (>1 year). Outcome measures were compared across and within treatment groups at four time points (baseline, 6 weeks, 1 year, and 2 years). RESULTS Following PSM, 118 patients were included (NON=39, OP=38, CROSS=41). Crossover rate was 21.7% (41/189). Mean time to crossover was 394 days. All groups had similar baseline sagittal alignment, but CROSS had larger pelvic incidence and lumbar lordosis (PI-LL) mismatch than NON (11.9° vs. 3.1°, p=.032). CROSS and OP had similar baseline PROM scores; however, CROSS had worse baseline ODI, PCS, SRS-22r (p<.05). At time of crossover, CROSS had worse ODI (35.7 vs. 27.8) and SRS Satisfaction (2.6 vs. 3.3) compared with NON (p<.05). Alignment remained similar for CROSS from baseline to conversion; however, PROMs (ODI, PCS, SRS Activity/Pain/Total) worsened (p<.05). Early and late crossover evaluation demonstrated CROSS-early (n=25) had worsening ODI, SRS Activity/Pain at time of crossover (p<.05). From time of crossover to 2-year follow-up, CROSS-early had less SRS Appearance/Mental improvement compared with OP. Both CROSS-early/late had worse baseline, but greater improvements, in ODI, PCS, SRS Pain/Total compared with NON (p<.05). Baseline alignment and disability parameters increased crossover odds-Non with Schwab T/L/D curves and ODI≥40 (odds ratio [OR]: 3.05, p=.031), and Non with high PI-LL modifier grades ("+"/'++') and ODI≥40 (OR: 5.57, p=.007) were at increased crossover risk. CONCLUSIONS High baseline and increasing disability over time drives conversion from non-operative to operative ASD care. CROSS patients had similar spinal deformity but worse PROMs than NON. CROSS achieved similar 2-year outcome scores as OP. Profiling at first visit for patients at risk of crossover may optimize physician counseling and cost savings.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 E 17th St, New York, NY 10003, USA.
| | - Cyrus M Jalai
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 E 17th St, New York, NY 10003, USA
| | | | - Gregory W Poorman
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 E 17th St, New York, NY 10003, USA
| | - Justin K Scheer
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 676 N. St. Clair Street Suite 2210, Chicago, IL 60611, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, 415 Ray C. Hunt Dr., Charlottesville, VA 22908, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, 415 Ray C. Hunt Dr., Charlottesville, VA 22908, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Kai-Ming G Fu
- Department of Neurosurgery, Cornell University School of Medicine, 525 East 68th Street, Box 99 Starr 651, New York, NY 10065, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Oregon Health & Sciences University, 3147 S.W. Sam Jackson Park Road, Portland, OR 97239, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, Hospital for Special Surgery, New York, NY 10021, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, Hospital for Special Surgery, New York, NY 10021, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 E 17th St, New York, NY 10003, USA
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- International Spine Study Group, Arvada, CO, USA
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Simon MJK, Halm HFH, Quante M. Perioperative complications after surgical treatment in degenerative adult de novo scoliosis. BMC Musculoskelet Disord 2018; 19:10. [PMID: 29316936 PMCID: PMC5761192 DOI: 10.1186/s12891-017-1925-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 12/27/2017] [Indexed: 01/14/2023] Open
Abstract
Background Degenerative adult de novo (DAD) scoliosis appears characteristically in the sixth or seventh decade with symptoms of severe back pain and radiculopathy or spinal claudication. The aim of this study was to enhance the knowledge of perioperative complications and detect possible risk factors in this selective DAD scoliosis surgery. Methods This retrospective study included only patients with DAD scoliosis undergone correction spondylodesis with previous failure of conservative treatment. Excluded were patients with other types of scoliosis and previous fusion surgeries. Patient epidemiological data, medical comorbidities and treatments were included. Intraoperative data and perioperative complications were documented. Analyses regarding early, late and no complications were undertaken. Results A total of 92 patients with a mean age of 67.29 ± 7.93 years and clinical follow-up visits of minimum 12 months were included. On average, 5.26 ± 2.24 segments were fused. Early complications (e.g. wound healing defects, paresis, screw loosing) occurred in 23 patients and often required a re-operation. Cardiac arrhythmias, pacemaker and coumarin derivative therapies were associated with increased perioperative complications. The transforaminal lumbar interbody fusion technique was associated with early complications. Adjacent segment failure occurred in 36% and was the major late complication. Twenty patients did not have any complications in the minimum follow-up. Conclusions This study analysed a selective DAD scoliosis collective and its’ surgical treatment outcomes. It identified numerous perioperative complications (adjacent segment failure, postoperative paresis and epidural hematoma) and multiple possible predisposing risk factors (e.g. operative techniques and anti-coagulation therapies). This here gained information raises awareness in preoperative patient selection and preparation. Further studies in DAD scoliosis and a risk-adjusted patient selection/preparation are needed to improve treatment quality and outcomes.
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Affiliation(s)
- Maciej J K Simon
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Spinal Surgery Center, Schön Klink Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany
| | - Henry F H Halm
- Spinal Surgery Center, Schön Klink Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany
| | - Markus Quante
- Spinal Surgery Center, Schön Klink Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany.
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Jun HS, Kim JH, Ahn JH, Chang IB, Song JH, Kim TH, Park MS, Chan Kim Y, Kim SW, Oh JK, Yoon DH. The Effect of Lumbar Spinal Muscle on Spinal Sagittal Alignment: Evaluating Muscle Quantity and Quality. Neurosurgery 2017; 79:847-855. [PMID: 27244469 DOI: 10.1227/neu.0000000000001269] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The majority of earlier studies of the parameters of sagittal balance did not consider the influence of spinal muscles on spinal sagittal alignment. OBJECTIVE To analyze the relationship between the paraspinal muscle (quantity and quality) and sagittal alignment in elderly patients. METHODS We reviewed 50 full-spine lateral standing radiographs and lumbar magnetic resonance images of elderly patients at a single center. The radiographic parameters examined were thoracic kyphosis, lumbar lordosis (LL), sagittal vertical axis, pelvic tilt, sacral slope, and pelvic incidence (PI). The lumbar muscularity (LM; quantity) and fatty degeneration ratio (FD; quality) in the paraspinal muscle were measured at the L3 level on magnetic resonance images. The relationships between the parameters, LM, and FD were analyzed with the Pearson correlation coefficient and multiple linear regression. RESULTS Pearson analysis demonstrated that the FD had significant correlations with age (r = 0.393), thoracic kyphosis (r = -0.559), pelvic tilt (r = 0.430), sagittal vertical axis (r = 0.488), and PI - LL (r = 0.479, P < .05), and a close negative correlation was found between the FD and LL (r = -0.505, P < .01). The LM had significant correlations with the LL (r = 0.342) and PI - LL (r = -0.283, P < .05). Regression models that controlled for confounding factors such as body mass index confirmed the correlations between the above parameters and FD (P < .05). CONCLUSION The quality of the paraspinal muscle could be one of the various factors that influence sagittal balance. ABBREVIATIONS BMI, body mass indexCSA, cross-sectional areaFD, fatty degeneration ratioLL, lumbar lordosisLM, lumbar muscularityPI, pelvic incidencePT, pelvic tiltSC, subcutaneous fatSS, sacral slopeSVA, sagittal vertical axisTK, thoracic kyphosisVB, vertebral body.
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Affiliation(s)
- Hyo Sub Jun
- Departments of ‡Neurosurgery and §Orthopedics, Hallym University Sacred Heart Hospital, Anyang, Korea; ¶Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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Wong E, Altaf F, Oh LJ, Gray RJ. Adult Degenerative Lumbar Scoliosis. Orthopedics 2017; 40:e930-e939. [PMID: 28598493 DOI: 10.3928/01477447-20170606-02] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/09/2017] [Indexed: 02/03/2023]
Abstract
Adult degenerative lumbar scoliosis is a 3-dimensional deformity defined as a coronal deviation of greater than 10°. It causes significant pain and disability in the elderly. With the aging of the population, the incidence of adult degenerative lumbar scoliosis will continue to increase. During the past decade, advancements in surgical techniques and instrumentation have changed the management of adult spinal deformity and led to improved long-term outcomes. In this article, the authors provide a comprehensive review of the pathophysiology, diagnosis, and management of adult degenerative lumbar scoliosis. [Orthopedics. 2017; 40(6):e930-e939.].
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Orientation of the Upper-most Instrumented Segment Influences Proximal Junctional Disease Following Adult Spinal Deformity Surgery. Spine (Phila Pa 1976) 2017; 42:1570-1577. [PMID: 28441306 DOI: 10.1097/brs.0000000000002191] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of a prospective database. OBJECTIVE The aim of this study was to define the role of sagittal orientation of the construct at the upper instrumented levels in the development of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) patients. SUMMARY OF BACKGROUND DATA PJK following ASD surgery remains challenging. The final alignment of the upper instrumented vertebral segments has been proposed as a risk factor for PJK, but has not been fully investigated. METHODS ASD patients with 2-year follow-up and long posterior fusion to the pelvis were analyzed. Radiographic measurements included pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt (PT), sagittal vertical axis, and two upper-most instrumented vertebra (UIV) parameters: UIV slope (UIV vs. horizontal) and inclination of the proximal-end of the construct. UIV parameters were secondarily evaluated with regard to the compensatory impact of post-PJK increased PT (PREF). A comparison between PJK and non-PJK patients was performed, according to the UIV location (upper thoracic [UT] or thoracolumbar). RESULTS A total of 252 patients (mean age, 61.5 years, 83% females) were included. PJK incidence was 56% at 2-years. PJK patients had a greater change in LL and thoracic kyphosis than non-PJK patients. In the UT group, there was no difference in UIV slope for PJK versus non-PJK. However, PJK patients had a smaller inclination of the upper instrumented segments versus vertical (P < 0.001) and the PREF (P = 0.005). Similarly, in the LT group, PJK patients had a posterior inclination versus the vertical (P < 0.001) and the PREF (P = 0.041). CONCLUSION Analysis revealed that a more posterior construct inclination was present in patients who developed PJK. These results support previous hypotheses suggesting that PJK may develop in response to excessive spinal realignment. Proper rod contouring, especially at the proximal end, may reduce the risk of PJK. LEVEL OF EVIDENCE 3.
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Principal Radiographic Characteristics for Cervical Spinal Deformity: A Health-related Quality-of-life Analysis. Spine (Phila Pa 1976) 2017; 42:1375-1382. [PMID: 28277386 DOI: 10.1097/brs.0000000000002144] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The aim of this study was to propose radiographic characteristics of patients with cervical disability and to investigate the relevant parameters when assessing cervical alignment. SUMMARY OF BACKGROUND DATA Although cervical kyphosis is traditionally recognized as presentation of cervical deformity, an increasing number of studies demonstrated that cervical kyphosis may not equal cervical deformity. Therefore, several other differentiating criteria for cervical deformity should be investigated and supported with quality of life scores. METHODS A database of full-body radiographs was retrospectively reviewed. Patients without previous cervical surgery, with a well-aligned thoracolumbar profile (defined as T1 pelvis angle <15°), and with an available Neck Disability Index (NDI) score were reviewed in this study. Subjects were stratified into an asymptomatic (64 subjects with NDI ≤15, Visual Analogue Scale [VAS] neck ≤3, and VAS arm ≤3) and a symptomatic group (107 subjects with NDI >15, VAS neck >3, or VAS arm >3). Independent t tests were performed to investigate differences between two groups. Logistic regressions and principal component analyses were then performed. RESULTS NDI averaged 5.43 in asymptomatic group, significantly smaller than symptomatic group (5.43 vs. 41.25). t Test revealed that C2-C7 sagittal vertical axis (SVA), McGregor slope, and the slope of line of sight (SLS) were significantly different while C2-C7 angle (cervical curvature, CC) did not show statistical difference (P = 0.09). Logistic regressions were performed using the significantly different parameters as well as CC. Results identified C2-C7 SVA and SLS as independent risk factors for low health-related quality of life. The principal component analysis leads to a new factor (0.55 × C2C7SVA + 0.34 × COC2 + 0.77 × CC) with strong correlations with NDI, VAS, and EQ5D measurements. CONCLUSION The traditional concept of cervical kyphosis should not be regarded as a standalone criterion of cervical deformity. The most clinically relevant components of cervical analysis are the C2-C7 SVA, C0C2 angle, and C2C7 angle. In addition, the three components should be assessed together in harmony and not individually. LEVEL OF EVIDENCE 4.
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