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The effect of age, BMI, and bone mineral density on the various lumbar vertebral measurements in females. Surg Radiol Anat 2020; 43:101-108. [PMID: 32876743 DOI: 10.1007/s00276-020-02560-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Healthy spinal balance is dependent on spinal sagittal alignment. It is evaluated by several spinopelvic measures. The objective of this study is to investigate the effect of age and body mass index and the bone mineral density on the several vertebral measures and sagittal spinopelvic measurements. METHODS In this cross-sectional study, a total of 89 female patients were grouped according to age (> 70, < 70); to BMI (underweight (< 18.5 kg/m2), normal weight (18.5-25 kg/m2), overweight (25-30 kg/m2); and to spine T scores (normal, osteopenia, and osteoporosis). On lateral lumbar X-ray, lumbar lordosis (LL) angle and pelvic incidence (PI) are measured. On sagittal T2 MRI images, anterior and posterior vertebral heights and foraminal height and area of the L1-L5 segments were measured. RESULTS The mean age of the participants was 70.54 ± 6.49. The distribution of the patients in BMI groups and BMD groups were even. Mean lumber lordosis (LL) was 48.27 ± 18.06, and the mean pelvic incidence (PI) was 60.20 ± 15.74. In the younger age group, LL was found to be higher than the older age group. The vertebral and spinopelvic angle measures within the different BMI and BMD groups revealed no difference in between. There were no statistically significant difference in correlation analysis. CONCLUSION In this cross-sectional study, the results revealed that younger patients have higher lordosis angle, and normal BMD patients have higher foraminal height and area measures than osteoporotic and osteopenic patients. Obesity seemed not to have any influence on vertebral measures. Spinopelvic parameters seem not to be effected by BMD and BMI.
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Clinical Performance and Concurrent Validity of the Adult Spinal Deformity Surgical Decision-making Score. Spine (Phila Pa 1976) 2020; 45:E847-E855. [PMID: 32609469 DOI: 10.1097/brs.0000000000003434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter, retrospective study. OBJECTIVE The aim of this study was to examine the performance and concurrent validity of the adult spinal deformity surgical decision-making (ASD-SDM) score compared to decision-making factors in the ASD population. SUMMARY OF BACKGROUND DATA The ASD-SDM score, which has been recently proposed, is a scoring system to guide the selection of treatment modality for the ASD population. To secure the justification for its clinical use, it is necessary to verify its clinical performance and concurrent validity. METHODS A multicenter prospective ASD database was retrospectively reviewed. The data were analyzed separately in younger (≤40 years) and older (≥41 years) age groups. The discriminating capacity of the ASD-SDM score in cases who selected surgical and nonsurgical management was compared using area under the receiver operator characteristic curves (AUROC). Concurrent validity was examined using Spearman correlation coefficients, comparing factors that are reported to be associated with the decision-making process for ASD, including baseline symptomatology, health-related quality of life measures, and the severity of radiographic spinal deformity. RESULTS There were 338 patients (mean age: 26.6 years; 80.8% female; 129 surgical and 209 nonsurgical) in the younger age group and 750 patients (mean age: 63.5 years; 84.3% female; 410 surgical and 340 nonsurgical) in the older age group. In both younger and older patients, the ASD-SDM score showed a significantly higher performance for discriminating the surgical and nonsurgical cases (AUROC: 0.767, standard error [SE]: 0.026, P < 0.001, 95% confidence interval [CI]: 0.712-0.813; AUROC: 0.781, SE: 0.017, P < 0.001, 95% CI: 0.747-0.812, respectively) compared to the decision-making factors analyzed. In addition, the ASD-SDM showed significant correlations with multiple decision-making factors. CONCLUSION The ASD-SDM score alone can effectively grade the indication for surgical management whilst considering multiple decision-making factors. LEVEL OF EVIDENCE 3.
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Fujishiro T, Boissière L, Cawley DT, Larrieu D, Gille O, Vital JM, Pellisé F, Pérez-Grueso FJS, Kleinstück F, Acaroglu E, Alanay A, Obeid I. Adult spinal deformity surgical decision-making score. Part 2: development and validation of a scoring system to guide the selection of treatment modalities for patients above 40 years with 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; 29:45-53. [PMID: 31317308 DOI: 10.1007/s00586-019-06068-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/01/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We aimed to develop and internally validate a scoring system, the adult spinal deformity surgical decision-making (ASD-SDM) score, to guide the decision-making process for ASD patients aged above 40 years. METHODS A multicentre prospective ASD database was retrospectively reviewed. The scoring system was developed using data from a derivation set and was internally validated in a validation set. The performance of the ASD-SDM score for predicting surgical management was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS A total of 702 patients were included for analysis in the present study. The scoring system developed based on 562 patients, ranging from 0 to 12 points, included five parameters: leg pain scored by the numerical rating scale; pain and self-image domains in the Scoliosis Research Society-22 score; coronal Cobb angle; and relative spinopelvic alignment. Surgical indication was graded as low (score 0 to 4), moderate (score 5 to 7), and high (score 8 to 12) groups. In the validation set of 140 patients, the AUC for predicting surgical management according to the ASD-SDM score was 0.797 (standard error = 0.037, P < 0.001, 95% confidence interval = 0.714 to 0.861), and in the low, moderate, and high surgical indication groups, 23.7%, 43.5%, and 80.4% of the patients, respectively, were treated surgically. CONCLUSIONS The ASD-SDM score demonstrated reliability, with higher scores indicating a higher probability of surgery. This index could aid in the selection of surgery for ASD patients in clinical settings. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki-shi, Osaka, 569-8686, Japan. .,L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France.
| | - Louis Boissière
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Derek Thomas Cawley
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Daniel Larrieu
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Gille
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Marc Vital
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ibrahim Obeid
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
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Rustenburg CME, Faraj SSA, Holewijn RM, Kingma I, van Royen BJ, Stadhouder A, Emanuel KS. The biomechanical effect of single-level laminectomy and posterior instrumentation on spinal stability in degenerative lumbar scoliosis: a human cadaveric study. Neurosurg Focus 2019; 46:E15. [PMID: 31042658 DOI: 10.3171/2019.2.focus1911] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDegenerative lumbar scoliosis, or de novo degenerative lumbar scoliosis, can result in spinal canal stenosis, which is often accompanied by disabling symptoms. When surgically treated, a single-level laminectomy is performed and short-segment posterior instrumentation is placed to restore stability. However, the effects of laminectomy on spinal stability and the necessity of placing posterior instrumentation are unknown. Therefore, the aim of this study was to assess the stability of lumbar spines with degenerative scoliosis, characterized by the range of motion (ROM) and neutral zone (NZ) stiffness, after laminectomy and placement of posterior instrumentation.METHODSTen lumbar cadaveric spines (T12-L5) with a Cobb angle ≥ 10° and an apex on L3 were included. Three loading cycles were applied per direction, from -4 Nm to 4 Nm in flexion/extension (FE), lateral bending (LB), and axial rotation (AR). Biomechanical evaluation was performed on the native spines and after subsequent L3 laminectomy and the placement of posterior L2-4 titanium rods and pedicle screws. Nonparametric and parametric tests were used to analyze the effects of laminectomy and posterior instrumentation on NZ stiffness and ROM, respectively, both on an individual segment's motion and on the entire spine section. Spearman's rank correlation coefficient was used to study the correlation between disc degeneration and spinal stability.RESULTSThe laminectomy increased ROM by 9.5% in FE (p = 0.04) and 4.6% in LB (p = 0.01). For NZ stiffness, the laminectomy produced no significant effects. Posterior instrumentation resulted in a decrease in ROM in all loading directions (-22.2%, -24.4%, and -17.6% for FE, LB, and AR, respectively; all p < 0.05) and an increase in NZ stiffness (+44.7%, +51.7%, and +35.2% for FE, LB, and AR, respectively; all p < 0.05). The same changes were seen in the individual segments around the apex, while the adjacent, untreated segments were mostly unaffected. Intervertebral disc degeneration was found to be positively correlated to decreased ROM and increased NZ stiffness.CONCLUSIONSLaminectomy in lumbar spines with degenerative scoliosis did not result in severe spinal instability, whereas posterior instrumentation resulted in a rigid construct. Also, prior to surgery, the spines already had lower ROM and higher NZ stiffness in comparison to values shown in earlier studies on nonscoliotic spines of the same age. Hence, the authors question the clinical need for posterior instrumentation to avoid instability.
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Affiliation(s)
| | - Sayf S A Faraj
- 2Department of Orthopedic Surgery, Radboud UMC, Nijmegen
| | | | - Idsart Kingma
- 4Amsterdam Movement Sciences, Faculty of Movement Sciences, Vrije Universiteit, Amsterdam; and
| | - Barend J van Royen
- 1Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam
| | - Agnita Stadhouder
- 1Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam
| | - Kaj S Emanuel
- 1Amsterdam Movement Sciences, Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam.,5Department of Orthopaedic Surgery, Maastricht UMC+, Maastricht, The Netherlands
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Fujishiro T, Boissière L, Cawley DT, Larrieu D, Gille O, Vital JM, Pellisé F, Pérez-Grueso FJS, Kleinstück F, Acaroglu E, Alanay A, Obeid I. Adult spinal deformity surgical decision-making score : Part 1: development and validation of a scoring system to guide the selection of treatment modalities for patients below 40 years with 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; 28:1652-1660. [PMID: 30847705 DOI: 10.1007/s00586-019-05932-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/04/2019] [Accepted: 02/26/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to develop and internally validate a simple scoring system: the adult spinal deformity (ASD) surgical decision-making (ASD-SDM) score, which is specific to the decision-making process for ASD patients aged below 40 years. METHODS A multicentre prospective ASD database was retrospectively reviewed. The scoring system was developed using data from a derivation cohort and was internally validated in a validation cohort. The accuracy of the ASD-SDM score was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS A total of 316 patients were randomly divided into derivation (253 patients, 80%) and validation (63 patients, 20%) cohorts. A 10-point scoring system was created from four variables: self-image score in the Scoliosis Research Society-22 score, coronal Cobb angle, pelvic incidence minus lumbar lordosis mismatch, and relative spinopelvic alignment, and the surgical indication was graded into low (score 0-4), moderate (score 5-7), and high (score 8-10) surgical indication groups. In the validation cohort, the AUC for selecting surgical management according to the ASD-SDM score was 0.789 (SE 0.057, P < 0.001, 95% CI 0.655-0.880). The percentage of patients treated surgically were 21.1%, 55.0%, and 80.0% in the low, moderate, and high surgical indication groups, respectively. CONCLUSIONS The ASD-SDM score, to the best of our knowledge, is the first algorithm to guide the decision-making process for the ASD population and could be one of the indices for aiding the selection of treatment for ASD. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki-shi, Osaka, 569-8686, Japan. .,Bordeaux University Hospital, L'Institut de la Colonne Vertébrale, Bordeaux, France.
| | - Louis Boissière
- Bordeaux University Hospital, L'Institut de la Colonne Vertébrale, Bordeaux, France
| | - Derek Thomas Cawley
- Bordeaux University Hospital, L'Institut de la Colonne Vertébrale, Bordeaux, France
| | - Daniel Larrieu
- Bordeaux University Hospital, L'Institut de la Colonne Vertébrale, Bordeaux, France
| | - Olivier Gille
- Bordeaux University Hospital, L'Institut de la Colonne Vertébrale, Bordeaux, France
| | - Jean-Marc Vital
- Bordeaux University Hospital, L'Institut de la Colonne Vertébrale, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ibrahim Obeid
- Bordeaux University Hospital, L'Institut de la Colonne Vertébrale, Bordeaux, France
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Faraj SSA, Boselie TFM, Vila-Casademunt A, de Kleuver M, Holewijn RM, Obeid I, Acaroglu E, Alanay A, Kleinstück F, Pérez-Grueso FS, Pellisé F. Radiographic Axial Malalignment is Associated With Pretreatment Patient-Reported Health-Related Quality of Life Measures in Adult Degenerative Scoliosis: Implementation of a Novel Radiographic Software Tool. Spine Deform 2019; 6:745-752. [PMID: 30348354 DOI: 10.1016/j.jspd.2018.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 10/28/2022]
Abstract
STUDY DESIGN Retrospective study of prospectively collected data. OBJECTIVES The purpose of this study was to evaluate the relationship between apical vertebral axial rotation and pretreatment patient-reported health-related quality of life (HRQOL), disability, and pain in patients with adult degenerative scoliosis (ADS) using a novel radiographic software tool. SUMMARY OF BACKGROUND DATA Recent studies have demonstrated that in ADS, sagittal and coronal plane deformity are weakly to moderately associated with HRQOL, disability, and pain. However, as ADS is a three-dimensional spinal deformity, the impact of axial malalignment on HRQOL is yet to be determined. METHODS A total of 74 ADS patients were enrolled. HRQOL measures included the Short Form-36v2 (SF-36v2) and Scoliosis Research Society questionnaire (SRS-22r). Disability and pain measures included the Oswestry Disability Index (ODI) and numeric rating scale back and leg pain. Radiographic measures included Cobb angle (CA), sagittal spinopelvic parameters, lateral and anteroposterior (AP) translation of the apical vertebra. The amount of apical vertebral axial rotation was measured on digital AP radiograph images using a novel software technology. Subjects were stratified into four clinical groups based on the degree of apical vertebral axial rotation. RESULTS Apical vertebral axial rotation showed no association with lateral (r = 0.21; p = .15) and AP (r = 0.08, p = .80) translation of the apical vertebra. A significant moderate association was found between apical vertebral axial rotation and Cobb angle (r = 0.57; p < .05). Patients in the group with the highest degree of apical vertebral axial rotation reported significantly worse ODI and SRS-22r Subtotal and Pain scores (p < .05), irrespective of sagittal spinopelvic parameters. CONCLUSIONS This is the first study that reports on the association between apical vertebral axial rotation and pretreatment HRQOL, disability, and pain in ADS. This study suggests that increased apical vertebral axial rotation is associated with suboptimal pretreatment health status scores. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sayf S A Faraj
- Orthopedics, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | - Toon F M Boselie
- Neurosurgery, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Alba Vila-Casademunt
- Spine Surgery Unit, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Marinus de Kleuver
- Orthopedics, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Roderick M Holewijn
- Orthopaedic Surgery, VU Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ibrahim Obeid
- Spine Unit, Bordeaux University Hospital, 12 rude Dubernat, Talence 33404, Bordeaux, France
| | - Emre Acaroglu
- Ankara Spine Center, Iran Caddesi, 45/2, Kavaklidere, Ankara, Turkey
| | - Ahmet Alanay
- Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, İçerenköy Mahallesi, Kayışdağı Cd. No: 32, 34752, Ataşehir/Istanbul, Turkey
| | | | - Francisco S Pérez-Grueso
- Spine Surgery Unit, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Ferran Pellisé
- Spine Surgery Unit, Vall d'Hebron Hospital, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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Faraj SSA, De Kleuver M, Vila-Casademunt A, Holewijn RM, Obeid I, Acaroğlu E, Alanay A, Kleinstück F, Pérez-Grueso FS, Pellisé F. Sagittal radiographic parameters demonstrate weak correlations with pretreatment patient-reported health-related quality of life measures in symptomatic de novo degenerative lumbar scoliosis: a European multicenter analysis. J Neurosurg Spine 2018; 28:573-580. [DOI: 10.3171/2017.8.spine161266] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPrevious studies have demonstrated that among patients with adult spinal deformity (ASD), sagittal plane malalignment is poorly tolerated and correlates with suboptimal patient-reported health-related quality of life (HRQOL). These studies included a broad range of radiographic abnormalities and various types of ASD. However, the clinical and radiographic characteristics of de novo degenerative lumbar scoliosis (DNDLS), a subtype of ASD, may influence previously reported correlation strengths. The aim of this study was to correlate sagittal radiographic parameters with pretreatment HRQOL in patients with symptomatic DNDLS.METHODSIn this multicenter retrospective study of prospectively collected data, 74 patients with symptomatic DNDLS were enrolled based on anteroposterior and lateral 36-inch standing radiographs. Measurements included Cobb angle, coronal imbalance, pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), thoracic kyphosis, pelvic incidence minus lumbar lordosis (PI−LL), T1-pelvic angle, and global tilt. HRQOL questionnaires included the Oswestry Disability Index (ODI), Scoliosis Research Society (SRS-22r), 36-item Short-Form Health Survey, and numeric rating scale (NRS) for back and leg pain. Correlations between radiographic parameters and HRQOL were assessed. Finally, HRQOL and increasing severity of sagittal modifiers (SVA, PI−LL, and PT) were evaluated.RESULTSWeak correlations were found between SVA and ODI (r = 0.296, p < 0.05) and PT with NRS back pain and the SRS pain domain (r = −0.260, p < 0.05, and r = 0.282, p < 0.05, respectively). Other sagittal radiographic parameters did not show any significant correlation with HRQOL. No significant differences in HRQOL were found concerning the increasing severity of PT, PI−LL, and SVA.CONCLUSIONSWhile DNDLS is a severe disabling condition, no noteworthy association between clinical and sagittal radiographic parameters was found through this study, demonstrating that sagittal radiographic parameters should not be considered the unique predictor of pretreatment suboptimal health status in this specific group of patients. Future studies addressing classification and treatment algorithms will have to take into account the existing subgroups of ASD.
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Affiliation(s)
- Sayf S. A. Faraj
- 1Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands
- 2Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marinus De Kleuver
- 1Department of Orthopedics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Roderick M. Holewijn
- 2Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Ibrahim Obeid
- 4Spine Unit, Bordeaux University Hospital, Bordeaux, France
| | - Emre Acaroğlu
- 5Department of Orthopedics and Traumatology, Ankara Spine Center, Ankara, Turkey
| | - Ahmet Alanay
- 6Department of Orthopedics and Traumatology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | | | | | - Ferran Pellisé
- 3Spine Surgery Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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Fujishiro T, Boissière L, Cawley DT, Larrieu D, Gille O, Vital JM, Pellisé F, Pérez-Grueso FJS, Kleinstück F, Acaroglu E, Alanay A, Obeid I. Decision-making factors in the treatment of 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; 27:2312-2321. [PMID: 29603012 DOI: 10.1007/s00586-018-5572-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 02/19/2018] [Accepted: 03/27/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE We aimed to elucidate the factors for the decision-making process in the treatment of adult spinal deformity (ASD), including sagittal parameters, that impact health-related quality of life (HRQOL). METHODS A multicenter prospective ASD database was retrospectively reviewed. The demographic data, HRQOL, and radiographic measures were analyzed using multivariate analyses in younger (≤ 50 years) and older (> 50 years) age groups. RESULTS This study included 414 patients (134 surgical and 280 nonsurgical; mean age 30.7 years) in the younger age group and 575 patients (323 surgical and 252 nonsurgical; mean age 65.8 years) in the older age group. Worse HRQOL measures drove surgical treatment, both in younger and older patients. The SRS-22 self-image score was the most differentiating domain, both in the younger and older age groups, and an additional significant factor in the older age group was pain and disability. Coronal deformity drove surgical treatment for the younger age group; however, older surgical patients were less likely to have coronal malalignment. Sagittal parameters were associated with the decision-making process. Greater pelvic incidence minus lumbar lordosis mismatch in the younger age group and smaller lumbar lordosis index in the older age group were most correlated with the decision to undergo surgery. CONCLUSIONS Aside from the HRQOL measures and coronal deformity, sagittal parameters were identified as significant factors for the decision-making process in the ASD population, and the lack of lumbar lordosis in relation to pelvic incidence was a strong driver to pursue surgical treatment. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Takashi Fujishiro
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France. .,Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan.
| | - Louis Boissière
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Derek Thomas Cawley
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Daniel Larrieu
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Olivier Gille
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Jean-Marc Vital
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ibrahim Obeid
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France
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Patel A, Oh J, Leven D, Cautela FS, Chatterjee D, Naziri Q, Langella F, Diebo BG, Paulino CB. Anatomical Modifications during the Lateral Transpsoas Approach to the Lumbar Spine. The Impact of Vertebral Rotation. Int J Spine Surg 2018; 12:8-14. [PMID: 30280077 DOI: 10.14444/5002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background We investigated impact of vertebral axial rotation on neurovascular anatomy in adult spinal deformity (ASD) patients and provided recommendations on the approach based on degree of axial rotation. In order to isolate vertebral rotation (VR) impact from the superimposed degenerative cascade observed in adulthood, adolescent idiopathic scoliosis (AIS) patients were analyzed. Methods Magnetic resonance imaging (MRI) scans (L1-S1) from 50 right-convex thoracic (left-convex lumbar) AIS patients were analyzed. At each intervertebral level, VR, lumbar plexus depth (LPD), and vascular structure depth (VSD) were evaluated. Paired t test analyses were used to describe anatomic differences between the concave and convex aspect of our patients' curves. Correlation analysis was used to investigate relationships with soft tissue modifications and VR. Results Fifty AIS patients (17M, 33F) with mean thoracic Cobb of 50.6° ± 17.0° and mean lumbar Cobb of 41.9° ± 13.0° were included. Mean VR at each level was L1-2 = -6.6°, L2-3 = -7.7°, L3-4 = -6.5°, L4-5 = -4.7°, L5-S1 = -2.6° (negative value denotes clockwise rotation). We found significant differences (P < .05) between concave-convex (right-left) LPD at each level (L1-2 = 3.7 mm, L2-3 = 5.1 mm, L3-4 = 4.2 mm, L4-5 = 2.2 mm, L5-S1 = 2.2 mm). Vascular structure depth was significantly different at L1-L2 (3.2 mm) and L5-S1 (3 mm). Significant correlation was found between increasing VR and concave-convex LPD difference (r = 0.68, P < .001). Conclusions This study demonstrates that displacement of the lumbar plexus is tied to the magnitude of VR in patients with AIS. When approaching the lumbar spine, this displacement widens the safe surgical corridor on the convex side and narrows the corridor on the concave side. Level of Evidence IV. Clinical Relevance Preoperative review of MRI scans should occur to assess the patient's safe surgical corridor for lateral lumbar interbody fusion (LLIF). Adult spinal deformity surgeons who approach a degenerated spine in patients with progressive AIS in adulthood must carefully plan for patient positioning, neurovascular anatomy, and realignment objectives prior to the day of surgical intervention.
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Affiliation(s)
- Ashish Patel
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, New York
| | - Jason Oh
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, New York
| | - Dante Leven
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, New York
| | - Frank S Cautela
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, New York
| | - Dipal Chatterjee
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, New York
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, New York
| | | | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, New York
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, New York
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Miller CA, Fu KM, Mummaneni PV. Editorial. The relevance of sagittal radiographic parameters. J Neurosurg Spine 2018; 28:571-572. [PMID: 29570049 DOI: 10.3171/2017.9.spine17857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Catherine A Miller
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Kai-Ming Fu
- 2Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
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