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Passias PG, Passfall L, Moattari K, Krol O, Kummer NA, Tretiakov P, Williamson T, Joujon-Roche R, Imbo B, Burhan Janjua M, Jankowski P, Paulino C, Schwab FJ, Owusu-Sarpong S, Singh V, Ahmad S, Onafowokan T, Lebovic J, Tariq M, Saleh H, Vira S, Smith JS, Diebo B, Schoenfeld AJ. Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery: A 3-Year Outcome Analysis. Spine (Phila Pa 1976) 2024; 49:90-96. [PMID: 37199423 DOI: 10.1097/brs.0000000000004717] [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: 09/13/2021] [Accepted: 12/07/2022] [Indexed: 05/19/2023]
Abstract
STUDY DESIGN This was a retrospective review. OBJECTIVE To assess the factors contributing to durability of surgical results following adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND Factors contributing to the long-term sustainability of ASD correction are currently undefined. MATERIALS AND METHODS Operative ASD patients with preoperatively (baseline) and 3-year postoperatively radiographic/health-related quality of life data were included. At 1 and 3 years postoperatively, a favorable outcome was defined as meeting at least three of four criteria: (1) no proximal junctional failure or mechanical failure with reoperation, (2) best clinical outcome (BCO) for Scoliosis Research Society (SRS) (≥4.5) or Oswestry Disability Index (ODI) (<15), (3) improving in at least one SRS-Schwab modifier, and (4) not worsening in any SRS-Schwab modifier. A robust surgical result was defined as having a favorable outcome at both 1 and 3 years. Predictors of robust outcomes were identified using multivariable regression analysis with conditional inference tree for continuous variables. RESULTS We included 157 ASD patients in this analysis. At 1 year postoperatively, 62 patients (39.5%) met the BCO definition for ODI and 33 (21.0%) met the BCO for SRS. At 3 years, 58 patients (36.9%) had BCO for ODI and 29 (18.5%) for SRS. Ninety-five patients (60.5%) were identified as having a favorable outcome at 1 year postoperatively. At 3 years, 85 patients (54.1%) had a favorable outcome. Seventy-eight patients (49.7%) met criteria for a durable surgical result. Multivariable adjusted analysis identified the following independent predictors of surgical durability: surgical invasiveness >65, being fused to S1/pelvis, baseline to 6-week pelvic incidence and lumbar lordosis difference >13.9°, and having a proportional Global Alignment and Proportion score at 6 weeks. CONCLUSIONS Nearly 50% of the ASD cohort demonstrated good surgical durability, with favorable radiographic alignment and functional status maintained up to 3 years. Surgical durability was more likely in patients whose reconstruction was fused to the pelvis and addressed lumbopelvic mismatch with adequate surgical invasiveness to achieve full alignment correction.
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Affiliation(s)
- Peter G Passias
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Lara Passfall
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Kevin Moattari
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Oscar Krol
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Nicholas A Kummer
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Peter Tretiakov
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Tyler Williamson
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Rachel Joujon-Roche
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Bailey Imbo
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | | | - Pawel Jankowski
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Carl Paulino
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Frank J Schwab
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | | | - Vivek Singh
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Salman Ahmad
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Tobi Onafowokan
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Jordan Lebovic
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Muhammad Tariq
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Hesham Saleh
- Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach
| | - Shaleen Vira
- Departments of Orthopaedic and Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA
| | - Bassel Diebo
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Park SJ, Lee CS, Park JS, Shin TS. Introduction of a New Radiographic Parameter to Predict Proximal Junctional Kyphosis in Adult Spinal Deformity: UIVPTA (Uppermost Instrumented Vertebra-Pelvic Tilt Angle). Neurospine 2023; 20:969-980. [PMID: 37798991 PMCID: PMC10562231 DOI: 10.14245/ns.2346420.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/23/2023] [Accepted: 06/26/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To introduce a new sagittal parameter, uppermost instrumented vertebra-pelvic tilt angle (UIVPTA), and to determine the effects on the proximal junctional kyphosis (PJK) development in adult spinal deformity (ASD) surgery. METHODS Patients ≥ 60 years with ASD who underwent low thoracic spine to pelvis fusion with a minimum of 2-years of follow-up were included in this study. Two groups were created according to PJK development. Various clinical and radiographic factors were compared between PJK and non-PJK groups to identify the risk factors for PJK. Cutoff value of UIVPTA for PJK development was calculated using receiver operating characteristic curve according to different pelvic incidence groups. Linear regression analysis was performed to identify factors to affect UIVPTA. RESULTS One hundred fifity-one patients were included in this study. There were 135 female patients (89.4%). Mean age was 70.5 years. PJK developed in 65 patients (43.0%). Multivariate analysis showed that overcorrection relative to age-adjusted pelvic incidence (PI) minus lumbar lordosis (LL) (PI-LL) target and lower UIVPTA were independent risk factors for PJK. The cutoff value of UIVPTA for PJK development was calculated as 4.0° in patients with PI less than 45°, 9.5° in patients with PI between 45° and 60°, and 13.0° in patients with PI greater than 60°. Linear regression analysis showed that UIVPTA was positively affected by postoperative values of LL (coefficient = 0.505), PI-LL (coefficient = 0.674), and pelvic tilt (coefficient = 0.286). CONCLUSION Optimal correction within the age-adjusted PI-LL combined with keeping UIVPTA within optimal range is suggested for the prevention of PJK.
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Affiliation(s)
- Se-Jun Park
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong-Suh Lee
- Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan, Korea
| | - Jin-Sung Park
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Soo Shin
- Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Validation of Age-adjusted Ideal Sagittal Alignment in Terms of Proximal Junctional Failure and Clinical Outcomes in Adult Spinal Deformity. Spine (Phila Pa 1976) 2022; 47:1737-1745. [PMID: 35917282 DOI: 10.1097/brs.0000000000004449] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To validate the age-adjusted ideal sagittal alignment in terms of proximal junctional failure (PJF) and clinical outcomes. SUMMARY OF BACKGROUND It is reported that optimal sagittal correction with regard to the age-adjusted ideal sagittal alignment reduces the risk of PJF development. However, few studies have validated this concept. The age-considered optimal correction is likely to be undercorrection in terms of conventional surgical target, such as pelvic incidence (PI)-lumbar lordosis (LL) within ±9°. Therefore, the clinical impact of age-adjusted sagittal alignment should be evaluated along with radiographic effect. MATERIALS AND METHODS Adult spinal deformity patients, aged 50 years and above, who underwent greater than or equal to four-level fusion to sacrum with a minimum of four years of follow-up data were included in this study. Radiographic risk factors for PJF (including age-adjusted ideal PI-LL) were evaluated with multivariate analyses. Three groups were created based on PI-LL offset between age-adjusted ideal PI-LL and actual actual PI-LL: undercorrection, ideal correction, and overcorrection. Clinical outcomes were compared among the three groups. RESULTS This study included 194 adult spinal deformity patients. The mean age was 68.5 years and there were 172 females (88.7%). PJF developed in 99 patients (51.0%) at a mean postoperative period of 14.9 months. Multivariate analysis for PJF revealed that only PI-LL offset group had statistical significance. The proportion of patients with PJF was greatest in the overcorrection group followed by the ideal correction and undercorrection groups. Overcorrected patients regard to the age-adjusted ideal alignment showed poorer clinical outcomes than the other patient groups. CONCLUSIONS Overcorrection relative to age-adjusted sagittal alignment increases the risk of PJF development and is associated with poor clinical outcomes. Older patients and those with small PI are likely to be overcorrected in terms of the age-adjusted PI-LL target. Therefore, the age-adjusted alignment should be considered more strictly in these patients.
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The validation study of preoperative surgical planning for corrective target in adult spinal deformity surgery with 5-year follow-up for mechanical complications. 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 2022; 31:3662-3672. [PMID: 36245039 DOI: 10.1007/s00586-022-07420-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE We used the Hamamatsu formula as an indicator of correction goals in surgery for adult spinal deformity (ASD). However, it is reported that correction according to Global Alignment and Proportion (GAP) score and the Roussouly algorithm reduces implant-related complications. The purpose of this study was to validate three preoperative plannings for the incidence of complications. METHODS Patients who underwent ASD surgery and followed up for 5 years were included. The Hamamatsu formula was also divided into three groups: ideal (I), moderate (M), and under (U). The GAP score was divided into three groups: proportioned (P), moderately disproportioned (MD), and severely disproportioned (SD). Patients who met the postoperative Roussouly classification algorithm were defined as the restored (R) group and those who did not were defined as the non-restored (NR) group. Proximal junctional kyphosis (PJK) and rod fractures were investigated. RESULTS In the Hamamatsu formula, there were 51, 108, and 44 patients in Groups I, M, and U, respectively, with no significant differences in their complications. In the GAP score, there were 45, 71, and 87 patients in the P, MD, and SD group, respectively, with no significant differences in their complications. In the Roussouly classification, there were 102 and 101 patients in the R and NR group, respectively, with a significant difference in their complication rate (R/NR = 51%:70%; P = 0.005). PJK was significantly lower in the R group (R/NR = 15%:30%; P = 0.010). CONCLUSION Correction according to the Roussouly algorithm is useful for the prevention of mechanical complications, especially PJK.
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Age and Gender Based Spinopelvic and Regional Spinal Alignment in Asymptomatic Adult Volunteers: Results of the Multi-Ethnic Alignment Normative Study (MEANS). Spine (Phila Pa 1976) 2022; 47:1382-1390. [PMID: 35797462 DOI: 10.1097/brs.0000000000004415] [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: 06/22/2021] [Accepted: 03/17/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Spinal alignment can have a significant impact on a patient's overall quality of life. Predicting the ideal sagittal spinal alignment of a specific individual is still a difficult task. The Multi-Ethnic Alignment Normative Study (MEANS) investigated skeletal alignment, including the spine and lower extremities, of the largest multi-ethnic cohort of asymptomatic adult volunteers. In this analysis, the authors aim to assess normative values of spinopelvic parameters and the regional cervical, thoracic, and lumbar spinal alignment in asymptomatic volunteers stratified by age and sex. MATERIALS AND METHODS Asymptomatic volunteers between ages 18 and 80 years were enrolled prospectively from centers in France, Japan, Singapore, Tunisia, and the United States. Volunteers included reported no significant neck or back pain (Visual Analog Scale ≤2), nor any known spinal disorder(s). All volunteers underwent a standing full-body or full-spine low-dose stereoradiograph. RESULTS MEANS consisted of 468 volunteers with a mean age of 40.4±14.8 years. Mean cervical lordosis from C2 to C7 was -0.4±12.7°. The T1-slope averaged 23.0±7.9° and showed strong correlation ( r =0.87) with the C7-slope mean of 19.8±8.6°. Thoracic kyphosis (TK) from T4 to T12 showed a mean of 37.4±10.9°. Average L1-S1 lumbar lordosis (LL) was -57.4±11.3°. The mean pelvic incidence (PI) measured 52.0±10.7° and pelvic tilt was 12.5±7.3°. Sacral slope averaged 39.5±8.2°. The average PI-LL was -5.4±10.7°. Approximately 60% of volunteers met the PI-LL criteria within ±10°, 8.3% were ≥10°, while 32.1% were ≤-10°. LL showed moderate correlation with PI ( r =0.53) and TK ( r =0.50), while there was no correlation between TK and PI. Multiple linear regression including PI, TK, and age resulted in the following equation LL=14.6+0.57 (PI)+0.57 (TK)-0.2 (age) ( r =0.75). CONCLUSIONS LL did not change with increasing age in asymptomatic volunteers. However, TK did increase with age leading to an increase in T1-slope and a compensatory increase in cervical lordosis. TK did not correlate with PI and was an independent variable in the prediction of LL. LEVEL OF EVIDENCE Level II-prospective cohort study.
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Nyayapati P, Booker J, Wu PIK, Theologis A, Dziesinski L, O'Neill C, Zheng P, Lotz JC, Matthew RP, Bailey JF. Compensatory biomechanics and spinal loading during dynamic maneuvers in patients with chronic low back pain. 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 2022; 31:1889-1896. [PMID: 35604457 PMCID: PMC9252943 DOI: 10.1007/s00586-022-07253-4] [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: 08/15/2021] [Revised: 04/06/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022]
Abstract
Purpose This study explores the biomechanics underlying the sit-to-stand (STS) functional maneuver in chronic LBP patients to understand how different spinal disorders and levels of pain severity relate to unique compensatory biomechanical behaviors. This work stands to further our understanding of the relationship between spinal loading and symptoms in LBP patients. Methods We collected in-clinic motion data from 44 non-specific LBP (NS-LBP) and 42 spinal deformity LBP (SD-LBP) patients during routine clinical visits. An RGB-depth camera tracked 3D joint positions from the frontal view during unassisted, repeated STS maneuvers. Patient-reported outcomes (PROs) for back pain (VAS) and low back disability (ODI) were collected during the same clinical visit. Results Between patient groups, SD-LBP patients had 14.3% greater dynamic sagittal vertical alignment (dSVA) and 10.1% greater peak spine torque compared to NS-LBP patients (p < 0.001). SD-LBP patients also had 11.8% greater hip torque (p < 0.001) and 86.7% greater knee torque (p = 0.04) compared to NS-LBP patients. There were no significant differences between patient groups in regard to anterior or vertical torso velocities, but anterior and vertical torso velocities correlated with both VAS (r = − 0.38, p < 0.001) and ODI (r = − 0.29, p = 0.01). PROs did not correlate with other variables. Conclusion Patients with LBP differ in movement biomechanics during an STS transfer as severity of symptoms may relate to different compensatory strategies that affect spinal loading. Further research aims to establish relationships between movement and PROs and to inform targeted rehabilitation approaches.
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Affiliation(s)
- Priya Nyayapati
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA.,Albany Medical College, Albany, NY, USA
| | - Jacqueline Booker
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA.,School of Medicine, University of California, San Francisco, CA, USA
| | - Peter I-Kung Wu
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Alekos Theologis
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Lucas Dziesinski
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Conor O'Neill
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Patricia Zheng
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Robert P Matthew
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA
| | - Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California, 95 Kirkham St., San Francisco, CA, 94122, USA.
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Byun CW, Cho JH, Lee CS, Lee DH, Hwang CJ. Effect of overcorrection on proximal junctional kyphosis in adult spinal deformity: analysis by age-adjusted ideal sagittal alignment. Spine J 2022; 22:635-645. [PMID: 34740820 DOI: 10.1016/j.spinee.2021.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/06/2021] [Accepted: 10/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The effect of the degree of lumbar lordosis (LL) correction on proximal junctional kyphosis (PJK) has not been analyzed in context of the age-adjusted sagittal alignment goal. PURPOSE To determine the effect of sagittal correction on the incidence of PJK after an age-adjusted analysis in patients with adult spinal deformity (ASD). STUDY DESIGN/SETTING Retrospective comparative study. PATIENT SAMPLE Seventy-eight ASD patients who underwent deformity correction. OUTCOME MEASURES Visual analog scale (VAS), Oswestry Disability Index (ODI), and imaging. METHODS This study included 78 ASD patients who underwent deformity correction and were followed-up more than 2 years. Patients were grouped according to the degree of LL correction relative to pelvic incidence (PI) by adjusting for age using the following formula: (age-adjusted ideal PI - LL) - (postoperative PI - LL). These were group U (undercorrection; <-10˚, N=15), group I (ideal correction; -10˚-10˚, N=34), and group O (over correction, >10˚, N=29). Various clinical and radiological parameters were compared among groups. The risk factors for PJK were also evaluated. RESULTS The overall incidence of PJK was 32.1% (25/78), with significantly higher PJK rate in group O (48.3%) compared with groups U (13.3%) and I (26.5%) (p=.041). The degree of postoperative LL correction relative to the PI by adjusting for age was a risk factor for the development of PJK (11.4° for PJK vs. 0.2° for non-PJK, p=.033). In addition, 2-year postoperative VAS (7.0 vs. 3.4, p<.001) and ODI (28.9 vs. 24.8, p=.040) scores were significantly higher in the PJK group than in the non-PJK group. A small PI (PI < 45°) was associated with a tendency of overcorrection (73.3%, P < 0.001) and thereby with the high incidence of PJK (53.3%, p=.005). CONCLUSIONS Overcorrection of LL relative to PI considering age-adjusted ideal sagittal alignment tends to increase the incidence of PJK. The incidence of PJK is expected to be high in patients with low PI (<45°) because of the tendency of overcorrection. To reduce the risk of PJK, surgeons should take age-adjusted parameters into account and exercise caution not to overcorrect patients with low PI, since this can result in suboptimal clinical outcomes.
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Affiliation(s)
- Chan Woong Byun
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Perioperative Predictive Factors for Positive Outcomes in Spine Fusion for Adult Deformity Correction. J Clin Med 2021; 11:jcm11010144. [PMID: 35011885 PMCID: PMC8745190 DOI: 10.3390/jcm11010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/21/2021] [Accepted: 12/26/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: Identifying perioperative factors that may influence the outcomes of long spine fusion for the treatment of adult deformity is key for tailored surgical planning and targeted informed consent. The aim of this study was to analyze the association between demographic or perioperative factors and clinical outcomes 2 years after long spine fusion for the treatment of adult deformity. Methods: This study is a multivariate analysis of retrospectively collected data. All patients who underwent long fusion of the lumbar spine for adult spinal deformity (January 2016–June 2019) were included. The outcomes of interest were the Oswestry disability index (ODI), visual analogic scale (VAS) preoperatively and at 1 and 2 years’ follow up, age, body mass index, American Society of Anaesthesiologists (ASA) score, upper and lowest instrumented vertebrae (UIV and LIV, respectively), length of surgery, estimated blood loss, and length of hospital stay. Results: Data from 192 patients were available. The ODI at 2 years correlated weakly to moderately with age (r = 0.4), BMI (r = 0.2), ASA (r = 0.3), and LIV (r = 0.2), and strongly with preoperative ODI (r = 0.6). The leg VAS at 2 years moderately correlated with age (r = 0.3) and BMI (r = 0.3). Conclusion: ODI and VAS at 2 years’ follow-up had no to little association to preoperative age, health status, LIV, or other peroperative data, but showed a strong correlation with preoperative ODI and pain level.
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Arima H, Hasegawa T, Yamato Y, Yoshida G, Banno T, Oe S, Mihara Y, Ushirozako H, Yamada T, Watanabe Y, Ide K, Nakai K, Kurosu K, Matsuyama Y. Importance of achieving Scoliosis Research Society-22r minimal clinically important difference for improving patient satisfaction after adult spinal deformity surgery. J Neurosurg Spine 2021; 35:495-503. [PMID: 34298504 DOI: 10.3171/2021.1.spine201855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Achievement of minimal clinically important differences (MCIDs) in the Scoliosis Research Society-22r (SRS-22r) subdomains represents surgical efficacy. However, whether achievements of MCIDs in SRS-22r domains are associated with long-term satisfaction in patients with adult spinal deformity (ASD) is unclear. This study aimed to elucidate factors affecting patient satisfaction after thoracopelvic corrective fusion surgery in patients with ASD. METHODS Data obtained in 187 patients with ASD who underwent extensive corrective fusion surgery from the thoracic spine to the pelvis between 2010 and 2017 and underwent follow-up for 2 years were retrospectively reviewed. The authors investigated the likelihood of achieving MCIDs in the function, pain, self-image, mental health, and subtotal domains 2 years after surgery. The following MCID values were used: function, 0.90; pain, 0.85; self-image, 1.05; mental health, 0.70; and subtotal, 1.05. Multivariate analysis was performed to evaluate factors associated with patient satisfaction 2 years after surgery. RESULTS The average satisfaction scores in the group that achieved MCID and the group that did not were as follows: 3.97 and 3.37 for function (p < 0.001), 3.66 and 3.51 for pain (p = 0.221), 3.84 and 3.06 for self-image (p < 0.001), 3.82 and 3.28 for mental health (p < 0.001), and 3.96 and 3.30 for subtotal (p < 0.001), respectively. Except for the pain domain, the group that achieved MCIDs showed greater satisfaction than the group that did not achieve MCIDs. On multivariate analysis, factors related to postoperative satisfaction were achievement of SRS-22r self-image (standardization coefficient 0.322, p < 0.001) and function (standardization coefficient 0.179, p = 0.026) MCIDs. Perioperative complications and revision surgery were not related to patient satisfaction. CONCLUSIONS Multivariate analysis demonstrated that achievement of MCIDs in SRS-22r self-image and function domains was significantly associated with postoperative satisfaction. Given that patients with poor preoperative health-related quality of life are more likely to achieve MCIDs in SRS-22r domains, surgeons should carefully consider whether to operate on patients with relatively good baseline health-related quality of life when making surgical decisions.
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Affiliation(s)
| | | | - Yu Yamato
- 1Department of Orthopaedic Surgery and
- 2Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu-City, Shizuoka, Japan
| | | | | | - Shin Oe
- 1Department of Orthopaedic Surgery and
- 2Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu-City, Shizuoka, Japan
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Arima H, Yamato Y, Hasegawa T, Togawa D, Yoshida G, Yasuda T, Banno T, Oe S, Ushirozako H, Yamada T, Watanabe Y, Ide K, Matsuyama Y. Improvements in physical functionality in elderly patients with spinal deformity after corrective fusion surgery: a gait analysis. J Neurosurg Spine 2021; 35:235-242. [PMID: 34087789 DOI: 10.3171/2020.10.spine201323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Extensive corrective fusion surgery was performed on elderly patients with adult spinal deformity (ASD) to improve abnormal posture. Varying improvements in postoperative walking function were expected owing to differences in muscular strength and bone quality between patients in their 40s and those over 75 years of age. The purpose of this study was to compare preoperative and postoperative gait posture and physical functionality in elderly patients with ASD who underwent extensive corrective fusion to the thoracic spine. METHODS A prospectively maintained surgical database was reviewed for patients with ASD who underwent corrective fusion surgery (thoracic spine to pelvis) between 2011 and 2016. The cohort was divided into three age groups: nonelderly (40-64 years), young-old (65-74 years), and old-old (> 75 years). Patients underwent a 4-m walk test preoperatively and 2 years postoperatively to measure gait-trunk tilt angle and walking speed (meters per minute). RESULTS Among 291 patients with ASD who underwent corrective fusion surgery, 56 patients (14 men and 42 women; mean age 68.8 years) were included. Mean preoperative gait-trunk tilt angle (12.9° vs 5.2°, p < 0.01) and walking speed (41.2 m/min vs 45.7 m/min, p < 0.01) significantly improved postoperatively. Intergroup analysis revealed that the mean preoperative gait-trunk tilt angles in the nonelderly (n = 13), young-old (n = 28), and old-old (n = 15) groups were 11.9°, 10.0°, and 19.3°, respectively; postoperatively, these improved to 4.5°, 4.5°, and 7.2°, respectively. Mean preoperative walking speeds of 47.9, 40.0, and 37.7 m/min improved to 52.4, 44.8, and 41.5 m/min postoperatively in the nonelderly, young-old, and old-old groups, respectively. There were no statistically significant differences in degree of improvement in gait-trunk tilt angle and walking speed among groups. CONCLUSIONS Extensive corrective fusion surgery improved the postoperative walking posture of patients with ASD. Statistical analysis of gait measurements demonstrated intergroup equivalence, indicating comparable improvement in physical functionality in elderly and middle-aged patients after corrective fusion surgery.
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Affiliation(s)
| | - Yu Yamato
- 1Department of Orthopaedic Surgery and
- 2Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu; and
| | | | - Daisuke Togawa
- 3Department of Orthopaedic Surgery, Kinki University Nara Hospital, Ikoma, Japan
| | | | | | | | - Shin Oe
- 1Department of Orthopaedic Surgery and
- 2Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu; and
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Savioli G, Ceresa IF, Macedonio S, Gerosa S, Belliato M, Luzzi S, Lucifero AG, Manzoni F, Ricevuti G, Bressan MA. Major Trauma in Elderly Patients: Worse Mortality and Outcomes in an Italian Trauma Center. J Emerg Trauma Shock 2021; 14:98-103. [PMID: 34321808 PMCID: PMC8312913 DOI: 10.4103/jets.jets_55_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/24/2020] [Accepted: 01/04/2021] [Indexed: 01/24/2023] Open
Abstract
Introduction: Major trauma is the leading cause of mortality in the world in patients younger than 40 years. However, the proportion of elderly people who suffer trauma has increased significantly. The purpose of this study is to assess the correlation of old age with mortality and other unfavorable outcomes. Methods: We assessed on one hand, anatomical criteria such as ISS values and the number of body regions affected, on the other hand, hemodynamic instability criteria, various shock indices, and Glasgow Coma Scale. Finally, we also evaluated biochemical parameters, such as lactate, BE, and pH values. We conducted a prospective and monocentric observational study of all the patients referred to the Emergency Department of the IRCCS Fondazione Policlinico S. Matteo in Pavia for major trauma in 13 consecutive months: January 1, 2018–January 30, 2019. We compared the elderly population (>75 years) and the younger population (≤75). Results: We included 501 patients, among which 10% were over the age of 75 years. The mortality rate was higher among the older patients than among the younger (4% vs. 1.33%; P = 0.050). Hemodynamic instability was more common in the older patients than in the younger (26% vs. 9%; P < 0.001). More older patients (44%) had an ISS >16, in comparison with 32% of younger patients (P = 0.01). Conclusions: The elderly showed worse outcomes in terms of mortality, hospitalization rate, hemodynamic instability criteria, and anatomical and biochemical parameters.
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Affiliation(s)
- Gabriele Savioli
- Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Sarah Macedonio
- Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sebastiano Gerosa
- Department of Emergency, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mirko Belliato
- Department of Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Federica Manzoni
- Department of Hygiene and Health Prevention, Health Promotion-Environmental Epidemiology Unit, Health Protection Agency, Pavia, Italy
| | - Giovanni Ricevuti
- Department of Drug Science, University of Pavia, Saint Camillus International University of Health Sciences, Rome, Italy
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Factors Associated with Improved Quality of Life Outcomes in Patients Undergoing Surgery for Adult Spinal Deformity. Spine (Phila Pa 1976) 2021; 46:E384-E391. [PMID: 33394978 DOI: 10.1097/brs.0000000000003908] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective longitudinal cohort study. OBJECTIVE This study aimed to elucidate factors affecting the likelihood of achieving minimum clinically important difference (MCID) to patient-reported outcomes defined by the Scoliosis Research Society-22r (SRS-22r) among patients with adult spinal deformity (ASD) who underwent extensive corrective fusion surgery from the thoracic spine to the pelvis. SUMMARY OF BACKGROUND DATA Achieving MCID for SRS-22r parameters was a measure of surgical efficacy. Patient characteristics and surgical and radiographic factors that affect the likelihood of achieving MCID for SRS-22r parameters are unknown. METHODS Data from patients with ASD who underwent extensive corrective fusion surgery from the thoracic spine to the pelvis during 2010 to 2016 were retrospectively reviewed. Data from a total of 167 patients with ≥2 years of follow-up were included. Multivariate analysis was used to investigate factors associated with the likelihood of achieving MCID for each of the SRS-22r domains (Function, Pain, Subtotal) 2 years after surgery. The following MCID values were used: 0.90 for Function, 0.85 for Pain, and 1.05 for the Subtotal. RESULTS MCID achievement rate was 36.5% for Function, 46.1% for Pain, and 44.3% for the Subtotal domain. In multivariate analysis, preoperative SRS-22r Function (odds ratio [OR] = 0.204, 95% confidence interval [CI] 0.105-0.396) increased the likelihood of achieving MCID for SRS-22r Function. Preoperative SRS-22r Subtotal (OR = 0.211, 95% CI, 0.107-0.413), preoperative pelvic tilt (OR = 1.072, 95% CI, 1.012-1.136), preoperative pelvic incidence minus lumbar lordosis (OR = 0.965, 95% CI, 0.934-0.997), and postoperative sagittal vertical axis (OR = 0.985, 95% CI, 0.974-0.995) affected the likelihood of achieving MCID for the SRS-22r Subtotal. CONCLUSION Patients with poor preoperative health-related quality of life were more likely to achieve improvement in SRS-22r parameters after extensive corrective fusion surgery for ASD. Achieving postoperative sagittal alignment increased the likelihood of achieving MCID for the SRS-22r Subtotal domain.Level of Evidence: 3.
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Lee CS, Park JS, Nam Y, Choi YT, Park SJ. Long-term benefits of appropriately corrected sagittal alignment in reconstructive surgery for adult spinal deformity: evaluation of clinical outcomes and mechanical failures. J Neurosurg Spine 2021; 34:390-398. [PMID: 33338999 DOI: 10.3171/2020.7.spine201108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It has been well documented that optimal sagittal alignment is highly correlated with good clinical outcomes in adult spinal deformity (ASD) surgery. However, it remains to be determined whether the clinical benefit of appropriately corrected sagittal alignment can be maintained in the long term. Therefore, the aim of this study was to investigate whether appropriately corrected sagittal alignment continues to offer benefits over time with regard to clinical outcomes and mechanical failure. METHODS Patients older than 50 years who underwent ≥ 4-level fusion for ASD and were followed up for ≥ 5 years were included in this study. Appropriateness of sagittal alignment correction was defined as pelvic incidence minus lumbar lordosis ≤ 10°, pelvic tilt ≤ 25°, and sagittal vertical axis ≤ 50 mm. Two groups were created based on this appropriateness: group A (appropriate) and group IA (inappropriate). Clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Scoliosis Research Society Outcomes Questionnaire-22 (SRS-22). The development of mechanical failures, such as rod fracture and proximal junctional kyphosis (PJK), was compared between the two groups. RESULTS The study included 90 patients with a follow-up duration of 90.3 months. There were 30 patients in group A and 60 patients in group IA. The clinical outcomes at 2 years were significantly better in group A than in group IA in terms of the VAS scores, ODI scores, and all domains of SRS-22. At the final follow-up visit, back VAS and ODI scores were still lower in group A than they were in group IA, but the VAS score for leg pain did not differ between the groups. The SRS-22 score at the final follow-up showed that only the pain and self-image/appearance domains and the total sum were significantly higher in group A than in group IA. The incidence of rod fracture and PJK did not differ between the two groups. The rate of revision surgery for rod fracture or PJK was also similar between the two groups. CONCLUSIONS The clinical benefits from appropriate correction of sagittal alignment continued for a mean of 90.3 months. However, the intergroup difference in clinical outcomes between groups A and IA decreased over time. The development of rod fracture or PJK was not affected by the appropriateness of sagittal alignment.
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Lower Satisfaction After Adult Spinal Deformity Surgery in Japan Than in the United States Despite Similar SRS-22 Pain and Function Scores: A Propensity-Score Matched Analysis. Spine (Phila Pa 1976) 2020; 45:E1097-E1104. [PMID: 32205706 DOI: 10.1097/brs.0000000000003483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A multicenter retrospective case series. OBJECTIVE The purpose of this study was to compare the clinical outcomes of a surgical treatment for adult spinal deformity (ASD) in the United States (US) with those in Japan (JP) in a matched cohort. SUMMARY OF BACKGROUND DATA Surgical outcomes of thoracic-lumbar-sacral (TLS) spinal fusions in adult spinal deformity ASD patients who live in Asian countries are poorly understood. METHODS A total of 300 surgically treated ASDs of age more than 50 years with the lowest instrumented vertebra at the pelvis and a minimum follow-up of 2 years (2y) were consecutively included. Patients were propensity-score matched for age, sex, levels fused, and 2y postop sagittal spinal alignment. Demographic, surgical, and radiographic parameters were compared between the US and JP groups. RESULTS A total of 186 patients were matched by propensity score and were almost identical within these parameters: age (US vs. JP: 66 ± 8 vs. 65 ± 7 yr), sex (females: 90% vs. 89%), levels fused (10 ± 3 vs. 10 ± 2), 2y C7 sagittal vertical axis (C7SVA) (5 ± 5 vs. 5 ± 4 cm), 2y Pelvic incidence minus lumbar lordosis (9 ± 15° vs. 9 ± 15°), and 2y pelvic tilt (PT) (25 ± 10° vs. 24 ± 10°). Oswestry Disability Index (ODI) scores and Scoliosis Research Society patient questionnaire ((SRS-22) function and pain scores were similar at 2y between the US and JP groups (ODI: 27 ± 19% vs. 28 ± 14%, P = 0.72; SRS-22 function: 3.6 ± 0.9 vs. 3.6 ± 0.7, P = 0.54; SRS-22 pain: 3.6 ± 1.0 vs. 3.8 ± 0.8, P = 0.11). However, significantly lower satisfaction was observed in JP than in the US (SRS-22 satisfaction: 4.3 ± 0.9 vs. 4.0 ± 0.8, P < 0.01). CONCLUSION Surgical treatment for ASD was similarly effective in patients in the US and in JP. However, satisfaction scores were lower in JP compared with the US. Differences in lifestyle and cultural expectations may impact patient satisfaction following ASD surgery. LEVEL OF EVIDENCE 3.
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Influence of spino-pelvic and postural alignment parameters on gait kinematics. Gait Posture 2020; 76:318-326. [PMID: 31891899 DOI: 10.1016/j.gaitpost.2019.12.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/07/2019] [Accepted: 12/21/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Postural alignment is altered with spine deformities that might occur with age. Alteration of spino-pelvic and postural alignment parameters are known to affect daily life activities such as gait. It is still unknown how spino-pelvic and postural alignment parameters are related to gait kinematics. RESEARCH QUESTION To assess the relationships between spino-pelvic/postural alignment parameters and gait kinematics in asymptomatic adults. METHODS 134 asymptomatic subjects (aged 18-59 years) underwent 3D gait analysis, from which kinematics of the pelvis and lower limbs were extracted in the 3 planes. Subjects then underwent full-body biplanar X-rays, from which skeletal 3D reconstructions and spino-pelvic and postural alignment parameters were obtained such as sagittal vertical axis (SVA), center of auditory meatus to hip axis plumbline (CAM-HA), thoracic kyphosis (TK) and radiologic pelvic tilt (rPT). In order to assess the influence of spino-pelvic and postural alignment parameters on gait kinematics a univariate followed by a multivariate analysis were performed. RESULTS SVA was related to knee flexion during loading response (β = 0.268); CAM-HA to ROM pelvic obliquity (β = -0.19); rPT to mean pelvic tilt (β = -0.185) and ROM pelvic obliquity (β = -0.297); TK to ROM hip flexion/extension in stance (β = -0.17), mean foot progression in stance (β = -0.329), walking speed (β = -0.19), foot off (β = 0.223) and step length (β = -0.181). SIGNIFICANCE This study showed that increasing SVA, CAM-HA, TK and rPT, which is known to occur in adults with spinal deformities, could alter gait kinematics. Increases in these parameters, even in asymptomatic subjects, were related to a retroverted pelvis during gait, a reduced pelvic obliquity and hip flexion/extension mobility, an increased knee flexion during loading response as well as an increase in external foot progression angle. This was associated with a decrease in the walking pace: reduced speed, step length and longer stance phase.
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