1
|
Chung A, Robinson J, Gendelberg D, Jimenez J, Anand A, Rao A, Khandehroo B, Khandehroo B, Kahwaty S, Anand N. Do peri-operative parathyroid hormone (PTH) analogues improve bone density and decrease mechanical complications in spinal deformity correction?-a minimum 2-year radiological study measuring Hounsfield units. 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 2023; 32:3651-3658. [PMID: 37553471 DOI: 10.1007/s00586-023-07859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 06/19/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To delineate whether use of a PTH analogue in the 1-year peri-operative period improves lumbar bone density. METHODS A prospectively collected data registry of 254 patients who underwent CMIS correction of ASD (Cobb angle > 20 or SVA > 50 mm or (PI-LL) > 10) from Jan 2011 to Jan 2020 was analysed. Patients who were placed on PTH analogues for one year in conjunction with surgery were included in the study. Ultimately, 41 patients who had pre- and two-year post-operative CT scans for review were included in this study. Hounsfield units were measured off of the L1-L3 levels for all patients before and after surgery on pre-op and post-op CT scans. RESULT The mean age of patients in this study was 70 (52-84, SD 7). Mean follow-up was 66 (24-132, SD 33) months. Twenty-three patients met criteria for severe deformity (Cobb angle > 50 degrees or SVA > 95 mm or PI/LL mismatch > 20 or PT > 30). Based off 2-year post-op CT scan, there were significant improvements in L1 Hounsfield units when comparing pre-op values (96; SD 55) to post-op values (185 SD 102); p. < 0.05. There was no screw loosening or screw pull out. There were 2 patients with PJF (4.8%). Both these patients had not completed their PTH treatment: one only took PTH for 3 months (PJF at 2-year post-op) and the other one took it only for 1 month (PJF at 1-year post-op). No increase in bone density was noted (based off of Hounsfield units) in five patients (12%) despite completion of their PTH therapy. Only one patient experienced nausea from PTH therapy. There were no other PTH related adverse events. CONCLUSION The incidence of PTH analogues failing to increase bone density in our series was low at 12%. This study shows that PTH analogues may be a powerful adjunct for increasing bone density and may help to mitigate the risk of mechanical complications in patients undergoing deformity correction with minimally invasive techniques. Future comparative studies are warranted to confirm these latter findings and to potentially protocolize the ideal peri-operative bone health optimization strategy.
Collapse
Affiliation(s)
- Andrew Chung
- Department of Orthopedics, Banner Health, 13995 W Statler Blvd #200, Surprise, Phoenix, AZ, 85374, USA.
| | - Jerry Robinson
- Department of Orthopedics, University of Pittsburg Medical Center (UPMC) Harrisburg, Harrisburg, PA, USA
| | - David Gendelberg
- Department of Orthopedics, University of California, San Francisco (UCSF) Orthopedics Trauma Institute, San Francisco, CA, USA
| | - Jose Jimenez
- Department of Orthopedics, Central Florida Bone & Joint Institute, Orange City, FL, USA
| | - Anita Anand
- Department of Orthopedics, Cedars-Sinai Spine Center, Los Angeles, CA, USA
| | - Arya Rao
- Department of Orthopedics, Cedars-Sinai Spine Center, Los Angeles, CA, USA
| | | | - Babak Khandehroo
- Department of Orthopedics, Cedars-Sinai Spine Center, Los Angeles, CA, USA
| | - Sheila Kahwaty
- Department of Orthopedics, Cedars-Sinai Spine Center, Los Angeles, CA, USA
| | - Neel Anand
- Department of Orthopedics, Cedars-Sinai Spine Center, Los Angeles, CA, USA
| |
Collapse
|
2
|
Passias PG, Ahmad W, Tretiakov P, Krol O, Segreto F, Lafage R, Lafage V, Soroceanu A, Daniels A, Gum J, Line B, Schoenfeld AJ, Vira S, Hart R, Burton D, Smith JS, Ames CP, Shaffrey C, Schwab F, Bess S. Identifying Subsets of Patients With Adult Spinal Deformity Who Maintained a Positive Response to Nonoperative Management. Neurosurgery 2023; 93:480-488. [PMID: 36942962 PMCID: PMC10586862 DOI: 10.1227/neu.0000000000002447] [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: 10/12/2021] [Accepted: 01/11/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Adult spinal deformity (ASD) represents a major cause of disability in the elderly population in the United States. Surgical intervention has been shown to reduce disability and pain in properly indicated patients. However, there is a small subset of patients in whom nonoperative treatment is also able to durably maintain or improve symptoms. OBJECTIVE To examine the factors associated with successful nonoperative management in patients with ASD. METHODS We retrospectively evaluated a cohort of 207 patients with nonoperative ASD, stratified into 3 groups: (1) success, (2) no change, and (3) failure. Success was defined as a gain in minimal clinically importance difference in both Oswestry Disability Index and Scoliosis Research Society-Pain. Logistic regression model and conditional inference decision trees established cutoffs for success according to baseline (BL) frailty and sagittal vertical axis. RESULTS In our cohort, 44.9% of patients experienced successful nonoperative treatment, 22.7% exhibited no change, and 32.4% failed. Successful nonoperative patients at BL were significantly younger, had a lower body mass index, decreased Charlson Comorbidity Index, lower frailty scores, lower rates of hypertension, obesity, depression, and neurological dysfunction (all P < .05) and significantly higher rates of grade 0 deformity for all Schwab modifiers (all P < .05). Conditional inference decision tree analysis determined that patients with a BL ASD-frailty index ≤ 1.579 (odds ratio: 8.3 [4.0-17.5], P < .001) were significantly more likely to achieve nonoperative success. CONCLUSION Success of nonoperative treatment was more frequent among younger patients and those with less severe deformity and frailty at BL, with BL frailty the most important determinant factor. The factors presented here may be useful in informing preoperative discussion and clinical decision-making regarding treatment strategies.
Collapse
Affiliation(s)
- Peter G. Passias
- Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Waleed Ahmad
- Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Peter Tretiakov
- Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Oscar Krol
- Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Frank Segreto
- Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA
| | - Renaud Lafage
- Department of Orthopedics, Lenox Hill Hospital, New York, New York, USA
| | - Virginie Lafage
- Department of Orthopedics, Lenox Hill Hospital, New York, New York, USA
| | - Alex Soroceanu
- Department of Orthopedics, University of Calgary, Calgary, Alberta, Canada
| | - Alan Daniels
- Department of Orthopedics, Brown University, Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffrey Gum
- Norton Leatherman Spine Center, Louisville, Kentucky, USA
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Andrew J. Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shaleen Vira
- Departments of Orthopaedic and Neurosurgery, Utah Southwestern Medical Center, Dallas, Texas, USA
| | - Robert Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher P. Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher Shaffrey
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Frank Schwab
- Department of Orthopedics, Lenox Hill Hospital, New York, New York, USA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado, USA
- Rocky Mountain Scoliosis and Spine, Denver, Colorado, USA
| |
Collapse
|
3
|
Zuckerman SL, Chanbour H, Hassan FM, Lai CS, Shen Y, Kerolus MG, Ha A, Buchanan I, Lee NJ, Leung E, Cerpa M, Lehman RA, Lenke LG. The Lumbosacral Fractional Curve vs Maximum Coronal Cobb Angle in Adult Spinal Deformity Patients with Coronal Malalignment: Which Matters More? Global Spine J 2023:21925682231161564. [PMID: 36987946 DOI: 10.1177/21925682231161564] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES In patients undergoing adult spinal deformity (ASD) surgery we sought to: 1) report preoperative and postoperative lumbosacral fractional (LSF) curve and maximum coronal Cobb angles and 2) determine their impact on radiographic, clinical, and patient-reported outcomes (PROs). METHODS A single-institution cohort study was undertaken. The LSF curve was the cobb angle between the sacrum and most tilted lower lumbar vertebra. Coronal/sagittal vertical axis (CVA/SVA) were collected. Patients were compared between 4 groups: 1) Neutral Alignment (NA); 2) coronal malalignment only (CM); 3) Sagittal malalignment only (SM); and 4) Combined-Coronal-Sagittal-Malalignment (CCSM). Outcomes including postoperative CM, postoperative coronal vertical axis, complications, readmissions, reoperation, and PROs. RESULTS A total of 243 patients underwent ASD surgery with mean total instrumented levels of 13.5. Mean LSF curve was 12.1±9.9°(0.2-62.3) and mean max Cobb angle was 43.0±26.5° (0.0-134.3). The largest mean LSF curves were seen in patients with CM (14.6°) and CCSM (13.1°) compared to NA (12.1°) and SM (9.5°) (p=0.100). A higher LSF curve was seen in patients with fusion to the sacrum and instrumentation to the pelvis (p=0.009), and a higher LSF curve was associated with more TLIFs (p=0.031). Postoperatively, more TLIFs were associated with greater amount of LSF curve correction (p<0.001). Comparing the LSF and the max Cob angle among Qiu types, the highest mean max Cobb angle was in Qiu Type B patients (p=0.025), whereas the highest mean LSF curve was in Qiu Type C patients (p=0.037). Moreover, 82.7% of patients had a LSF curve opposite the max Cobb angle. The LSF curve was larger than the max Cobb angle in 22/243 (9.1%) patients, and most of these 22 patients were Qiu Type A (59.1%). Regarding correction, the max Cobb angle achieved more correction than the LSF curve, judged by the percent improved from preop (54.5% Cobb vs. 46.5% LSF, p=0.025) in patients with max cobb>20° and LSF curve >5°. The LSF curve underwent greater correction in Qiu Type C patients (9.2°) compared to Type A (5.7°) and Type B (5.1°) (p=0.023); however, the max Cobb angle was similarly corrected among Qiu Types: Type A 21.8°, Type B 24.6°, and Type C 25.4° (p=0.602). Minimal differences were seen comparing the preop/postop/change in LSF curve and max Cobb angle regarding postop CM, postop CVA, complications, readmissions, reoperation, and PROs. CONCLUSIONS The LSF curve was highest in patients with CM, CCSM, and Qiu Type C curves. Most patients had a LSF curve opposite the max Cobb angle. The max Cobb angle was more often corrected than the LSF curve. The LSF curve underwent greater correction among Qiu Type C patients, whereas the max Cobb angle was similarly corrected among all Qiu Types. No clear trend was seen regarding postoperative complications and PROs between the LSF curve and max Cobb angle.
Collapse
Affiliation(s)
- Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fthimnir M Hassan
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Christopher S Lai
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yong Shen
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Mena G Kerolus
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Alex Ha
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Ian Buchanan
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Nathan J Lee
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Eric Leung
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Meghan Cerpa
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
4
|
Gomez-Rice A, Capdevila-Bayo M, Núñez-Pereira S, Haddad S, Vila-Casademunt A, Pérez-Grueso F, Kleinstück F, Obeid I, Alanay A, Pellise F, Pizones J. A 5-year follow-up of the effect of corrective surgery in young adults with idiopathic scoliosis. Spine Deform 2023; 11:605-615. [PMID: 36607558 DOI: 10.1007/s43390-023-00642-9] [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: 07/09/2022] [Accepted: 12/31/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to determine mid-long-term outcomes (5 years) following surgery for young adult idiopathic scoliosis (YAdIS). METHODS This is a retrospective review of a prospective, multicenter adult deformity database including patients operated on idiopathic scoliosis by a single posterior approach, age at surgery between 19 and 29 (considered young adults), and 5-year follow-up. Demographic, radiographic and PROMS were analyzed preoperatively, at 2 years and at final follow-up. RESULTS Forty-two patients were included. Mean preoperative major curve angle was 59.65 ± 18.94. Main coronal curve initial correction was 56.38%, with 6% loss at 5 years. From baseline to 5 years after surgery, there was improvement in all PROMs (P < 0.004)-especially self-image-, except NRS-leg pain. This improvement was present at 6 months for all PROMs except for functional outcomes (SRS-Function and ODI) in which the improvement took place between 6 months and 2 years. In the 2- to 5-year follow-up period, no significant changes were seen in any PROMs. The percentage of patients reaching MCID from baseline at 5 years was: 75% for SRS-image, 45% for SRS-pain, 47.5% for SRS-function, 51.3% for SRS-mental, 42.5% for SRS-total and 15.4% for ODI. Patients reaching PASS at 5 years were: 88.1% for SRS-image, 81% for SRS-pain, 92.9% for SRS-function, 57.1% for SRS-mental, 88.1% for SRS-total, 92.7% for ODI and 69% for NRS pain. 11 minor and 4 major complications were identified. CONCLUSION YAdIS surgery resulted in an early and significant improvement in PROMs, especially for self-image, significantly reaching MCID and PASS thresholds. These results were maintained during long-term (5-year) follow-up.
Collapse
Affiliation(s)
- Alejandro Gomez-Rice
- Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo Km 9, 100, 28034, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
The Effect of a Comprehensive Corrective Exercise Program on Kyphosis Angle and Balance in Kyphotic Adolescents. Healthcare (Basel) 2022; 10:healthcare10122478. [PMID: 36554002 PMCID: PMC9778671 DOI: 10.3390/healthcare10122478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
This study aimed to investigate the effects of a comprehensive corrective exercise program on the kyphosis angle and balance in kyphotic adolescents. A total of 62 male adolescents (between the ages of 10 and 18, mean BMI 21.7 kg/m2) with a thoracic kyphosis (TK) angle of ≥ 50° were divided into three groups using the simple randomization method: CCEP (comprehensive corrective exercise program), TEP (thoracic exercise program) and control group. The CCEP program consisted of corrective exercises plus postural perception training (PPT). Exercise programs were applied for 40−50 min, 3 days a week for 12 weeks. The kyphosis angle was measured using a flexible ruler, and balance was assessed using the Romberg index obtained from pedobarography. After training, a highly significant reduction in the kyphosis angle was observed in the CCEP and TEP groups (p < 0.001). Comparison among the groups showed a greater reduction in the kyphosis angle in the CCEP group (p < 0.020). Postural perception improved in the CCEP group versus other groups (p < 0.001). Improvement of the Romberg index (balance) was found only in the CCEP group upon within-group comparison (p < 0.001), with no difference among the groups (p > 0.05). The use of postural perception in combination with corrective exercise programs for thoracic kyphosis represents a comprehensive approach, and PPT can increase the effectiveness of the intervention.
Collapse
|
6
|
Zuckerman SL, Cerpa M, Lenke LG, Shaffrey CI, Carreon LY, Cheung KMC, Kelly MP, Fehlings MG, Ames CP, Boachie-Adjei O, Dekutoski MB, Kabeaish KM, Lewis SJ, Matsuyama Y, Pellisé F, Qiu Y, Schwab FJ, Smith JS. Patient-Reported Outcomes After Complex Adult Spinal Deformity Surgery: 5-Year Results of the Scoli-Risk-1 Study. Global Spine J 2022; 12:1736-1744. [PMID: 33557622 PMCID: PMC9609523 DOI: 10.1177/2192568220988276] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
STUDY DESIGN Prospective cohort. OBJECTIVE To prospectively evaluate PROs up to 5-years after complex ASD surgery. METHODS The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers. Inclusion criteria was Cobb angle of >80°, corrective osteotomy for congenital or revision deformity, and/or 3-column osteotomy. The following PROs were measured prospectively at intervals up to 5-years postoperative: ODI, SF36-PCS/MCS, SRS-22, NRS back/leg. Among patients with 5-year follow-up, comparisons were made from both baseline and 2-years postoperative to 5-years postoperative. PROs were analyzed using mixed models for repeated measures. RESULTS Seventy-seven patients (28.3%) had 5-year follow-up data. Comparing baseline to 5-year data among these 77 patients, significant improvement was seen in all PROs: ODI (45.2 vs. 29.3, P < 0.001), SF36-PCS (31.5 vs. 38.8, P < 0.001), SF36-MCS (44.9 vs. 49.1, P = 0.009), SRS-22-total (2.78 vs. 3.61, P < 0.001), NRS-back pain (5.70 vs. 2.95, P < 0.001) and NRS leg pain (3.64 vs. 2.62, P = 0.017). In the 2 to 5-year follow-up period, no significant changes were seen in any PROs. The percentage of patients achieving MCID from baseline to 5-years were: ODI (62.0%) and the SRS-22r domains of function (70.4%), pain (63.0%), mental health (37.5%), self-image (60.3%), and total (60.3%). Surprisingly, mean values (P > 0.05) and proportion achieving MCID did not differ significantly in patients with major surgery-related complications compared to those without. CONCLUSIONS After complex ASD surgery, significant improvement in PROs were seen at 5-years postoperative in ODI, SF36-PCS/MCS, SRS-22r, and NRS-back/leg pain. No significant changes in PROs occurred during the 2 to 5-year postoperative period. Those with major surgery-related complications had similar PROs and proportion of patients achieving MCID as those without these complications.
Collapse
Affiliation(s)
| | - Meghan Cerpa
- Columbia University Medical Center, New
York, NY, USA,Meghan Cerpa, MPH, Department of Orthopedic
Surgery, Columbia University Medical Center, The Spine Hospital at New York
Presbyterian, New York, NY 10032, USA.
| | | | | | | | | | | | - Michael G. Fehlings
- University of Toronto and Toronto
Western Hospital, Toronto, Ontario, Canada
| | | | | | | | | | - Stephen J. Lewis
- University of Toronto and Toronto
Western Hospital, Toronto, Ontario, Canada
| | | | | | - Yong Qiu
- Affiliated Drum Tower Hospital of
Nanjing University Medical School, Nanjing, China
| | | | | | | |
Collapse
|
7
|
Zuckerman SL, Chanbour H, Hassan FM, Lai CS, Shen Y, Lee NJ, Kerolus MG, Ha AS, Buchanan IA, Leung E, Cerpa M, Lehman RA, Lenke LG. Evaluation of coronal alignment from the skull using the novel orbital-coronal vertical axis line. J Neurosurg Spine 2022; 37:410-419. [PMID: 35364571 DOI: 10.3171/2022.1.spine211527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE When treating patients with adult spinal deformity (ASD), radiographic measurements evaluating coronal alignment above C7 are lacking. The current objectives were to: 1) describe the new orbital-coronal vertical axis (ORB-CVA) line that evaluates coronal alignment from cranium to sacrum, 2) assess correlation with other radiographic variables, 3) evaluate correlations with patient-reported outcomes (PROs), and 4) compare the ORB-CVA with the standard C7-CVA. METHODS A retrospective cohort study of patients with ASD from a single institution was undertaken. Traditional C7-CVA measurements were obtained. The ORB-CVA was defined as the distance between the central sacral vertical line and the vertical line from the midpoint between the medial orbital walls. The ORB-CVA was correlated using traditional coronal measurements, including C7-CVA, maximum coronal Cobb angle, pelvic obliquity, leg length discrepancy (LLD), and coronal malalignment (CM), defined as a C7-CVA > 3 cm. Clinical improvement was analyzed as: 1) group means, 2) minimal clinically important difference (MCID), and 3) minimal symptom scale (MSS) (Oswestry Disability Index < 20 or Scoliosis Research Society-22r Instrument [SRS-22r] pain + function domains > 8). RESULTS A total of 243 patients underwent ASD surgery, and 175 had a 2-year follow-up. Of the 243 patients, 90 (37%) had preoperative CM. The mean (range) ORB-CVA at each time point was as follows: preoperatively, 2.9 ± 3.1 cm (-14.2 to 25.6 cm); 1 year postoperatively, 2.0 ± 1.6 cm (-12.4 to 6.7 cm); and 2 years postoperatively, 1.8 ± 1.7 cm (-6.0 to 11.1 cm) (p < 0.001 from preoperatively to 1 and 2 years). Preoperative ORB-CVA correlated best with C7-CVA (r = 0.842, p < 0.001), maximum coronal Cobb angle (r = 0.166, p = 0.010), pelvic obliquity (r = 0.293, p < 0.001), and LLD (r = 0.158, p = 0.006). Postoperatively, the ORB-CVA correlated only with C7-CVA (r = 0.629, p < 0.001) and LLD (r = 0.153, p = 0.017). Overall, 155 patients (63.8%) had an ORB-CVA that was ≥ 5 mm different from C7-CVA. The ORB-CVA correlated as well and sometimes better than C7-CVA with SRS-22r subdomains. After multivariate logistic regression, a greater ORB-CVA was associated with increased odds of complication, whereas C7-CVA was not associated with any of the three clinical outcomes (complication, readmission, reoperation). A larger difference between the ORB-CVA and C7-CVA was significantly associated with readmission and reoperation after univariate and multivariate logistic regression analyses. A threshold of ≥ 1.5-cm difference between the preoperative ORB-CVA and C7-CVA was found to be predictive of poorer outcomes. CONCLUSIONS The ORB-CVA correlated well with known coronal measurements and PROs. ORB-CVA was independently associated with increased odds of complication, whereas C7-CVA was not associated with any outcomes. A ≥ 1.5-cm difference between the preoperative ORB-CVA and C7-CVA was found to be predictive of poorer outcomes.
Collapse
Affiliation(s)
- Scott L Zuckerman
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- 2Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Hani Chanbour
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fthimnir M Hassan
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Christopher S Lai
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Yong Shen
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Nathan J Lee
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Mena G Kerolus
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Alex S Ha
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Ian A Buchanan
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Eric Leung
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Meghan Cerpa
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Ronald A Lehman
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Lawrence G Lenke
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| |
Collapse
|
8
|
Cheung JPY, Wong HL, Cheung PWH. Predictive factors for successful non-operative treatment and achieving MCID improvement in health-related quality of life in adult spinal deformity. BMC Musculoskelet Disord 2022; 23:802. [PMID: 35996091 PMCID: PMC9394065 DOI: 10.1186/s12891-022-05757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Adult spinal deformity is a spectrum of degenerative spinal diseases with increasing prevalence and healthcare burden worldwide. Identification of patients who are more likely to improve through conservative management may reduce cost and potentially prevent surgery and its associated costs and complications. This study aims to identify predictive factors for MCID in improvement of ODI and SRS-22r questionnaires in patients with adult spinal deformity treated with conservative treatment. Methods A prospective, observational cohort study of 46 patients was conducted at a spine specialist clinic. Inclusion criteria were 30–80 years of age, diagnosis of neglected adolescent idiopathic scoliosis, de-novo scoliosis, degenerative spondylolisthesis, and sagittal plane deformities (thoracic hypokyphosis, lumbar hypolordosis), presenting with mechanical back pain with or without radicular leg pain. All patients received conservative management including medication and physiotherapy. Radiological and clinical parameters were measured at baseline and at 1-year follow-up. Primary outcomes were ODI and SRS-22r scores. Secondary outcomes were EQ-5D-5L scores and requiring spine surgery during conservative treatment. Predictors for MCID improvement in ODI and SRS-22r were identified using multivariate regressions and receiver operating characteristic (ROC) analyses. Results At baseline, patients who reached MCID in ODI and/or SRS-22r showed less comorbidities (diabetes mellitus, hypertension, ischemic heart disease, osteoarthritis, cancer), smaller range of lateral spinal flexion, larger trunk shift, larger pelvic incidence, a higher EQ-5D-5L anxiety/depression dimension score, a lower SRS-22r total score, and presence of spondylolisthesis. Lateral flexion range < 25 degrees, trunk shift > 14 mm, pelvic incidence > 50 degrees, EQ-5D-5L anxiety/depression dimension score > 1, and SRS-22r total score < 3.5 were the cut-off values generated by ROC analysis. Conclusions Both radiological and clinical predictive factors for MCID improvement in health-related quality of life were identified. Future research should identify subgroups of patients who are responsive to specific conservative treatment modalities, so as to provide information for personalized medicine. Level of evidence II
Collapse
Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
| | - Hei Lung Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China
| | - Prudence Wing Hang Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5th Floor, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China
| |
Collapse
|
9
|
Zuckerman SL, Lai CS, Shen Y, Cerpa M, Lee NJ, Kerolus MG, Ha AS, Buchanan IA, Leung E, Lehman RA, Lenke LG. Understanding the role of pelvic obliquity and leg length discrepancy in adult spinal deformity patients with coronal malalignment: unlocking the black box. J Neurosurg Spine 2022; 37:64-72. [PMID: 35171835 DOI: 10.3171/2021.10.spine21800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study had 3 objectives: 1) to describe pelvic obliquity (PO) and leg-length discrepancy (LLD) and their relationship with coronal malalignment (CM); 2) to report rates of isolated PO and PO secondary to LLD; and 3) to assess the importance of preoperative PO and LLD in postoperative complications, readmission, reoperation, and patient-reported outcomes. METHODS Patients undergoing surgery (≥ 6-level fusions) for adult spinal deformity at a single institution were reviewed. Variables evaluated were as follows: 1) PO, angle between the horizontal plane and a line touching bilateral iliac crests; and 2) LLD, distance from the head to the tibial plafond. Coronal vertical axis (CVA) and sagittal vertical axis measurements were collected, both from C7. The cutoff for CM was CVA > 3 cm. The Oswestry Disability Index (ODI) was collected preoperatively and at 2 years. RESULTS Of 242 patients undergoing surgery for adult spinal deformity, 90 (37.0%) had preoperative CM. Patients with preoperative CM had a higher PO (2.8° ± 3.2° vs 2.0° ± 1.7°, p = 0.013), a higher percentage of patients with PO > 3° (35.6% vs 23.5%, p = 0.044), and higher a percentage of patients with LLD > 1 cm (21.1% vs 9.8%, p = 0.014). Whereas preoperative PO was significantly positively correlated with CVA (r = 0.26, p < 0.001) and maximum Cobb angle (r = 0.30, p < 0.001), preoperative LLD was only significantly correlated with CVA (r = 0.14, p = 0.035). A total of 12.2% of patients with CM had significant PO and LLD, defined as follows: PO ≥ 3°; LLD ≥ 1 cm. Postoperatively, preoperative PO was significantly associated with both postoperative CM (OR 1.22, 95% CI 1.05-1.40, p = 0.008) and postoperative CVA (β = 0.14, 95% CI 0.06-0.22, p < 0.001). A higher preoperative PO was independently associated with postoperative complications after multivariate logistic regression (OR 1.24, 95% CI 1.05-1.45, p = 0.010); however, 2-year ODI scores were not. Preoperative LLD had no significant relationship with postoperative CM, CVA, ODI, or complications. CONCLUSIONS A PO ≥ 3° or LLD ≥ 1 cm was seen in 44.1% of patients with preoperative CM and in 23.5% of patients with normal coronal alignment. Preoperative PO was significantly associated with preoperative CVA and maximum Cobb angle, whereas preoperative LLD was only associated with preoperative CVA. The direction of PO and LLD showed no consistent pattern with CVA. Preoperative PO was independently associated with complications but not with 2-year ODI scores.
Collapse
Affiliation(s)
- Scott L Zuckerman
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
- 2The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Christopher S Lai
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Yong Shen
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Meghan Cerpa
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Nathan J Lee
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Mena G Kerolus
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Alex S Ha
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Ian A Buchanan
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Eric Leung
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Ronald A Lehman
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Lawrence G Lenke
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| |
Collapse
|
10
|
Jo DJ, Seo EM. Efficacy and radiographic analysis of oblique lumbar interbody fusion in treating adult spinal deformity. PLoS One 2021; 16:e0257316. [PMID: 34506593 PMCID: PMC8432864 DOI: 10.1371/journal.pone.0257316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/30/2021] [Indexed: 11/18/2022] Open
Abstract
Adult spinal deformity (ASD) is usually rigid and requires a combined anterior–posterior approach for deformity correction. Anterior lumbar interbody fusion (ALIF) allows direct access to the disc space and placement of a large interbody graft. A larger interbody graft facilitates correction of ASD. However, an anterior approach carries significant risks. Lateral lumbar interbody fusion (LLIF) through a minimally invasive approach has recently been used for ASD. The present study was performed to evaluate the effectiveness of oblique lumbar interbody fusion (OLIF) in the treatment of ASD. We performed a retrospective study utilizing the data of 74 patients with ASD. The inclusion criteria were lumbar coronal Cobb angle > 20°, pelvic incidence (PI)–lumbar lordosis (LL) mismatch > 10°, and minimum follow–up of 2 years. Patients were divided into two groups: ALIF combined with posterior spinal fixation (ALIF+PSF) (n = 38) and OLIF combined with posterior spinal fixation (OLIF+PSF) (n = 36). The perioperative spinal deformity radiographic parameters, complications, and health-related quality of life (HRQoL) outcomes were assessed and compared between the two groups. The preoperative sagittal vertical axis (SVA), LL, PI–LL mismatch, and lumbar Cobb angles were similar between the two groups. Patients in the OLIF+PSF group had a slightly higher mean number of interbody fusion levels than those in the ALIF+PSF group. At the final follow–up, all radiographic parameters and HRQoL scores were similar between the two groups. However, the rates of perioperative complications were higher in the ALIF+PSF than OLIF+PSF group. The ALIF+PSF and OLIF+PSF groups showed similar radiographic and HRQoL outcomes. These observations suggest that OLIF is a safe and reliable surgical treatment option for ASD.
Collapse
Affiliation(s)
- Dae-Jean Jo
- Department of Neurosurgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Eun-Min Seo
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| |
Collapse
|
11
|
Harris AB, Puvanesarajah V, Raad M, Marrache M, Ren M, Skolasky RL, Kebaish KM, Neuman BJ. How is staging of ALIF following posterior spinal arthrodesis to the pelvis related to functional improvement in patients with adult spinal deformity? Spine Deform 2021; 9:1085-1091. [PMID: 33464551 DOI: 10.1007/s43390-020-00272-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES To compare postoperative functional improvement in patients who underwent staged versus non-staged anterior-posterior spinal arthrodesis for adult spinal deformity (ASD). In patients with ASD, spinal arthrodesis can be performed in 2 stages to avoid the physiologic insult of a lengthy surgery. The association between staged surgery and postoperative functional improvement has not been well studied. METHODS We included 87 patients (59 women) with ASD who underwent anterior-posterior spinal arthrodesis of > 5 levels with fixation to the pelvis from 2010-2014. Primary outcomes were the frequency of achieving at least a minimal clinically important difference (MCID) in the Scoliosis Research Society-22r (SRS-22r) Activity domain and the timeframe in which it was achieved. The secondary outcome was patient satisfaction (SRS-22r Patient Satisfaction domain). A Cox proportional hazard model was used to compare functional improvement over time between staged and non-staged groups. Our study was powered to detect a relative hazard ratio of 0.53, β = 0.20. α = 0.05. RESULTS The frequency of achieving an MCID in SRS-22r Activity score did not differ significantly between the staged group (33/41 patients) and the non-staged group (34/46 patients) (hazard ratio 0.74; 95% confidence interval 0.41-1.36). Median times to achieving an MCID in SRS-22r Activity score were 191 days (interquartile range: 86-674) in the staged group and 181 days (interquartile range: 72-474) in the non-staged group (p = .75). The staged and non-staged groups had similar SRS-22r Patient Satisfaction scores at 3-9 months postoperatively and at final follow-up (both, p > .05). CONCLUSION Patients with ASD who underwent staged anterior-posterior spinal arthrodesis within 3 months after index surgery were similarly likely to experience functional improvement in the same timeframe as patients who underwent non-staged surgery. Patient satisfaction did not differ significantly between staged and non-staged groups. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5241, Baltimore, MD, 21287, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5241, Baltimore, MD, 21287, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5241, Baltimore, MD, 21287, USA
| | - Majd Marrache
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5241, Baltimore, MD, 21287, USA
| | - Mark Ren
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5241, Baltimore, MD, 21287, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5241, Baltimore, MD, 21287, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5241, Baltimore, MD, 21287, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5241, Baltimore, MD, 21287, USA.
| |
Collapse
|
12
|
Chung AS, Crandall D, Revella J, Adeniyi B, Chang YHH, Chang MS. Does Local Administration of Liposomal Bupivacaine Reduce Pain and Narcotic Consumption in Adult Spinal Deformity Surgery? Global Spine J 2021; 11:896-902. [PMID: 32677519 PMCID: PMC8258814 DOI: 10.1177/2192568220931053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine if local administration of liposomal bupivacaine (LB) reduces postoperative pain scores and narcotic use in spinal deformity patients. METHODS Adult patients undergoing elective spinal fusion (7 or more levels) for scoliosis or kyphosis were selected for inclusion. Patients received either periincisional injections of combined liposomal and standard bupivacaine (n = 90, group L) or standard bupivacaine only (n = 69, group C). Perioperative pain scores (VAS [visual analogue scale]), opioid use, length of stay, functional outcome (ODI [Oswestry Disability Index]), and perioperative complications were recorded. No external funding was received for this study. RESULTS A total of 159 patients met inclusion criteria (mean age was 54.2 years of age). No significant baseline demographic differences were noted between the 2 groups. Group L experienced slight improvements in pain control on postoperative day (POD) 1 (P = .02). No difference in pain scores were otherwise noted. Group L transitioned off of intravenous (IV) narcotics faster with 52.6% less IV use by POD3 (P = .03). No differences in total narcotic consumption, perioperative complications, lengths of stay, and functional outcome scores were otherwise noted between the 2 cohorts. CONCLUSIONS The use of LB in adult spinal deformity surgery does not appear to provide clinically important improvements in postoperative pain at the manufacturer's recommended dosage. Furthermore, while patients receiving LB may transition more quickly off of IV narcotics, this does not appear to translate into an overall decrease in narcotic consumption, hasten return of bowel function, or decrease hospital lengths of stay. Future prospective randomized control trials are warranted. The use of varying dosages of LB may also help further clarify the true efficacy of LB in the setting of spinal deformity surgery.
Collapse
Affiliation(s)
- Andrew S. Chung
- Sonoran Spine Center, Phoenix, AZ, USA,Andrew S. Chung, Sonoran Spine Center, 1255 W Rio Salado Pkwy #107, Tempe, AZ 85281, USA.
| | - Dennis Crandall
- Sonoran Spine Center, Phoenix, AZ, USA,Sonoran Spine Research and Education Foundation, Phoenix, AZ, USA
| | - Jan Revella
- Sonoran Spine Research and Education Foundation, Phoenix, AZ, USA
| | - Biodun Adeniyi
- Sonoran Spine Research and Education Foundation, Phoenix, AZ, USA
| | | | - Michael S. Chang
- Sonoran Spine Center, Phoenix, AZ, USA,Sonoran Spine Research and Education Foundation, Phoenix, AZ, USA
| |
Collapse
|
13
|
Zuckerman SL, Lai CS, Shen Y, Cerpa M, Lee NJ, Kerolus MG, Ha AS, Buchanan IA, Devin CJ, Lehman RA, Lenke LG. Do Adult Spinal Deformity Patients Undergoing Surgery Continue to Improve From 1-Year to 2-Years Postoperative? Global Spine J 2021; 13:1080-1088. [PMID: 34036834 DOI: 10.1177/21925682211019352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Evaluate clinical improvement as measured by patient-reported outcomes (PROs) during the 1 to 2-year interval. STUDY DESIGN Retrospective Cohort. METHODS A single-institution registry of ASD patients undergoing surgery was queried for patients with ≥6 level fusions. Demographics and radiographic variables were collected. PROs collected were the ODI and SRS-22r scores at: preoperative, 1-year and 2-years. Outcome measures of clinical improvement during the 1-2 year time interval were: 1) group medians, 2) percent minimum clinically important difference (MCID), and 3) percent minimal symptom scale (MSS)(ODI < 20 or SRS-pain + function >8). Wilcoxon rank-sum tests, chi-squared tests, Kruskal-Wallis tests, and logistic regression were performed. RESULTS 157 patients undergoing ASD surgery with minimum of 1-year follow-up were included. Mean age was 53.2 and mean instrumented levels was 13.1. Preoperative alignment was: Neutral Alignment (NA) 49%, Coronal Malalignment (CM) 17%, Sagittal Malalignment (SM 17%), and Combined Coronal/Sagittal Malalignment (CCSM) 18%. Preoperative to 1-year, and preoperative to 2-years, all ODI/SRS-22r significantly improved (P < .001). In all patients, the only significant improvement in PROs between 1-and 2-year postoperative were those reaching ODI MCID (69% 1-year vs. 84% 2-years; P < .001). Subgroup analysis: ≥55 years had an improved median ODI (18 vs. 8; P = .047) and an improved percent achieving ODI MCID (73% vs. 84%, P = .048). CCSM patients experienced significant improvement in SRS-appearance score (75% vs. 100%; P = .050), along with those with severe preoperative SM >7.5 cm (73% vs. 100%; P = .032). CONCLUSIONS Most ASD patients experience the majority of PRO improvement by 1-year postoperative. However, subsets of patients that may continue to improve up to 2-years postoperative include patients ≥55 years, combined coronal/sagittal malalignment, and those with severe sagittal malalignment ≥7.5 cm.
Collapse
Affiliation(s)
- Scott L Zuckerman
- Department of Orthopaedic Surgery, 21611Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA.,Department of Neurological Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher S Lai
- Department of Orthopaedic Surgery, 21611Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Yong Shen
- Department of Orthopaedic Surgery, 21611Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Meghan Cerpa
- Department of Orthopaedic Surgery, 21611Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Nathan J Lee
- Department of Orthopaedic Surgery, 21611Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Mena G Kerolus
- Department of Orthopaedic Surgery, 21611Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Alex S Ha
- Department of Orthopaedic Surgery, 21611Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Ian A Buchanan
- Department of Orthopaedic Surgery, 21611Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Clinton J Devin
- Steamboat Orthopaedic and Spine Institute, Steamboat Springs, CO, USA
| | - Ronald A Lehman
- Department of Orthopaedic Surgery, 21611Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, 21611Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| |
Collapse
|
14
|
Chen T, Hu X, Chen Z, Cui X. The Total Solubility of the Co-Solubilized PAHs with Similar Structures Indicated by NMR Chemical Shift. Molecules 2021; 26:molecules26092793. [PMID: 34068475 PMCID: PMC8125976 DOI: 10.3390/molecules26092793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
The synergism/inhibition level, solubilization sites and the total solubility (St) of co-solubilization systems of phenanthrene, anthracene and pyrene in Tween 80 and sodium dodecyl sulfate (SDS) are studied by 1H-NMR, 2D nuclear overhauser effect spectroscopy (NOESY) and rotating frame overhauser effect spectroscopy (ROESY). In Tween 80, inhibition for phenanthrene, anthracene and pyrene is observed in most binary and ternary systems. However, in SDS, synergism is predominant. After analysis, we find that the different synergism or inhibition situation between Tween 80 and SDS is related to the different types of surfactants used and the resulting different co-solubilization mechanisms. In addition, we also find that three polycyclic aromatic hydrocarbons (PAHs) have similar solubilization sites in both Tween 80 and SDS, which are almost unchanged in co-solubilization systems. Due to the similar solubilization sites, the chemical shift changes of surfactant and PAH protons follow the same pattern in all solubilization systems, and the order of chemical shift changes is consistent with the order of changes in the St of PAHs. In this case, it is feasible to evaluate St of PAHs by chemical shift. In both Tween 80 and SDS solutions, the ternary solubilization system has relatively high St rankings. Therefore, in practical applications, a good overall solubilization effect can be expected.
Collapse
|
15
|
Ogura Y, Gum JL, Soroceanu A, Daniels AH, Line B, Protopsaltis T, Hostin RA, Passias PG, Burton DC, Smith JS, Shaffrey CI, Lafage V, Lafage R, Klineberg EO, Kim HJ, Harris A, Kebaish K, Schwab F, Bess S, Ames CP, Carreon LY. Practical answers to frequently asked questions for shared decision-making in adult spinal deformity surgery. J Neurosurg Spine 2020; 34:218-227. [PMID: 33065535 DOI: 10.3171/2020.6.spine20363] [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: 03/15/2020] [Accepted: 06/04/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The shared decision-making (SDM) process provides an opportunity to answer frequently asked questions (FAQs). The authors aimed to present a concise list of answers to FAQs to aid in SDM for adult spinal deformity (ASD) surgery. METHODS From a prospective, multicenter ASD database, patients enrolled between 2008 and 2016 who underwent fusions of 5 or more levels with a minimum 2-year follow-up were included. All deformity types were included to provide general applicability. The authors compiled a list of FAQs from patients undergoing ASD surgery and used a retrospective analysis to provide answers. All responses are reported as either the means or the proportions reaching the minimal clinically important difference at the 2-year follow-up interval. RESULTS Of 689 patients with ASD who were eligible for 2-year follow-up, 521 (76%) had health-related quality-of-life scores available at the time of that follow-up. The mean age at the initial surgery was 58.2 years, and 78% of patients were female. The majority (73%) underwent surgery with a posterior-only approach. The mean number of fused levels was 12.2. Revision surgery accounted for 48% of patients. The authors answered 12 FAQs as follows:1. Will my pain improve? Back and leg pain will both be reduced by approximately 50%.2. Will my activity level improve? Approximately 65% of patients feel improvement in their activity level.3. Will I feel better about myself? More than 70% of patients feel improvement in their appearance.4. Is there a chance I will get worse? 4.1% feel worse at 2 years postoperatively.5. What is the likelihood I will have a complication? 67.8% will have a major or minor complication, with 47.8% having a major complication.6. Will I need another surgery? 25.0% will have a reoperation within 2 years.7. Will I regret having surgery? 6.5% would not choose the same treatment.8. Will I get a blood transfusion? 73.7% require a blood transfusion.9. How long will I stay in the hospital? You need to stay 8.1 days on average.10. Will I have to go to the ICU? 76.0% will have to go to the ICU.11. Will I be able to return to work? More than 70% will be working at 1 year postoperatively.12. Will I be taller after surgery? You will be 1.1 cm taller on average. CONCLUSIONS The above list provides concise, practical answers to FAQs encountered in the SDM process while counseling patients for ASD surgery.
Collapse
Affiliation(s)
- Yoji Ogura
- 1Norton Leatherman Spine Center, Louisville, Kentucky
| | - Jeffrey L Gum
- 1Norton Leatherman Spine Center, Louisville, Kentucky
| | - Alex Soroceanu
- 2Department of Orthopedics, University of Calgary, Alberta, Canada
| | - Alan H Daniels
- 3Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
| | - Breton Line
- 4Denver International Spine Center, Presbyterian St. Luke's Medical Center, Denver, Colorado
| | | | - Richard A Hostin
- 6Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Peter G Passias
- 5Department of Orthopaedics, NYU Hospital for Joint Diseases, New York, New York
| | - Douglas C Burton
- 7Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Justin S Smith
- 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | | | - Virginie Lafage
- 10Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- 10Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eric O Klineberg
- 11Department of Orthopaedic Surgery, University of California, Davis, California
| | - Han Jo Kim
- 10Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Andrew Harris
- 12Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland; and
| | - Khaled Kebaish
- 12Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland; and
| | - Frank Schwab
- 10Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- 4Denver International Spine Center, Presbyterian St. Luke's Medical Center, Denver, Colorado
| | - Christopher P Ames
- 13Department of Neurological Surgery, University of California, San Francisco, California
| | | |
Collapse
|
16
|
Schoutens C, Cushman DM, McCormick ZL, Conger A, van Royen BJ, Spiker WR. Outcomes of Nonsurgical Treatments for Symptomatic Adult Degenerative Scoliosis: A Systematic Review. PAIN MEDICINE 2020; 21:1263-1275. [PMID: 31617915 DOI: 10.1093/pm/pnz253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of nonsurgical treatments in symptomatic adult degenerative scoliosis (ADS). DESIGN A systematic literature review. METHODS PubMed, Web of Science, and The Cochrane Library were searched to identify research published since 1988. Randomized controlled trials (RCTs) and observational cohort studies were eligible if they featured symptomatic ADS patients aged ≥50 who received nonsurgical treatment. Minimum follow-up was six weeks, and outcomes of interest were pain, disability, quality of life, and Cobb angle. Evidence quality per intervention was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Six studies were included. Of these, four focused specifically on injections, bracing, or yoga; two involved multiple treatments. One RCT provided evidence for greater effectiveness of transforaminal epidural steroid injection over anesthetic alone in reducing radiating pain and disability. Two single-group retrospective cohort studies lent support for bracing to slow curve progression. One retrospective single-group cohort study suggested an association between yoga and reduced curve progression. Evidence for injections to reduce ADS symptoms was rated as low quality; evidence for bracing and yoga was rated as very low quality. No specific evidence was identified regarding other treatments, including physical therapy and analgesics. CONCLUSIONS Literature describing the effectiveness of nonoperative treatments in symptomatic ADS is scarce. The quantity and quality of the evidence regarding injections, bracing, and yoga are insufficient to advise for or against the use of these methods to improve outcomes in symptomatic ADS. For these and other nonoperative treatment forms, further research is needed.
Collapse
Affiliation(s)
- Carlijn Schoutens
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | | | | | - Aaron Conger
- Division of Physical Medicine and Rehabilitation
| | - Barend J van Royen
- Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - William R Spiker
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
17
|
The Transverse Gravitational Deviation Index, a Novel Gravity Line-Related Spinal Parameter, Relates to Balance Control and Health-Related Quality of Life in Adults With Spinal Deformity. Spine (Phila Pa 1976) 2020; 45:E25-E36. [PMID: 31842109 DOI: 10.1097/brs.0000000000003301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cross-sectional case-control study design. OBJECTIVE This study aims to analyze the relation between balance control as well as health-related quality of life (HRQOL) in patients with adult spinal deformity (ASD), with a novel gravity line (GL)-related 3D spinal alignment parameter, the transverse gravitational deviation index (TGDI), defined to quantify the transverse plane position of any vertebra with respect to the GL. SUMMARY OF BACKGROUND DATA Demographic data and balance control have both been identified as important determinants of HRQOL in ASD patients during a preoperative setting. Therefore, a better understanding of the relation between spinal alignment and balance is required. METHODS After informed consent, 15 asymptomatic healthy volunteers (mean age 60.1 ± 11.6 years old) and 55 ASD patients (mean age 63.5 ± 10.1 years old) were included. Relation between performance on BESTest as well as core outcome measures index (COMI) with spinopelvic alignment was explored using General Linear Modeling (GLM). A P-value ≤0.05 was considered statistically significant. RESULTS The L3 TGDI was identified to relate to balance control in the total ASD population after correction for confounding demographic factors (P = 0.001; adjusted R = 0.500) and explained 19% of the observed variance in balance performance. In addition, COMI is related to L3 TGDI in a subgroup of ASD patients with combined coronal and sagittal malalignment of L3 (P = 0.027; slope B = 0.047), despite significant influence of age (P = 0.020). CONCLUSION In ASD patients with a combined coronal and sagittal malalignment of the L3 vertebra, both the level of balance impairment as well as HRQOL are related to the distance component of the L3 TGDI, that is, the offset between the center of the L3 vertebral body and the GL in the transverse plane. LEVEL OF EVIDENCE 2.
Collapse
|
18
|
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: 38] [Impact Index Per Article: 9.5] [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.
Collapse
Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, China
| |
Collapse
|
19
|
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: 1.2] [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.
Collapse
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
| | | |
Collapse
|
20
|
Diebo BG, Shah NV, Boachie-Adjei O, Zhu F, Rothenfluh DA, Paulino CB, Schwab FJ, Lafage V. Adult spinal deformity. Lancet 2019; 394:160-172. [PMID: 31305254 DOI: 10.1016/s0140-6736(19)31125-0] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022]
Abstract
Adult spinal deformity affects the thoracic or thoracolumbar spine throughout the ageing process. Although adolescent spinal deformities taken into adulthood are not uncommon, the most usual causes of spinal deformity in adults are iatrogenic flatback and degenerative scoliosis. Given its prevalence in the expanding portion of the global population aged older than 65 years, the disorder is of growing interest in health care. Physical examination, with a focus on gait and posture, along with radiographical assessment are primarily used and integrated with risk stratification indices to establish optimal treatment planning. Although non-operative treatment is regarded as the first-line response, surgical outcomes are considerably favourable. Global disparities exist in both the assessment and treatment of adults with spinal deformity across countries of varying incomes, which represents an area requiring further investigation. This Seminar presents evidence and knowledge that represent the evolution of data related to spinal deformity in adults over the past several decades.
Collapse
Affiliation(s)
- Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA.
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | | | - Feng Zhu
- Department of Orthopaedic and Traumatology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dominique A Rothenfluh
- Division of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
21
|
Buell TJ, Chen CJ, Nguyen JH, Christiansen PA, Murthy SG, Buchholz AL, Yen CP, Shaffrey ME, Shaffrey CI, Smith JS. Surgical correction of severe adult lumbar scoliosis (major curves ≥ 75°): retrospective analysis with minimum 2-year follow-up. J Neurosurg Spine 2019; 31:548-561. [PMID: 31226681 DOI: 10.3171/2019.3.spine1966] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/28/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Prior reports have demonstrated the efficacy of surgical correction for adult lumbar scoliosis. Many of these reports focused on mild to moderate scoliosis. The authors' objective was to report their experience and to assess outcomes and complications after deformity correction for severe adult scoliosis. METHODS The authors retrospectively analyzed consecutive adult scoliosis patients with major thoracolumbar/lumbar (TL/L) curves ≥ 75° who underwent deformity correction at their institution. Those eligible with a minimum 2 years of follow-up were included. Demographic, surgical, coronal and sagittal plane radiographic measurements, and health-related quality of life (HRQL) scores were analyzed. RESULTS Among 26 potentially eligible patients, 22 (85%) had a minimum 2 years of follow-up (range 24-89 months) and were included in the study (mean age 57 ± 11 years; 91% women). The cohort comprised 16 (73%), 4 (18%), and 2 (9%) patients with adult idiopathic scoliosis, de novo degenerative scoliosis, and iatrogenic scoliosis, respectively. The surgical approach was posterior-only and multistage anterior-posterior in 18 (82%) and 4 (18%) patients, respectively. Three-column osteotomy was performed in 5 (23%) patients. Transforaminal and anterior lumbar interbody fusion were performed in 14 (64%) and 4 (18%) patients, respectively. All patients had sacropelvic fixation with uppermost instrumented vertebra in the lower thoracic spine (46% [10/22]) versus upper thoracic spine (55% [12/22]). The mean fusion length was 14 ± 3 levels. Preoperative major TL/L and lumbosacral fractional (L4-S1) curves were corrected from 83° ± 8° to 28° ± 13° (p < 0.001) and 34° ± 8° to 13° ± 6° (p < 0.001), respectively. Global coronal and sagittal balance significantly improved from 5 ± 4 cm to 1 ± 1 cm (p = 0.001) and 9 ± 8 cm to 2 ± 3 cm (p < 0.001), respectively. Pelvic tilt significantly improved from 33° ± 9° to 23° ± 10° (p < 0.001). Significant improvement in HRQL measures included the following: Scoliosis Research Society (SRS) pain score (p = 0.009), SRS appearance score (p = 0.004), and SF-12/SF-36 physical component summary (PCS) score (p = 0.026). Transient and persistent neurological deficits occurred in 8 (36%) and 2 (9%) patients, respectively. Rod fracture/pseudarthrosis occurred in 6 (27%) patients (supplemental rods were utilized more recently in 23%). Revisions were performed in 7 (32%) patients. CONCLUSIONS In this single-center surgical series for severe adult scoliosis (major curves ≥ 75°), a posterior-only or multistage anterior-posterior approach provided major curve correction of 66% and significant improvements in global coronal and sagittal spinopelvic alignment. Significant improvements were also demonstrated in HRQL measures (SRS pain, SRS appearance, and SF-12/SF-36 PCS). Complications and revisions were comparable to those of other reports involving less severe scoliosis. The results of this study warrant future prospective multicenter studies to further delineate outcomes and complication risks for severe adult scoliosis correction.
Collapse
Affiliation(s)
- Thomas J Buell
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
- 2Department of Neurological Surgery, Auckland City Hospital, Auckland, New Zealand; and
| | - Ching-Jen Chen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - James H Nguyen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Peter A Christiansen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Saikiran G Murthy
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Avery L Buchholz
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Chun-Po Yen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mark E Shaffrey
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher I Shaffrey
- 3Departments of Orthopaedic and Neurological Surgery, Duke University Medical Center, Durham, North Carolina
| | - Justin S Smith
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| |
Collapse
|
22
|
Smith JS, Shaffrey CI, Ames CP, Lenke LG. Treatment of adult thoracolumbar spinal deformity: past, present, and future. J Neurosurg Spine 2019; 30:551-567. [PMID: 31042666 DOI: 10.3171/2019.1.spine181494] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/22/2019] [Indexed: 01/27/2023]
Abstract
Care of the patient with adult spinal deformity (ASD) has evolved from being primarily supportive to now having the ability to directly treat and correct the spinal pathology. The focus of this narrative literature review is to briefly summarize the history of ASD treatment, discuss the current state of the art of ASD care with focus on surgical treatment and current challenges, and conclude with a discussion of potential developments related to ASD surgery.In the past, care for ASD was primarily based on supportive measures, including braces and assistive devices, with few options for surgical treatments that were often deemed high risk and reserved for rare situations. Advances in anesthetic and critical care, surgical techniques, and instrumentation now enable almost routine surgery for many patients with ASD. Despite the advances, there are many remaining challenges currently impacting the care of ASD patients, including increasing numbers of elderly patients with greater comorbidities, high complication and reoperation rates, and high procedure cost without clearly demonstrated cost-effectiveness based on standard criteria. In addition, there remains considerable variability across multiple aspects of ASD surgery. For example, there is currently very limited ability to provide preoperative individualized counseling regarding optimal treatment approaches (e.g., operative vs nonoperative), complication risks with surgery, durability of surgery, and likelihood of achieving individualized patient goals and satisfaction. Despite the challenges associated with the current state-of-the-art ASD treatment, surgery continues to be a primary option, as multiple reports have demonstrated the potential for surgery to significantly improve pain and disability. The future of ASD care will likely include techniques and technologies to markedly reduce complication rates, including greater use of navigation and robotics, and a shift toward individualized medicine that enables improved counseling, preoperative planning, procedure safety, and patient satisfaction.Advances in the care of ASD patients have been remarkable over the past few decades. The current state of the art enables almost routine surgical treatment for many types of ASD that have the potential to significantly improve pain and disability. However, significant challenges remain, including high complication rates, lack of demonstrated cost-effectiveness, and limited ability to meaningfully counsel patients preoperatively on an individual basis. The future of ASD surgery will require continued improvement of predictability, safety, and sustainability.
Collapse
Affiliation(s)
- Justin S Smith
- 1Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher I Shaffrey
- 2Departments of Neurosurgery and Orthopaedic Surgery, Duke Medical Center, Durham, North Carolina
| | - Christopher P Ames
- 3Department of Neurosurgery, University of California, San Francisco, California; and
| | - Lawrence G Lenke
- 4Department of Orthopaedic Surgery, Columbia University, New York, New York
| |
Collapse
|
23
|
Tate Q, House LM, McCormick ZL, Mahan MA. High-Frequency Spinal Cord Stimulation for the Treatment of Primarily Axial Back Pain due to Degenerative Scoliosis with Spinopelvic Imbalance: Case Report. PAIN MEDICINE 2019; 20:2071-2074. [DOI: 10.1093/pm/pnz043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Quinn Tate
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah
| | - L McLean House
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, California
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
24
|
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: 6] [Impact Index Per Article: 1.2] [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.
Collapse
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
| | | |
Collapse
|
25
|
Sethi RK, Buchlak QD, Leveque JC, Wright AK, Yanamadala VV. Quality and safety improvement initiatives in complex spine surgery. ACTA ACUST UNITED AC 2018. [DOI: 10.1053/j.semss.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
26
|
Pugely AJ, Kelly MP, Baldus CR, Gao Y, Zebala L, Shaffrey C, Glassman S, Boachie-Adjei O, Parent S, Lewis S, Koski T, Edwards C, Schwab F, Bridwell KH. Serious Adverse Events Significantly Reduce Patient-Reported Outcomes at 2-Year Follow-up: Nonoperative, Multicenter, Prospective NIH Study of 105 Patients. Spine (Phila Pa 1976) 2018; 43:747-753. [PMID: 29095407 PMCID: PMC5930151 DOI: 10.1097/brs.0000000000002479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is an analysis of a prospective 2-year study on nonoperative patients enrolled in the Adult Symptomatic Lumbar Scoliosis (ASLS) National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) trial. OBJECTIVE The purpose was to evaluate the impact of serious adverse events (SAEs) on patient-reported outcomes (PROs) in nonoperative management of ASLS as measured by Scoliosis Research Society-22 (SRS-22), Oswestry Disability Index (ODI), and Short Form-12 (SF-12) at 2-year follow-up. SUMMARY OF BACKGROUND DATA Little is known about PROs in the nonoperative management of ASLS or the prevalence and impact of SAEs on PROs. METHODS The ASLS trial dataset was analyzed to identify adult lumbar scoliosis patients electively choosing or randomly assigned to nonoperative treatment with minimum 2-year follow-up. Patient data were collected prospectively from 2010 to 2015 as part of NIAMS R01-AR055176-01A2 "A Multi-Centered Prospective Study of Quality of Life in Adult Scoliosis." SAEs were defined as life-threatening medical events, new significant or permanent disability, new or prolonged hospitalization, or death. RESULTS One hundred five nonoperative patients were studied to 2-year follow-up. Twenty-seven patients (25.7%) had 42 SAEs; 15 (14.3%) had a SAE during the first year. The SAE group had higher body mass index (29.4 vs. 25.2; P = 0.008) and reported worse SRS-22 Function scores than the non-SAE group at baseline (3.3 vs. 3.6; P = 0.024). At 2-year follow-up, SAE patients experienced less improvement (change) in SRS-22 Self-Image (-0.07 vs. 0.26; P = 0.018) and Mental Health domains (-0.19 vs. 0.25; P = 0.002) than non-SAE patients and had lower SRS-22 Function, Self-Image, Subscore, and SF-12 Mental and Physical component scores (MCS/PCS). Fewer SAE patients reached minimal clinically important difference (MCID) threshold in SRS-22 Mental Health (14.8% vs. 43.6%; P = 0.01). CONCLUSION A high percentage (25.7%) of ASLS patients managed nonoperatively experienced SAEs. Those patients who sustained a SAE had less improvement in reported outcomes. LEVEL OF EVIDENCE 2.
Collapse
Affiliation(s)
| | | | | | - Yubo Gao
- Washington University in St. Louis School of Medicine
| | - Lukas Zebala
- Washington University in St. Louis School of Medicine
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Kyrölä K, Repo J, Mecklin JP, Ylinen J, Kautiainen H, Häkkinen A. Spinopelvic Changes Based on the Simplified SRS-Schwab Adult Spinal Deformity Classification: Relationships With Disability and Health-Related Quality of Life in Adult Patients With Prolonged Degenerative Spinal Disorders. Spine (Phila Pa 1976) 2018; 43:497-502. [PMID: 28767623 DOI: 10.1097/brs.0000000000002370] [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 Cross-sectional, observational study. OBJECTIVE To study the occurrence of sagittal malalignment, the adaptability of a simplified sagittal modifiers grading of the Scoliosis Research Society (SRS)-Schwab adult spinal deformity (ASD) classification, and the deformity-specific SRS questionnaire version 30 (SRS-30) in an unselected adult cohort with symptomatic degenerative spinal disorders. SUMMARY OF BACKGROUND DATA The sagittal modifiers of the SRS-Schwab ASD classification correlate with health-related quality of life (HRQoL) measures in patients with ASD. The deformities and disabilities caused by sagittal malalignment in patients with common degenerative spinal disorders of multiple etiologies are rarely studied. A simplified and categorizing version of the SRS-Schwab ASD classification in relation to the Oswestry Disability Index (ODI) and the SRS-30 outcomes has not yet been developed. METHODS We recruited 874 consecutive patients with degenerative spinal disorders between March 2013 and February 2014. Full spine radiographs were taken and the patients divided into sagittal deformity severity groups: mild or none, moderate, and marked deformity. Participants completed the ODI, SRS-30, and a general health questionnaire. RESULTS We included 637 patients in the analysis. The severity of sagittal deformity was mild or none in 407 (63.9%) patients, moderate in 159 (25.0%), and marked in 71 (11.1%). Linearity across the modifier grades and deformity classes was found for ODI total score (P = 0.033), and the function/activity (P = 0.004) and self-image/appearance (P = 0.030) domains of the SRS-30. Age, body mass index, duration of symptoms, and the use of painkillers increased while physical activity, working, and educational status decreased significantly with deformity severity. CONCLUSION Sagittal spinopelvic malalignment is significantly related to deterioration of the ODI and the SRS-30 in symptomatic adults with degenerative spinal disorders. The SRS-Schwab classification sagittal modifiers categorized into three groups is a practical tool to detect various clinically significant grades of deformity in a cohort with no recognized ASD. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Kati Kyrölä
- Department of Orthopaedics and Traumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Jussi Repo
- Department of Orthopaedics and Traumatology, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Jukka-Pekka Mecklin
- Department of Education and Science, Central Finland Health Care District, Jyväskylä, Finland.,Department of Surgery, University of Eastern Finland, Jyväskylä, Finland
| | - Jari Ylinen
- Department of Physical Rehabilitation, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Arja Häkkinen
- Department of Physical Rehabilitation, Central Hospital of Central Finland, Jyväskylä, Finland.,Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| |
Collapse
|
28
|
Shukla DR, Vaichinger AM, Shields MN, Lee J, Gupta S, Fitzsimmons JS, O'Driscoll SW. Patient-Physician Agreement Using Summary Outcome Determination Scores. Mayo Clin Proc 2018; 93:32-39. [PMID: 29217336 DOI: 10.1016/j.mayocp.2017.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/20/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether the Summary Outcome Determination (SOD) score had exhibited a high level of physician-patient agreement in surgical patients. PATIENTS AND METHODS The medical records of 320 postoperative patients were reviewed, of whom 164 patients were included in the study. Patients were included if both physician-assigned and patient-assigned SOD scores had been recorded. The SOD is administered as follows: the patient is asked "Compared to before surgery, is your elbow/shoulder better, worse or no different?" If better: "Is it improved, greatly improved, almost normal or normal?" If worse: "Is it worse or profoundly worse, or as bad as dying?" Each category is associated with a numerical value and definition for further clarification. The patient is asked to assign a category and a numerical value after the physician has already done so. These categories and values were evaluated between raters (ie, physician and patient) to assess reliability. RESULTS The intraclass correlation coefficient of physician-patient numerical ratings was "excellent" (0.93). The Bland-Altman 95% limits of agreement on the differences between the physician and the patient ranged from -1.3 to 1.3. The physician and patient numerical rankings matched exactly in 118 patients (72%) or differed by a factor of no more than 1 (26%) in 161 (98%) patients. CONCLUSION The SOD score can be used as both a surgeon-based and a patient-based outcome score, given the high level of agreement. Given its brevity, ease of understanding, and high interrater reliability, the SOD has the potential to be used across multiple specialties to rate outcomes.
Collapse
Affiliation(s)
- Dave R Shukla
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Julia Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Shabnum Gupta
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | |
Collapse
|
29
|
Bae J, Theologis AA, Strom R, Tay B, Burch S, Berven S, Mummaneni PV, Chou D, Ames CP, Deviren V. Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance. J Neurosurg Spine 2017; 28:40-49. [PMID: 29087808 DOI: 10.3171/2017.5.spine161370] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical treatment of adult spinal deformity (ASD) is an effective endeavor that can be accomplished using a variety of surgical strategies. Here, the authors assess and compare radiographic data, complications, and health-related quality-of-life (HRQoL) outcome scores among patients with ASD who underwent a posterior spinal fixation (PSF)-only approach, a posterior approach combined with lateral lumbar interbody fusion (LLIF+PSF), or a posterior approach combined with anterior lumbar interbody fusion (ALIF+PSF). METHODS The medical records of consecutive adults who underwent thoracolumbar fusion for ASD between 2003 and 2013 at a single institution were reviewed. Included were patients who underwent instrumentation from the pelvis to L-1 or above, had a sagittal vertical axis (SVA) of < 10 cm, and underwent a minimum of 2 years' follow-up. Those who underwent a 3-column osteotomy were excluded. Three groups of patients were compared on the basis of the procedure performed, LLIF+PSF, ALIF+PSF, and PSF only. Perioperative spinal deformity parameters, complications, and HRQoL outcome scores (Oswestry Disability Index [ODI], Scoliosis Research Society 22-question Questionnaire [SRS-22], 36-Item Short Form Health Survey [SF-36], visual analog scale [VAS] for back/leg pain) from each group were assessed and compared with each other using ANOVA. The minimal clinically important differences used were -1.2 (VAS back pain), -1.6 (VAS leg pain), -15 (ODI), 0.587/0.375/0.8/0.42 (SRS-22 pain/function/self-image/mental health), and 5.2 (SF-36, physical component summary). RESULTS A total of 221 patients (58 LLIF, 91 ALIF, 72 PSF only) met the inclusion criteria. Average deformities consisted of a SVA of < 10 cm, a pelvic incidence-lumbar lordosis (LL) mismatch of > 10°, a pelvic tilt of > 20°, a lumbar Cobb angle of > 20°, and a thoracic Cobb angle of > 15°. Preoperative SVA, LL, pelvic incidence-LL mismatch, and lumbar and thoracic Cobb angles were similar among the groups. Patients in the PSF-only group had more comorbidities, those in the ALIF+PSF group were, on average, younger and had a lower body mass index than those in the LLIF+PSF group, and patients in the LLIF+PSF group had a significantly higher mean number of interbody fusion levels than those in the ALIF+PSF and PSF-only groups. At final follow-up, all radiographic parameters and the mean numbers of complications were similar among the groups. Patients in the LLIF+PSF group had proximal junctional kyphosis that required revision surgery significantly less often and fewer proximal junctional fractures and vertebral slips. All preoperative HRQoL scores were similar among the groups. After surgery, the LLIF+PSF group had a significantly lower ODI score, higher SRS-22 self-image/total scores, and greater achievement of the minimal clinically important difference for the SRS-22 pain score. CONCLUSIONS Satisfactory radiographic outcomes can be achieved similarly and adequately with these 3 surgical approaches for patients with ASD with mild to moderate sagittal deformity. Compared with patients treated with an ALIF+PSF or PSF-only surgical strategy, patients who underwent LLIF+PSF had lower rates of proximal junctional kyphosis and mechanical failure at the upper instrumented vertebra and less back pain, less disability, and better SRS-22 scores.
Collapse
Affiliation(s)
- Junseok Bae
- 1Department of Neurological Surgery, Wooridul Spine Hospital, Seoul, South Korea; and
| | | | | | - Bobby Tay
- Departments of2Orthopaedic Surgery and
| | | | | | | | - Dean Chou
- 3Neurological Surgery, University of California, San Francisco, California
| | - Christopher P Ames
- 3Neurological Surgery, University of California, San Francisco, California
| | | |
Collapse
|
30
|
Lin T, Meng Y, Li T, Jiang H, Gao R, Zhou X. Predictors of Postoperative Recovery Based on Health-Related Quality of Life in Patients after Degenerative Lumbar Scoliosis Surgery. World Neurosurg 2017; 109:e539-e545. [PMID: 29038078 DOI: 10.1016/j.wneu.2017.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/02/2017] [Accepted: 10/04/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the factors associated with the recovery process of elderly patients after degenerative lumbar scoliosis surgery. METHODS A total of 213 elderly patients who had undergone surgical treatment for degenerative lumbar scoliosis from 2011 to 2015 were included retrospectively in this study. Clinical data and demographics were collected for logistic regression analysis. RESULTS Among 213 eligible patients, 77 (38.5%) were classified as being in the excellent group, 70 (35%) as showing improvement, 24 (12%) as showing no change, and 29 (14.5%) as having deteriorated. At baseline, patients differed significantly from matched normative data in all Scoliosis Research Society domains. Larger differences from normative values were found for pain and activity domains. After surgery, each domain improved significantly. In the multivariate logistic regression, age 60-70 years (odds ratio [OR], 2.431; 95% confidence interval [CI], 1.143-5.174), and American Society of Anesthesiologists grade <3 (OR, 2.987; 95% CI, 1.519-5.874) may be predictive factors for a satisfying recovery, whereas presence of complications (OR, 0.342; 95% CI, 0.153-0.765), fusion to the sacrum (OR, 0.200; 95% CI, 0.076-0.523), and more osteotomies (OR, 0.360; 95% CI, 0.132-0.985) have negative effects on the recovery process. CONCLUSIONS The factors that affect postoperative recovery in elderly patients with degenerative lumbar scoliosis are age, American Society of Anesthesiologists grade, distal fusion level, presence of complications, and number of osteotomies.
Collapse
Affiliation(s)
- Tao Lin
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China
| | - Yichen Meng
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China
| | - Tangbo Li
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China
| | - Heng Jiang
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China
| | - Rui Gao
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
| | - Xuhui Zhou
- Department of Orthopedics, Changzheng Hospital, Second Affiliated Hospital of Second Military Medical University, Shanghai, People's Republic of China.
| |
Collapse
|
31
|
Theis JC, Grauers A, Diarbakerli E, Savvides P, Abbott A, Gerdhem P. An observational study on surgically treated adult idiopathic scoliosis patients' quality of life outcomes at 1- and 2-year follow-ups and comparison to controls. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:11. [PMID: 28413830 PMCID: PMC5389187 DOI: 10.1186/s13013-017-0118-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 03/28/2017] [Indexed: 12/05/2022]
Abstract
Background Prospective data on health-related quality of life in patients with idiopathic scoliosis treated surgically as adults is needed. We compared preoperative and 1- and 2-year follow-up data in surgically treated adults with idiopathic scoliosis with juvenile or adolescent onset. Results were compared to untreated adults with scoliosis and population normative data. Methods A comparison of preoperative and 1- and 2-year follow-up data of 75 adults surgically treated for idiopathic scoliosis at a mean age of 28 years (range 18 to 69) from a prospective national register study, as well as a comparison with age- and sex-matched data from 75 untreated adults with less severe scoliosis and 75 adults without scoliosis, was made. Outcome measures were EuroQol-5 dimensions (EQ-5D) and Scoliosis Research Society (SRS)-22r questionnaire. Results In the surgically treated, EQ-5D and SRS-22r scores had statistically significant improvements at both 1- and 2-year follow-ups (all p
< 0.015). The effect size of surgery on EQ-5D at 1-year follow-up was large (r = −0.54) and small-medium (r = −0.20) at 2-year follow-up. The effect size of surgery on SRS-22r outcomes was medium-large at 1- and 2-year follow-ups (r = −0.43 and r = −0.42 respectively). At the 2-year follow-up, the EQ-5D score and the SRS-22r subscore were similar to the untreated scoliosis group (p = 0.56 and p = 0.91 respectively), but lower than those in the adults without scoliosis (p < 0.001 for both comparisons). Conclusions Adults with idiopathic scoliosis experience an increase in health-related quality of life following surgery at 2-year follow-up, approaching the health-related quality of life of untreated individuals with less severe scoliosis, but remain lower than normative population data.
Collapse
Affiliation(s)
- Jennifer C Theis
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, 2 Promethean Way, Robina, Queensland 4226 Australia.,Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Anna Grauers
- Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden.,Department of Orthopaedics, Sundsvall and Härnösand County Hospital, 85186 Sundsvall, Sweden
| | - Elias Diarbakerli
- Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Panayiotis Savvides
- Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Allan Abbott
- Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, 2 Promethean Way, Robina, Queensland 4226 Australia.,Department of Physical Therapy, Karolinska University Hospital, SE-141 86 Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-141 86 Stockholm, Sweden.,Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, SE-58183 Linköping, Sweden
| | - Paul Gerdhem
- Department of Orthopaedics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| |
Collapse
|
32
|
Function and Clinical Symptoms are the Main Factors that Motivate Thoracolumbar Adult Scoliosis Patients to Pursue Surgery. Spine (Phila Pa 1976) 2017; 42:E31-E36. [PMID: 27196023 DOI: 10.1097/brs.0000000000001694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective two-cohort comparative analysis of data collected prospectively in an adult deformity multicenter database. OBJECTIVE The aim of this study was to define the radiographic and clinical parameters that motivate adult thoracolumbar (TL) scoliosis patients to undergo surgery. SUMMARY OF BACKGROUND DATA TL curves are a primary concern in adulthood, and it is necessary to establish why patients are motivated to seek surgical intervention. METHODS Patients with only main TL/lumbar (TL/L) idiopathic curves were included, defined as Schwab type L curves and Schwab type D curves in which thoracic curves were <40° and the difference between the TL/L-MT Cobb was ≥15°. Demographic data, health-related quality of life (HRQOL) questionnaires, and 14 different radiological preoperative parameters were assessed. Surgical versus conservative cohorts were compared with the Student t test, Chi-square, and the Mann-Whitney U test. RESULTS A total of 184 patients met the inclusion criteria. Ninety-four were treated conservatively (C), while 90 underwent surgery (S). No differences were found between groups in terms of demographic or radiographic preoperative data. Age (C: 57.5 ± 18 vs. S: 54.2 ± 18 yr; P = 0.18), coronal TL/L Cobb (C: 52.3° ± 15 vs. S: 50.6° ± 13; P = 0.61), and sagittal alignment (SVA C: 3.1 cm ± 5.7 vs. S: 4.9 cm ± 6.4; P = 0.054) were similar. No differences were found in pelvic parameters (pelvic incidence, pelvic tilt, sacral slope), apical translation, coronal balance, lumbar rotatory subluxation, or lumbar lordosis. However, significant differences were found in HRQOL questionnaires. Surgical patients initially had worse COMI scores (C: 4.6 ± 2.3 vs. S: 6 ± 2.3; P = 0.001), worse ODI scores (C: 27.7 ± 16 vs. S: 38.9 ± 20; P = 0.000), worse SF-36 physical (C: 40.9 ± 8.5 vs. S: 36 ± 9.5; P = 0.001) and mental scores (C: 45.8 ± 12 vs. S: 42.2 ± 11.8; P = 0.032), and worse SRS-22 scores in all domains with mean values under 3.1 points (range = 2.4-3.1). In both SF-36 physical and SRS-22 function, differences between groups were higher than the minimum clinically important difference. CONCLUSION After analyzing a large multicenter database, we found that only clinical factors-particularly function impairment-motivated adult TL scoliosis patients to undergo surgery. Demographic and radiographic parameters did not seem to influence decision-making. LEVEL OF EVIDENCE 3.
Collapse
|
33
|
Validity, Reliability, and Responsiveness of SRS-7 as an Outcomes Assessment Instrument for Operatively Treated Patients With Adult Spinal Deformity. Spine (Phila Pa 1976) 2016; 41:1463-1468. [PMID: 26937607 DOI: 10.1097/brs.0000000000001540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis. OBJECTIVE The aim of our study was to compare the normality, concurrent validity, internal consistency, responsiveness, and dimensionality of an item response theory-derived seven-question instrument (SRS-7), against the Scoliosis Research Society-22r (SRS-22r) questionnaire in operatively treated patients with adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA Compared with SRS-22r, SRS-7 (which has been validated in operatively treated patients with adolescent idiopathic scoliosis) has advantages of being short, unidimensional, and linear. METHODS A prospective database of ASD patients was queried for patients 18 years or older who were operatively treated, and who answered pre- and postoperative (at 2-year follow-up) SRS-22r questions (n = 276). Corresponding SRS-7 scores were calculated using answers to SRS-22r items 1, 4, 6, 10, 18, 19, and 20. Significance was set at a P value less than 0.01. RESULTS SRS-7 and SRS-22r were normally distributed preoperatively but not postoperatively. SRS-7 and SRS-22r scores had high correlation both preoperatively (r = 0.76, P < 0.01) and postoperatively (r = 0.83, P < 0.01). The internal consistency reliability Cronbach α values were 0.61 (SRS-7) and 0.83 (SRS-22r) preoperatively and 0.91 (SRS-7) and 0.95 (SRS-22r) postoperatively. SRS-7 was found to be more responsive than SRS-22r with measures of effect size: Cohen d = 1.21 versus 1.13, Hedge g = 1.21 versus 1.13, and effect size correlation r = 0.52 versus 0.49. Iterative principal factor analysis of pre- and postoperative scores showed the presence of one dominant latent factor in SRS-7 (unidimensionality) and four latent factors in SRS-22r (multidimensionality). CONCLUSION SRS-7 is a valid, reliable, responsive, and unidimensional instrument, which can be used as a short-form alternative to the SRS-22r for assessing global changes in patient-reported outcomes over time in patients with ASD. LEVEL OF EVIDENCE 3.
Collapse
|
34
|
Putzier M, Pumberger M, Halm H, Zahn RK, Franke J. [Surgical treatment of de-novo scoliosis]. DER ORTHOPADE 2016; 45:744-54. [PMID: 27514825 DOI: 10.1007/s00132-016-3313-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND De-novo scoliosis is most commonly associated with chronic back pain and in 70 % of cases with neurological symptoms of the lower extremities. In recent literature, the occurrence and severity of segmental lateral listhesis has been discussed as being an important prognostic factor of sagittal and frontal deformity progression. In general, operative interventions in patients with de-novo scoliosis are associated with a high rate of complications. Therefore, conservative treatment modalities are recommended at early stages of the disease. If conservative management fails and a sufficient reduction of the patient's symptoms cannot be achieved, depending on the symptoms, a selective decompression, short-segment fusion or long-instrumented reduction and fusion are indicated. Additionally to the patient's symptoms, specific imaging diagnostics are necessary to develop an adequate surgical treatment strategy. TREATMENT Selective decompression without fusion is indicated in patients with a fixed deformity and primarily neurologic pain or deficits. In conditions of a focal pathology as cause of significant low back pain and/or neurologic symptoms at early stages of deformity, a short segment fusion is the treatment of choice. However, short-segment fusion as a less-invasive procedure must not be performed in biplanar unbalanced patients and/or advanced de-novo scoliosis. In advanced degenerative de-novo scoliosis a long-segment reposition and fusion following an alignment correction are needed. Standardized pre-operative planning and perioperative management are highly critical to the post-operative success. CONCLUSION All operative treatment strategies in patients with de-novo scoliosis can be successful but they require sophisticated and individual surgical indication.
Collapse
Affiliation(s)
- M Putzier
- Centrum für Muskuloskeletale Chirurgie Klinik für Orthopädie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - M Pumberger
- Centrum für Muskuloskeletale Chirurgie Klinik für Orthopädie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - H Halm
- Schön Klinik Neustadt, Fachzentrum Wirbelsäulenchirurgie & Skoliosezentrum, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland
| | - R K Zahn
- Centrum für Muskuloskeletale Chirurgie Klinik für Orthopädie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - J Franke
- Klinik für Wirbelsäulenchirurgie, Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Deutschland
| |
Collapse
|