1
|
Deng Z, Xiu P, Wang L, Zhou C, Liu L, Song Y, Yang X. The Comparison of Posterior Intervertebral Release Combined with Posterior Column Osteotomy and Posterior Column Osteotomy Alone for the Treatment of Moderate-to-Severe Rigid Scoliosis: A Prospective Controlled Study. Orthop Surg 2024; 16:594-603. [PMID: 38237925 PMCID: PMC10925497 DOI: 10.1111/os.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/23/2023] [Accepted: 12/15/2023] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES There is no consensus on the treatment of moderate-to-severe rigid scoliosis. Anterior release and three-column osteotomy are excessively traumatic, whereas posterior column osteotomy (PCO) alone results in poor outcomes. An emerging surgical technique, posterior intervertebral release (PR), can release the rigid spine from the posterior approach. This study was performed to compare the multi-segment apical convex PR combined with PCO and PCO alone in patients with moderate-to-severe rigid scoliosis. METHODS From June 2021 to June 2022, this prospective study of moderate-to-severe (Cobb: 70-90°) rigid scoliosis (flexibility of main curve <25%) involved two groups defined by surgical procedure: the PR group, the patients undergoing PR combined with PCO; and the PCO group, the patients undergoing PCO alone. Follow-up was at least 12 months. Radiographic results mainly included main curve Cobb, correction of per PR/PCO segment, apical vertebra rotation (AVR) and apical vertebra translation (AVT). Demographics, surgical data, complications were also recorded. Student's independent samples t test and Pearson's chi-square test were used to compare the differences between groups. RESULTS Forty patients with an average age of 16.65 years were included (PR group, n = 20; PCO group, n = 20). The main curves averaged 77.56° ± 5.86° versus 78.02° ± 5.72° preoperatively and 20.07° ± 6.73° versus 33.58° ± 5.76° (p < 0.001) at the last follow-up in the PR and PCO groups, respectively. The mean correction rates were 74.30% and 56.84%, respectively (p < 0.001). The average coronal curve correction was 13.49° per release segment, which was significantly higher than the PCO correction of 6.20° (p < 0.001). The correction of apical vertebra rotation and translation in the main thoracic curve was significantly better in the PR group than in the PCO group (p < 0.05). Several minor complications in the two groups improved after conservative treatment. CONCLUSION The multi-segment apical convex PR combined with PCO offers more advantages than PCO alone in the treatment of patients with moderate-to-severe rigid scoliosis. Owing to its excellent corrective effect and few complications, this is a high benefit-risk ratio surgical strategy for rigid scoliosis.
Collapse
Affiliation(s)
- Zhipeng Deng
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Peng Xiu
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Lei Wang
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Chunguang Zhou
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Limin Liu
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Yueming Song
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Xi Yang
- Department of Orthopedics, Orthopedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| |
Collapse
|
2
|
Denisov A, Rowland A, Zaborovskii N, Ptashnikov D, Kondrashov D. Moderate sagittal plane deformity patients have similar radiographic and functional outcomes with either anterior or posterior surgery. 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 2024; 33:620-629. [PMID: 38151636 DOI: 10.1007/s00586-023-08075-8] [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: 07/31/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE This study aimed to compare the functional and radiographic outcomes of two surgical interventions for adult spinal deformity (ASD): anterior lumbar interbody fusion with anterior column realignment (ALIF-ACR) and posterior approach using Smith-Peterson osteotomy with transforaminal lumbar interbody fusion and pedicle screw fixation (TLIF-Schwab2). METHODS A retrospective cohort study included 61 ASD patients treated surgically between 2019 and 2020 at a single tertiary orthopedic specialty hospital. Patients were divided into two groups: Group 1 (ALIF-ACR, 29 patients) and Group 2 (TLIF-Schwab2, 32 patients). Spinopelvic radiographic parameters and functional outcomes were evaluated at 3, 6, and 12 months postsurgery. RESULTS Perioperative outcomes favored the ALIF-ACR group, with significantly smaller blood loss, shorter hospital stay, and operative time. Radiographic and functional outcomes were similar for both groups; however, the ALIF-ACR group did have a greater degree of correction in lumbar lordosis at 12 months. Complication profiles varied, with the ALIF-ACR group experiencing mostly hardware-related complications, while the TLIF-Schwab2 group faced dural tears, wound dehiscence, and proximal junctional kyphosis. Both groups had similar revision rates. CONCLUSION Both ALIF-ACR and TLIF-Schwab2 achieved similar radiographic and functional outcomes in ASD patients with moderate sagittal plane deformity at 1-year follow-up. However, the safety profiles of the two techniques differed. Further research is required to optimize patient selection for each surgical approach, aiming to minimize perioperative complications and reoperation rates in this challenging patient population.
Collapse
Affiliation(s)
- Anton Denisov
- Hospital Quironsalud San Jose, Madrid, Spain
- 12 de Octubre University Hospital, Madrid, Spain
| | - Andrea Rowland
- San Francisco Orthopaedic Residency Program and St. Mary's Medical Center, 450 Stanyan St., San Francisco, CA, 94117, USA.
| | - Nikita Zaborovskii
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
- Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Dmitrii Ptashnikov
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
- North-Western State Medical University named after I. I. Mechnikov, Saint-Petersburg, Russia
| | - Dimitriy Kondrashov
- San Francisco Orthopaedic Residency Program and St. Mary's Medical Center, 450 Stanyan St., San Francisco, CA, 94117, USA
| |
Collapse
|
3
|
Mundis GM, Eastlack RK, LaMae Price A. Anterior Column Realignment: Adult Sagittal Deformity Treatment Through Minimally Invasive Surgery. Neurosurg Clin N Am 2023; 34:633-642. [PMID: 37718109 DOI: 10.1016/j.nec.2023.06.010] [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] [Indexed: 09/19/2023]
Abstract
This article focuses on the treatment of sagittal spinal deformity using a minimally invasive technique, anterior column realignment. Traditional methods to address sagittal spine deformity have been associated with high morbidity, long operative times, and excessive blood loss. This technique uses a minimally invasive lateral retroperitoneal approach to release the anterior longitudinal ligament and apply a hyperlordotic implant for interbody fusion to restore lumbar lordosis and sagittal alignment.
Collapse
Affiliation(s)
- Gregory M Mundis
- Scripps Clinic, Department of Spine Surgery, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA; San Diego Spine Foundation, Suite 212, 6190 Cornerstone Ct. East, San Diego, CA 92121, USA
| | - Robert Kenneth Eastlack
- Scripps Clinic, Department of Spine Surgery, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA; San Diego Spine Foundation, Suite 212, 6190 Cornerstone Ct. East, San Diego, CA 92121, USA
| | - Amber LaMae Price
- Scripps Clinic, Department of Spine Surgery, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA; San Diego Spine Foundation, Suite 212, 6190 Cornerstone Ct. East, San Diego, CA 92121, USA.
| |
Collapse
|
4
|
Yang C, Zhao X, An X, Zhang Y, Sun W, Zhang Y, Duan Y, Kang X, Sun Y, Jiang L, Lian F. Axonal transport deficits in the pathogenesis of diabetic peripheral neuropathy. Front Endocrinol (Lausanne) 2023; 14:1136796. [PMID: 37056668 PMCID: PMC10086245 DOI: 10.3389/fendo.2023.1136796] [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: 01/03/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Diabetic peripheral neuropathy (DPN) is a chronic and prevalent metabolic disease that gravely endangers human health and seriously affects the quality of life of hyperglycemic patients. More seriously, it can lead to amputation and neuropathic pain, imposing a severe financial burden on patients and the healthcare system. Even with strict glycemic control or pancreas transplantation, peripheral nerve damage is difficult to reverse. Most current treatment options for DPN can only treat the symptoms but not the underlying mechanism. Patients with long-term diabetes mellitus (DM) develop axonal transport dysfunction, which could be an important factor in causing or exacerbating DPN. This review explores the underlying mechanisms that may be related to axonal transport impairment and cytoskeletal changes caused by DM, and the relevance of the latter with the occurrence and progression of DPN, including nerve fiber loss, diminished nerve conduction velocity, and impaired nerve regeneration, and also predicts possible therapeutic strategies. Understanding the mechanisms of diabetic neuronal injury is essential to prevent the deterioration of DPN and to develop new therapeutic strategies. Timely and effective improvement of axonal transport impairment is particularly critical for the treatment of peripheral neuropathies.
Collapse
|
5
|
Menachem S, Seex K. A biomechanical study shows the direction of compression influences the amount of lordosis gained in lumbar fusion. Clin Biomech (Bristol, Avon) 2023; 101:105862. [PMID: 36549049 DOI: 10.1016/j.clinbiomech.2022.105862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
STUDY DESIGN Biomechanical model study. BACKGROUND Lumbar lordosis is usually lost in the degenerative process, and when lumbar fusion is required, its restoration is one of the modern metrics of a successful operation. We sought to investigate the hypothesis that changing direction of compression during surgical fusion, would gain more lordosis. METHODS Using a biomechanical Sawbones™ model we inserted polyaxial pedicle screws from S1 to L4. A rod was placed in the screws without requiring reduction. Markers were attached to the spinous processes to allow photographic analysis of lordosis. Two methods were compared. Method A - caudal screws were locked first and compression proceeded in a cranial direction prior to locking. Method B - cranial screws were locked first and compression proceeded caudally. Increasing levels of surgical invasiveness were tested; intact, interbody cage, inferior facet resection, and Ponte resection and using different rods including: lordotic, hyperlordotic and straight. FINDINGS Method B demonstrated to be consistently superior to Method A, regardless of the type of rod used and for every level of surgical invasiveness performed. (P < 0.001). INTERPRETATION locking the top screws first was a consistently superior method of compression, gaining more lordosis. To explain this finding we suggest the following: During posterior compression of pedicle screws along a fixed rod, screw motion is limited by the conflict between the fixed lordotic rod position, and the need for the moving screw to move in a kyphotic arc which is determined by the cage which acts as a pivot point.
Collapse
Affiliation(s)
- Shay Menachem
- Macquarie University, Faculty of Medicine and Health Sciences, Sydney, Australia.
| | - Kevin Seex
- Macquarie University, Faculty of Medicine and Health Sciences, Sydney, Australia; Macquarie University Hospital, Department of Neurosurgery, Sydney, Australia
| |
Collapse
|
6
|
Panico M, Bertoli M, Villa TMT, Galbusera F, Messori M, La Maida GA, Misaggi B, Gallazzi E. Does the anterior column realignment technique influences the stresses on posterior instrumentation in sagittal imbalance correction? A biomechanical, finite-element analysis of L5-S1 ALIF and L3-4 lateral ACR. Spine Deform 2023; 11:41-47. [PMID: 35999490 DOI: 10.1007/s43390-022-00567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/30/2022] [Indexed: 10/15/2022]
Abstract
STUDY DESIGN Biomechanical finite-element study. OBJECTIVE To directly compare the biomechanical effects of two different techniques for sagittal plane correction of adult spine deformity based on the anterior longitudinal ligament (ALL) resection and use of hyperlordotic cages, namely, the anterior column realignment (ACR) in L3-4, and ALIF in L5-S1 in terms of primary stability and rod stresses using finite-element models. METHODS A finite-element model of the thoracolumbar spine was used to perform the analysis. Starting from this "intact" model, three further models were constructed through the insertion of spinal instrumentation, i.e., pedicle screws, rods and cages: 1) posterior instrumentation between T9 and S1 (referred to as "T9-S1"); 2) posterior instrumentation T9-S1 + Hyperlordotic (26°) ALIF cage in L5-S1 ("ALIF"); 3) posterior instrumentation T9-S1 + Hyperlordotic (30°) ACR cage in L3-4 ("ACR"). These models were studied by simulations applying, alternately, a pure moment of 7.5 Nm between the three planes of motion (flexion, extension, lateral bending, and bilateral axial rotation), uniformly distributed over the upper surface of the T9 thoracic vertebra. A total of 24 simulations were performed (6 per models). RESULTS All models presented a significant reduced ROM when compared to the intact model; the ROM reduction was higher both at L3-4 in the ACR model and at L5-S1 in the ALIF model. At L3-4, the ACR model had, in all cases, the lowest maximum values of Von Mises stresses on the rods, especially in flexion-extension. At L4-5, the ALIF model had the lowest stresses during flexion-extension and axial rotation, while the ACR model had the lowest stresses during lateral bending. At L5-S1, the ALIF model had, in all cases, the lowest stresses on the rods. CONCLUSIONS This finite-element study showed how both ACR at L3-4 and ALIF-ACR at L5-S1 are effective in restoring lumbar lordosis (LL), stabilizing the spine and reducing stress on posterior rods at the index level when compared to a simple fixation model. Interestingly, ALIF-ACR reduces rod stress even at L4-5 in flexion-extension and axial rotation, possibly due to a better distribution of LL, especially on the lower arch, while ACR reduces the stress at L4-5 in lateral bending, possibly thanks to the larger footprint of the cage that increases the area of contact with the lateral side of the endplates.
Collapse
Affiliation(s)
- Matteo Panico
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico Di Milano, Milano, Italy
| | - Marco Bertoli
- Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico Di Milano, Milano, Italy
| | - Tomaso Maria Tobia Villa
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico Di Milano, Milano, Italy
| | | | | | | | - Bernardo Misaggi
- U.O.C. Patologia Vertebrale E Scoliosi, ASST Gaetano Pini-CTO, Milano, Italy
| | - Enrico Gallazzi
- U.O.C. Patologia Vertebrale E Scoliosi, ASST Gaetano Pini-CTO, Milano, Italy.
| |
Collapse
|
7
|
Qiu H, Chu TW, Niu XJ, Zhang Y, Yang SZ, Chen WG. Multisegment transforaminal lumbar interbody fusion (TLIF) combined with Ponte osteotomy in degenerative lumbar scoliosis (DLS) surgery: a minimum of five years' follow-up. INTERNATIONAL ORTHOPAEDICS 2022; 46:2897-2906. [PMID: 36153365 PMCID: PMC9674761 DOI: 10.1007/s00264-022-05572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/31/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the long-term clinical outcomes of degenerative lumbar scoliosis (DLS) with the administration of multisegment transforaminal lumbar interbody fusion (TLIF) combined with Ponte osteotomy long-level fixation fusion, as well as to identify the factors affecting health-related quality of life (HRQOL). METHODS This was a retrospective single-centre study involving comprehensive clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) outcomes, and Scoliosis Research Society (SRS-22) questionnaire were recorded to assess HRQOL. A correlation analysis was performed to determine the association between HRQOL and radiographic parameters. RESULTS A total of 41 consecutive patients (15 males and 26 females) met the inclusion criteria with a follow-up of 8.62 ± 1.20 years. Factors associated with HRQOL were significantly improved post-operation. Global sagittal parameters, including the sagittal vertebral axis (SVA) and T1 pelvic angle (TPA), and local parameters, including apical vertebral translation (AVT) and apical vertebral rotation (AVR), were significantly improved at the last follow-up. Significantly strong correlations between each clinical and radiographic parameter were demonstrated. Moreover, a multiple linear regression analysis demonstrated that the differences in AVT and AVR were significantly correlated with the difference in lumbar lordosis (LL), which was significantly correlated with the differences in SVA and TPA. CONCLUSION The surgical treatment of DLS with multisegment TLIF accompanied by Ponte osteotomy and long-level fixations improved the quality of life of patients with a long-term effect. AVR correction is an important factor for LL restoration that significantly correlates with improvements in the sagittal balance parameters SVA and TPA, which are key factors for guaranteeing good HRQOL.
Collapse
Affiliation(s)
- Hao Qiu
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Tong-wei Chu
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Xiao-Jian Niu
- Department of Orthopedics, 907 Hospital of The Joint Logistics Team, Nanping, Fujian Province People’s Republic of China 353000
| | - Ying Zhang
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Si-Zhen Yang
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Wu-Gui Chen
- Department of Spinal Surgery, Mindong Hospital, Ningde, Fujian Province People’s Republic of China 355000
| |
Collapse
|
8
|
Jeon JM, Chung HW, Lee HD, Jeon CH, Chung NS. A Modified Anterior Column Realignment With Partial Anterior Longitudinal Ligament Release in Oblique Lateral Interbody Fusion. Spine (Phila Pa 1976) 2022; 47:1583-1589. [PMID: 35867596 DOI: 10.1097/brs.0000000000004433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/22/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective radiological analysis. OBJECTIVE To demonstrate the radiological outcome after a modified anterior column realignment (mACR) with partial anterior longitudinal ligament (ALL) release in oblique lateral interbody fusion (OLIF). SUMMARY OF BACKGROUND DATA Anterior column realignment (ACR) remains a powerful sagittal correction technique in minimally invasive adult spinal deformity surgery and is often combined with posterior column osteotomy (PCO) to achieve more lordosis. OLIF is ideal for ACR because the anterior-to-psoas corridor typically involves the anterolateral half of the disk. METHODS This study included 112 operated disk levels of 101 consecutive patients who underwent OLIF between L2-L3 and L4-L5 using a 12° lateral cage. The mACR was performed at 73 (65.2%) levels with 30% to 50% sectioning of the ALL. Each operated level was grouped according to the mACR and additional PCO as: (1) no mACR, OLIF only (n=39); (2) mACR with no PCO (n=18); (3) mACR with grade 1 PCO (n=27); (4) mACR with grade 2 PCO (n=22); or (5) mACR with grade 3 PCO (n=6). RESULTS At the last follow-up, the mean disk lordotic angles were 10.9±2.9°, 12.6±3.0°, 13.3±3.9°, 16.7±3.2°, and 16.8±2.4° in the no mACR, mACR with no PCO, mACR with grade 1 PCO, mACR with grade 2 PCO, and mACR with grade 3 PCO groups, respectively ( P <0.001). The mean increases in disk lordotic angle were 5.8±4.1°, 12.1±6.1°, 13.5±8.7°, 15.8±6.7°, and 17.9±6.2° in each group, respectively ( P <0.001). CONCLUSIONS ACR can be performed with partial ALL release under direct vision in OLIF without deep dissection into the ventral disk space. The mACR in OLIF is a simple, safe, and effective technique for anterior column lengthening. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Jong-Min Jeon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Gyeonggi Province, South Korea
| | | | | | | | | |
Collapse
|
9
|
Jamshidi AM, Martin JR, Kutlu OC, Wang MY. Diaphragmatic Hernia With Incarcerated Spleen as a Complication After Lateral Anterior Column Realignment. Oper Neurosurg (Hagerstown) 2022; 23:389-395. [DOI: 10.1227/ons.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022] Open
|
10
|
Kim HJ, Yang JH, Chang DG, Lenke LG, Suh SW, Nam Y, Park SC, Suk SI. Adult Spinal Deformity: A Comprehensive Review of Current Advances and Future Directions. Asian Spine J 2022; 16:776-788. [PMID: 36274246 PMCID: PMC9633249 DOI: 10.31616/asj.2022.0376] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Owing to rapidly changing global demographics, adult spinal deformity (ASD) now accounts for a significant proportion of the Global Burden of Disease. Sagittal imbalance caused by age-related degenerative changes leads to back pain, neurological deficits, and deformity, which negatively affect the health-related quality of life (HRQoL) of patients. Along with the recognized regional, global, and sagittal spinopelvic parameters, poor paraspinal muscle quality has recently been acknowledged as a key determinant of the clinical outcomes of ASD. Although the Scoliosis Research Society-Schwab ASD classification system incorporates the radiological factors related to HRQoL, it cannot accurately predict the mechanical complications. With the rapid advances in surgical techniques, many surgical options for ASD have been developed, ranging from minimally invasive surgery to osteotomies. Therefore, structured patient-specific management is important in surgical decision-making, selecting the proper surgical technique, and to prevent serious complications in patients with ASD. Moreover, utilizing the latest technologies such as robotic-assisted surgery and machine learning, should help in minimizing the surgical risks and complications in the future.
Collapse
Affiliation(s)
- Hong Jin Kim
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - Jae Hyuk Yang
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
- Corresponding author: Dong-Gune Chang Spine Center and Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-1284, Fax: +82-2-950-1287, E-mail:
| | - Lawrence G. Lenke
- Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, Columbia University, New York, NY, USA
| | - Seung Woo Suh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yunjin Nam
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Cheol Park
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Se-Il Suk
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| |
Collapse
|
11
|
Koffie RM, de Andrada Pereira B, Lehrman JN, Godzik J, Sawa AGU, Gandhi SV, Kelly BP, Uribe JS, Turner JD. Influence of Spinal Deformity Construct Design on Adjacent-Segment Biomechanics. World Neurosurg 2022; 166:e656-e663. [PMID: 35872128 DOI: 10.1016/j.wneu.2022.07.076] [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: 05/18/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adjacent level degeneration is a precursor to construct failure in adult spinal deformity surgery, but whether construct design affects adjacent level degeneration risk remains unclear. Here we present a biomechanical profile of common deformity correction constructs and assess adjacent level biomechanics. METHODS Standard nondestructive flexibility tests (7.5 Nm) were performed on 21 cadaveric specimens: 14 pedicle subtraction osteotomies (PSOs) and 7 anterior column realignment (ACR) constructs. The ranges of motion (ROM) at the adjacent free level in flexion, extension, axial rotation, and lateral bending were measured and analyzed. RESULTS ACR constructs had a lower ROM change on flexion at the proximal adjacent free level than constructs with PSO (1.02 vs. 1.32, normalized to the intact specimen, P < 0.01). Lateral lumbar interbody fusion adjacent to PSO and 4 rods limits ROM at the free level more effectively than transforaminal interbody fusion and 2 rods in correction constructs with PSO. Use of 2 screws to anchor the ACR interbody further decreased ROM at the proximal adjacent free level on flexion, but adding 4 rods in this setting added no further limitation to adjacent segment motion. CONCLUSIONS ACR constructs have less ROM change at the adjacent level compared to PSO constructs. Among constructs with ACR, anchoring the ACR interbody with 2 screws reduces motion at the proximal adjacent free level. When PSOs are used, lateral lumbar interbody fusion adjacent to the PSO level has a greater reduction in adjacent-segment motion than transforaminal interbody fusion, suggesting that deformity construct configuration influences proximal adjacent-segment biomechanics.
Collapse
Affiliation(s)
- Robert M Koffie
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Bernardo de Andrada Pereira
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jennifer N Lehrman
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Anna G U Sawa
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Shashank V Gandhi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Brian P Kelly
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
| |
Collapse
|
12
|
Are Minimally Invasive Spine Surgeons or Classical Open Spine Surgeons More Consistent with Their Treatment of Adult Spinal Deformity? World Neurosurg 2022; 165:e51-e58. [PMID: 35643400 DOI: 10.1016/j.wneu.2022.05.078] [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: 03/10/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Spine surgeons have a heuristic sense of how to surgically restore alignment and address adult spinal deformity (ASD) symptoms, but consensus on the extent of treatment remains unclear. We sought to determine the variability of surgical approaches in treating ASD. METHODS Sixteen spine surgeons were surveyed on treatment approaches in 10 select ASD cases. We repeated the survey with the same surgeons 4 weeks later, with cases ordered differently. We examined the variability in length of construct, use of interbody spacers, osteotomies, and pelvic fixation frequency. RESULTS Treatment approaches for each case varied by surgeon, with some surgeons opting for long fusion constructs in cases for which others offered no surgery. There was no consensus among surgeons on the number of levels fused, interbody spacer use, or anterior/posterior osteotomies. Intersurgeon and intrasurgeon variability was 48% (kappa = 0.31) and 59% (kappa = 0.44) for surgeons performing minimally invasive surgery (MIS) versus 37% (kappa = 0.21) and 47% (kappa = 0.30) for those performing open surgery. In the second-round survey, 8 of 15 (53%) surgeons substantially changed the construct length, number of interbody spacers, and osteotomies in at least half the cases they previously reviewed. Surgeons performing MIS versus open surgery were less likely to extend constructs to the pelvis (42.5% vs. 67.5%; P = 0.02), but construct length was not correlated with whether a surgeon performed MIS or open surgery. CONCLUSIONS Spinal deformity surgeons lack consensus on the optimal surgical approach for treating ASD. Classifying surgeons as performing MIS or open surgery does not mitigate this variability.
Collapse
|
13
|
Yilgor C, Kindan P, Yucekul A, Zulemyan T, Alanay A. Osteotomies for the Treatment of Adult Spinal Deformities: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202205000-00010. [PMID: 35613311 DOI: 10.2106/jbjs.rvw.21.00226] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Spinal osteotomies are powerful deformity correction techniques that may be associated with serious complications. » The anatomical spinal osteotomy classification system proposes 6 grades of resection corresponding to different anatomic bone, disc, facet, and ligament interventions. » Surgeons should be aware of the nuances of 3-column osteotomies with regard to spinal level selection, construct composition, and posterior column reconstruction and closure techniques. » There is a global tendency toward avoiding 3-column osteotomies as much as possible because of the growing evidence regarding the effectiveness of posterior column osteotomies and halo-gravity traction.
Collapse
Affiliation(s)
- Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Peri Kindan
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Altug Yucekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| |
Collapse
|
14
|
Mundis GM, Godzik J, Park P, Fu KM, Tran S, Uribe JS, Wang MY, Than KD, Okonkwo DO, Kanter AS, Nunley PD, Anand N, Fessler RG, Chou D, Lafage R, Eastlack RK, _ _. Prospective multicenter study of minimally invasive surgery for the treatment of adult spinal deformity. J Neurosurg Spine 2022. [DOI: 10.3171/2021.8.spine21369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Traditional surgery for adult spinal deformity (ASD) is effective but may result in exposure-related morbidity. Minimally invasive surgery (MIS) can potentially minimize this morbidity; however, high-level evidence is lacking. This study presents the first prospective multicenter investigation of MIS approaches for ASD.
METHODS
A prospective multicenter study was conducted. Inclusion criteria were age ≥ 18 years, with at least one of the following radiographic criteria: coronal Cobb (CC) angle ≥ 20°, sagittal vertical axis (SVA) > 5 cm, pelvic tilt (PT) > 25°, and thoracic kyphosis > 60°. Additional inclusion criteria were circumferential MIS, including interbody fusion (transforaminal lumbar interbody fusion [TLIF], lateral lumbar interbody fusion [LLIF], or anterior lumbar interbody fusion [ALIF]) with percutaneous posterior fixation on a minimum of 4 intervertebral levels. Radiographic and clinical outcomes (visual analog scale [VAS], Oswestry Disability Index [ODI], and Scoliosis Research Society–22 [SRS-22]) were collected preoperatively and at 12 months postoperatively; preoperative and postoperative values were compared using paired Student t-tests.
RESULTS
Seventy-five patients with a minimum 1-year follow-up were identified (75 of 111; 67.6%). The mean ± SD age was 68.8 ± 9.0 years, and 48 patients (64%) were female. Patients underwent a mean of 6.7 ± 2.9 levels of fusion with LLIF (85%), ALIF (55%), and TLIF (9%); the mean estimated blood loss was 547.6 ± 567.2 mL, and the mean length of stay was 7.0 ± 3.7 days. Significant improvements were observed in ODI (−19 ± 12.9, p < 0.001), SRS-22 (0.8 ± 0.66, p < 0.001), VAS back (−4.3 ± 2.8, p < 0.001), and VAS leg (−3.0 ± 3.2, p < 0.001) scores. Significant decreases in SVA (−26.4 ± 53.6 mm; p < 0.001), pelvic incidence–lumbar lordosis (−11.3° ± 14.9°, p < 0.001), and CC angle (−12.1° ± 11.8°, p < 0.001) were also observed. Complications occurred in 39 patients (52%); 11 patients (15%) experienced major complications, and 16 patients (21%) required reoperation.
CONCLUSIONS
MIS approaches for ASD resulted in meaningful symptomatic improvement. The complication rates were similar to historic norms, with a fairly high reoperation rate at 1 year. Longer follow-up will be necessary to evaluate the durability of this approach in the treatment of ASD.
Collapse
Affiliation(s)
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Kai-Ming Fu
- Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | - Stacie Tran
- San Diego Spine Foundation, Scripps Clinic, La Jolla, California
| | - Juan S. Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Michael Y. Wang
- Department of Neurosurgery, University of Miami, Coral Gables, Florida
| | - Khoi D. Than
- Department of Neurosurgery, Duke University, Durham, North Carolina
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Adam S. Kanter
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Neel Anand
- Anand Spine Group, Los Angeles, California
| | - Richard G. Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Dean Chou
- Department of Neurosurgery, University of California, San Francisco, California; and
| | - Renaud Lafage
- Department of Orthopedics, Hospital of Special Surgery, New York, New York
| | | | | |
Collapse
|
15
|
Takami M, Tsutsui S, Yukawa Y, Hashizume H, Minamide A, Iwasaki H, Nagata K, Taiji R, Schoenfeld AJ, Simpson AK, Yamada H. Lateral interbody release for fused vertebrae via transpsoas approach in adult spinal deformity surgery: a preliminary report of radiographic and clinical outcomes. BMC Musculoskelet Disord 2022; 23:245. [PMID: 35287645 PMCID: PMC8922844 DOI: 10.1186/s12891-022-05204-0] [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: 07/31/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lateral interbody release (LIR) via a transpsoas lateral approach is a surgical strategy to address degenerative lumbar scoliosis (DLS) patients with anterior autofusion of vertebral segments. This study aimed to characterize the clinical and radiographic outcomes of this lumbar reconstruction strategy using LIR to achieve anterior column correction. METHODS Data for 21 fused vertebrae in 17 consecutive patients who underwent LIR between January 2014 and March 2020 were reviewed. Demographic and intraoperative data were recorded. Radiographic parameters were assessed preoperatively and at final follow-up, including segmental lordotic angle (SLA), segmental coronal angle (SCA), bone union rate, pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt, sacral slope, PI-LL mismatch, sagittal vertical axis, Cobb angle, and deviation of the C7 plumb line from the central sacral vertical line. Clinical outcomes were evaluated using Oswestry Disability Index (ODI), visual analog scale (VAS) scores for low back and leg pain, and the short form 36 health survey questionnaire (SF-36) postoperatively and at final follow-up. Complications were also assessed. RESULTS Mean patient age was 70.3 ± 4.8 years and all patients were female. Average follow-up period was 28.4 ± 15.3 months. Average procedural time to perform LIR was 21.3 ± 9.7 min and was not significantly different from traditional lateral interbody fusion at other levels. Blood loss per single segment during LIR was 38.7 ± 53.2 mL. Fusion rate was 100.0% in this cohort. SLA improved significantly from - 7.6 ± 9.2 degrees preoperatively to 7.0 ± 8.8 degrees at final observation and SCA improved significantly from 19.1 ± 7.8 degrees preoperatively to 8.7 ± 5.9 degrees at final observation (P < 0.0001, and < 0.0001, respectively). All spinopelvic and coronal parameters, as well as ODI and VAS, improved significantly. Incidence of peri- and postoperative complications such as iliopsoas muscle weakness and leg numbness in patients who underwent LIR was as much as XLIF. Incidence of postoperative mechanical failure following LIR was also similar to XLIF. Reoperation rate was 11.8%. However, there were no reoperations associated with LIR segments. CONCLUSIONS The LIR technique for anterior column realignment of fused vertebrae in the context of severe ASD may be an option of a safe and effective surgical strategy.
Collapse
Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| |
Collapse
|
16
|
Han N, Pratt N, Usmani MF, Hayman E, Jones S, Johnsen P, Thomson AE, Ye I, Chryssikos T, Sharma A, Olexa J, Cavanaugh DL, Koh EY, Buraimoh K, Ludwig S, Sansur C. Anterior longitudinal ligament release from a posterior approach: an alternative to three-column osteotomy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2196-2203. [PMID: 34978600 DOI: 10.1007/s00586-021-07100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Expansion of the anterior column and compression of the posterior column restores lordosis and sagittal imbalance. Anterior longitudinal ligament (ALL) release has been described from lateral and anterior approaches as a technique to improve lumbar lordosis; however, posterior approach to release the ALL has not been adequately assessed. METHODS We demonstrate a case series of ALL release using a posterior approach performed in conjunction with posterior column osteotomy (PCO), with or without transforaminal lumbar interbody fusion (TLIF) for spinal deformity. Eleven cases were identified from billing records between 2010 and 2019. Retrospective review was conducted for perioperative complications and revision surgery. Overall and segmental lumbar lordosis (LL) correction was measured from pre- and postoperative imaging. RESULTS Eleven patients underwent ALL release with a PCO. Kyphosis, scoliosis, and flat back syndrome were the most common spinal deformities. On average, patients had 9 ± 3 levels fused and a single level ALL release. ALL release was most commonly performed at L1-L2 and L2-L3 levels. An overall LL correction of 28.6° ± 19.8o was achieved; ALL release introduced 16.7° ± 11.9° of lordotic correction and accounted for 49.2 ± 30.4% of the overall lordotic correction. Average blood loss was 1030 ± 573 mL. CONCLUSIONS ALL release as an adjunct to PCO and TLIF is a viable technique for providing increased deformity correction without subjecting the patient to a more invasive three-column osteotomy. While this approach may not be appropriate for all patients, it represents a useful option in spinal deformity correction while limiting blood loss and additional anterior surgery. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Nathan Han
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA.
| | - Nathan Pratt
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - M Farooq Usmani
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Erik Hayman
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Salazar Jones
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Parker Johnsen
- Department of Orthopaedics, Cooper University Hospital, Camden, NJ, USA
| | - Alexandra E Thomson
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Ivan Ye
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Timothy Chryssikos
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Ashish Sharma
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Joshua Olexa
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| | - Daniel L Cavanaugh
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Eugene Y Koh
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Kendall Buraimoh
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Steven Ludwig
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Charles Sansur
- Department of Neurosurgery, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA
| |
Collapse
|
17
|
Mumtaz M, Mendoza J, Vosoughi AS, Unger AS, Goel VK. A Comparative Biomechanical Analysis of Various Rod Configurations Following Anterior Column Realignment and Pedicle Subtraction Osteotomy. Neurospine 2021; 18:587-596. [PMID: 34610690 PMCID: PMC8497251 DOI: 10.14245/ns.2142450.225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the biomechanical differences of different rod configurations following anterior column realignment (ACR) and pedicle subtraction osteotomy (PSO) for an optimal correction technique and rod configuration that would minimize the risk of rod failure. METHODS A validated spinopelvic (L1-pelvis) finite element model was used to simulate ACR at the L3-4 level. The ACR procedure was followed by dual-rod fixation, and for 4-rod constructs, either medial/lateral accessory rods (connected to primary rods) or satellite rods (directly connected to ACR level screws). The range of motion (ROM), maximum von Mises stress on the rods, and factor of safety (FOS) were calculated for the ACR models and compared to the existing literature of different PSO rod configurations. RESULTS All of the 4-rod ACR constructs showed a reduction in ROM and maximum von Mises stress compared to the dual-rod ACR construct. Additionally, all of the 4-rod ACR constructs showed greater percentage reduction in ROM and maximum von Mises stress compared to the PSO 4-rod configurations. The ACR satellite rod construct had the maximum stress reduction i.e., 47.3% compared to dual-rod construct and showed the highest FOS (4.76). These findings are consistent with existing literature that supports the use of satellite rods to reduce the occurrence of rod fracture. CONCLUSION Our findings suggest that the ACR satellite rod construct may be the most beneficial in reducing the risk of rod failure compared to all other PSO and ACR constructs.
Collapse
Affiliation(s)
- Muzammil Mumtaz
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedics Surgery, Colleges of Engineering and Medicine, The University of Toledo, Toledo, OH, USA
| | - Justin Mendoza
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedics Surgery, Colleges of Engineering and Medicine, The University of Toledo, Toledo, OH, USA
| | - Ardalan Seyed Vosoughi
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedics Surgery, Colleges of Engineering and Medicine, The University of Toledo, Toledo, OH, USA
| | - Anthony S Unger
- Department of Orthopaedic Surgery, Sibley Gildenhorn Institute, Johns Hopkins University, Washington, District of Columbia, USA
| | - Vijay K Goel
- Engineering Center for Orthopaedic Research Excellence (ECORE), Departments of Bioengineering and Orthopaedics Surgery, Colleges of Engineering and Medicine, The University of Toledo, Toledo, OH, USA
| |
Collapse
|
18
|
Takami M, Taiji R, Tsutsui S, Iwasaki H, Okada M, Minamide A, Yukawa Y, Hashizume H, Yamada H. Impact of an intraoperative coronal spinal alignment measurement technique using a navigational tool for a 3D spinal rod bending system in adult spinal deformity cases. J Neurosurg Spine 2021; 36:62-70. [PMID: 34479187 DOI: 10.3171/2021.3.spine201856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In corrective spinal surgery for adult spinal deformity (ASD), the focus has been on achieving optimal spinopelvic alignment. However, the correction of coronal spinal alignment is equally important. The conventional intraoperative measurement methods currently used for coronal alignment are not ideal. Here, the authors have developed a new intraoperative coronal alignment measurement technique using a navigational tool for a 3D spinal rod bending system (CAMNBS). The purpose of this study was to test the feasibility of using the CAMNBS for coronal spinal alignment and to evaluate its usefulness in corrective spinal surgery for ASD. METHODS In this retrospective cohort study, patients with degenerative lumbar kyphoscoliosis, a Cobb angle ≥ 20°, and lumbar lordosis ≤ 20° who had undergone corrective surgery (n = 67) were included. The pelvic teardrops on both sides, the S1 spinous process, the central point of the apex, a point on the 30-mm cranial (or caudal) side of the apex, and the central point of the upper instrumented vertebra (UIV) and C7 vertebra were registered using the CAMNBS. The positional information of all registered points was displayed as 2D figures on a monitor. Deviation of the UIV plumb line from the central sacral vertical line (UIV-CSVL) and deviation of the C7 plumb line from the CSVL (C7-CSVL) were measured using the 2D figures. Nineteen patients evaluated using the CAMNBS (BS group) were compared with 48 patients evaluated using conventional intraoperative radiography (XR group). The UIV-CSVL measured intraoperatively using the CAMNBS was compared with that measured using postoperative radiography. The prevalence of postoperative coronal malalignment (CM) and the absolute value of postoperative C7-CSVL were compared between the groups on radiographs obtained in the standing position within 4 weeks after surgery. Postoperative CM was defined as the absolute value of C7-CSVL ≥ 30 mm. Further, the measurement time and amount of radiation exposure were measured. RESULTS No significant differences in demographic, sagittal, and coronal parameters were observed between the two groups. UIV-CSVL was 2.3 ± 9.5 mm with the CAMNBS and 1.8 ± 16.6 mm with the radiographs, showing no significant difference between the two methods (p = 0.92). The prevalence of CM was 2/19 (10.5%) in the BS group and 18/48 (37.5%) in the XR group, and absolute values of C7-CSVL were 15.2 ± 13.1 mm in the BS group and 25.0 ± 18.0 mm in the XR group, showing statistically significant differences in both comparisons (p = 0.04 and 0.03, respectively). The CAMNBS method required 3.5 ± 0.9 minutes, while the conventional radiograph method required 13.3 ± 1.5 minutes; radiation exposure was 2.1 ± 1.1 mGy in the BS group and 2.9 ± 0.6 mGy in the XR group. Statistically significant differences were demonstrated in both comparisons (p = 0.0002 and 0.03, respectively). CONCLUSIONS From this study, it was evident that the CAMNBS did not increase postoperative CM compared with that seen using the conventional radiographic method, and hence can be used in clinical practice.
Collapse
|
19
|
Martin CT, Polly DW, Holton KJ, San Miguel-Ruiz JE, Albersheim M, Lender P, Sembrano JN, Hunt MA, Jones KE. Acute failure of S2-alar-iliac screw pelvic fixation in adult spinal deformity: novel failure mechanism, case series, and review of the literature. J Neurosurg Spine 2021; 36:53-61. [PMID: 34479206 DOI: 10.3171/2021.2.spine201921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pelvic fixation with S2-alar-iliac (S2AI) screws is an established technique in adult deformity surgery. The authors' objective was to report the incidence and risk factors for an underreported acute failure mechanism of S2AI screws. METHODS The authors retrospectively reviewed a consecutive series of ambulatory adults with fusions extending 3 or more levels, and which included S2AI screws. Acute failure of S2AI screws was defined as occurring within 6 months of the index surgery and requiring surgical revision. RESULTS Failure occurred in 6 of 125 patients (5%) and consisted of either slippage of the rods or displacement of the set screws from the S2AI tulip head, with resultant kyphotic fracture. All failures occurred within 6 weeks postoperatively. Revision with a minimum of 4 rods connecting to 4 pelvic fixation points was successful. Two of 3 (66%) patients whose revision had less fixation sustained a second failure. Patients who experienced failure were younger (56.5 years vs 65 years, p = 0.03). The magnitude of surgical correction was higher in the failure cohort (number of levels fused, change in lumbar lordosis, change in T1-pelvic angle, and change in coronal C7 vertical axis, each p < 0.05). In the multivariate analysis, younger patient age and change in lumbar lordosis were independently associated with increased failure risk (p < 0.05 for each). There was a trend toward the presence of a transitional S1-2 disc being a risk factor (OR 8.8, 95% CI 0.93-82.6). Failure incidence was the same across implant manufacturers (p = 0.3). CONCLUSIONS All failures involved large-magnitude correction and resulted from stresses that exceeded the failure loads of the set plugs in the S2AI tulip, with resultant rod displacement and kyphotic fractures. Patients with large corrections may benefit from 4 total S2AI screws at the time of the index surgery, particularly if a transitional segment is present. Salvage with a minimum of 4 rods and 4 pelvic fixation points can be successful.
Collapse
Affiliation(s)
| | - David W Polly
- 1Department of Orthopaedic Surgery, University of Minnesota; and.,2Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Kenneth J Holton
- 1Department of Orthopaedic Surgery, University of Minnesota; and
| | | | | | - Paul Lender
- 1Department of Orthopaedic Surgery, University of Minnesota; and
| | | | - Matthew A Hunt
- 2Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Kristen E Jones
- 1Department of Orthopaedic Surgery, University of Minnesota; and.,2Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
20
|
Godzik J, de Andrada Pereira B, Sawa AGU, Lehrman JN, Mundis GM, Hlubek RJ, Uribe JS, Kelly BP, Turner JD. Biomechanics of open versus minimally invasive deformity correction: comparison of stability and rod strain between pedicle subtraction osteotomy and anterior column realignment. J Neurosurg Spine 2021:1-9. [PMID: 34214986 DOI: 10.3171/2020.12.spine201306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior column realignment (ACR) is a new minimally invasive approach for deformity correction that achieves a degree of lordosis similar to that obtained with pedicle subtraction osteotomy (PSO). This study compared the biomechanical profiles of ACR with PSO using range of motion (ROM) and posterior rod strain (RS) to gain insight into the ACR technique and the necessary surgical strategies to optimize longevity and stability. METHODS An in vitro biomechanical study using standard flexibility testing (7.5 Nm) was performed on 14 human cadaveric specimens, separated into 2 groups similar in age, sex, bone mineral density, and intact ROM. For group 1 (n = 7, instrumented L1-S1), a 30° ACR was performed at L3-4. For group 2 (n = 7, instrumented T12-S1), a 30° L3 PSO was performed. Specimens were subjected to nondestructive loads in flexion, extension, axial rotation, lateral bending, and compression. Conditions tested were 1) intact, 2) pedicle screw with 2 rods (PSR), 3) ACR or PSO with 2 rods (+2R), and 4) ACR or PSO with 4 rods (+4R). Primary outcome measures of interest were ROM stability and posterior RS at L3-4. RESULTS No difference was observed between groups in lumbar lordosis (p = 0.83) or focal angular lordosis at L3-4 (p = 0.75). No differences in stability were observed between ACR+2R and PSO+2R (p ≥ 0.06); however, ACR+2R was significantly less stable than PSR in flexion and extension (p ≤ 0.02), whereas PSO+2R was less stable than PSR only in extension (p = 0.04). ACR+4R was more stable than ACR+2R in flexion, extension, left axial rotation, and compression (p ≤ 0.02). PSO+4R was more stable than PSO+2R only in extension (p = 0.04). Both ACR+2R and PSO+2R resulted in significant increases in RS in flexion and extension compared with PSR (p ≤ 0.032). RS in flexion and extension decreased significantly for ACR+4R versus ACR+2R and for PSO+4R versus PSO+2R (p ≤ 0.047). PSO+2R yielded lower RS than ACR+2R in compression (p = 0.03). No differences existed in RS between ACR+4R and PSO+4R (p ≥ 0.05). CONCLUSIONS Although ACR appeared to be slightly more destabilizing than PSO using traditional 2R fixation, both techniques resulted in significant increases in posterior RS. The 4R technique increased stability in ACR and decreased RS in both ACR and PSO but may be more beneficial in ACR. Longer-term clinical studies are needed to appropriately identify the durability of the ACR technique in deformity correction.
Collapse
Affiliation(s)
| | - Bernardo de Andrada Pereira
- 2Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Anna G U Sawa
- 2Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Jennifer N Lehrman
- 2Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Gregory M Mundis
- 3San Diego Spine Foundation, Scripps Clinic Division of Orthopedic Surgery, La Jolla, California
| | | | | | - Brian P Kelly
- 2Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | | |
Collapse
|
21
|
Sadrameli SS, Davidov V, Lee JJ, Huang M, Kizek DJ, Mambelli D, Rajendran S, Barber SM, Holman PJ. Hybrid Anterior Column Realignment-Pedicle Subtraction Osteotomy for Severe Rigid Sagittal Deformity. World Neurosurg 2021; 151:e308-e316. [PMID: 33872839 DOI: 10.1016/j.wneu.2021.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Recently, a hybrid anterior column realignment-pedicle subtraction osteotomy (ACR-PSO) approach has been conceived for patients with severe rigid sagittal deformity, the clinical and radiographic outcomes of which require further investigation compared with ACR only. METHODS A single-center, retrospective chart review identified patients undergoing a combination of hyperlordotic lateral lumbar interbody grafting (ACR) and concurrent Schwab grade 3 three-column osteotomy and propensity-matched patients undergoing ACR only in the same time frame. Anterior longitudinal ligament was directly released or partially sectioned in all patients. Chart data included demographics, Oswestry Disability Index scores, ACR and osteotomy locations, cage dimensions, fusion length, and complications. Radiographic measurements included lumbar lordosis, sagittal vertical axis, pelvic tilt (PT), and proximal junctional kyphosis. RESULTS Fourteen patients were enrolled in the ACR + PSO group and 36 in the ACR-only group. Mean ages were 68.5 and 63.9 years, 64% and 67% were female, average body mass index was 27.9 and 29.2, and cardiopulmonary comorbidities were 21% and 17%, respectively. There was no difference in complications (P = 0.347). The average follow-up for the ACR + PSO and ACR-only groups were 22 and 18 months, respectively. Excluding 2 mortalities, fusion occurred in all patients. Average change in lumbar lordosis measured -40.8 ± 9.2 degrees and -19.1 ± 15.7 degrees (P = 0.0006), and PT correction measured 10.5 ± 3.4 degrees and 27.3 ± 1.6 degrees (P < 0.0001), respectively. CONCLUSIONS For patients with severe rigid sagittal deformity, the hybrid ACR-PSO approach offers significant restoration of lumbar lordosis compared with ACR only, with similar complications but reduced PT correction.
Collapse
Affiliation(s)
- Saeed S Sadrameli
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Vitaliy Davidov
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Jonathan J Lee
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Meng Huang
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Dominic J Kizek
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Dorian Mambelli
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Sibi Rajendran
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA.
| | - Sean M Barber
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| | - Paul J Holman
- Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA
| |
Collapse
|
22
|
Mummaneni PV, Hussain I, Shaffrey CI, Eastlack RK, Mundis GM, Uribe JS, Fessler RG, Park P, Robinson L, Rivera J, Chou D, Kanter AS, Okonkwo DO, Nunley PD, Wang MY, Marca FL, Than KD, Fu KM. The minimally invasive interbody selection algorithm for spinal deformity. J Neurosurg Spine 2021:1-8. [PMID: 33711811 DOI: 10.3171/2020.9.spine20230] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimally invasive surgery (MIS) for spinal deformity uses interbody techniques for correction, indirect decompression, and arthrodesis. Selection criteria for choosing a particular interbody approach are lacking. The authors created the minimally invasive interbody selection algorithm (MIISA) to provide a framework for rational decision-making in MIS for deformity. METHODS A retrospective data set of circumferential MIS (cMIS) for adult spinal deformity (ASD) collected over a 5-year period was analyzed by level in the lumbar spine to identify surgeon preferences and evaluate segmental lordosis outcomes. These data were used to inform a Delphi session of minimally invasive deformity surgeons from which the algorithm was created. The algorithm leads to 1 of 4 interbody approaches: anterior lumbar interbody fusion (ALIF), anterior column release (ACR), lateral lumbar interbody fusion (LLIF), and transforaminal lumbar interbody fusion (TLIF). Preoperative and 2-year postoperative radiographic parameters and clinical outcomes were compared. RESULTS Eleven surgeons completed 100 cMISs for ASD with 338 interbody devices, with a minimum 2-year follow-up. The type of interbody approach used at each level from L1 to S1 was recorded. The MIISA was then created with substantial agreement. The surgeons generally preferred LLIF for L1-2 (91.7%), L2-3 (85.2%), and L3-4 (80.7%). ACR was most commonly performed at L3-4 (8.4%) and L2-3 (6.2%). At L4-5, LLIF (69.5%), TLIF (15.9%), and ALIF (9.8%) were most commonly utilized. TLIF and ALIF were the most selected approaches at L5-S1 (61.4% and 38.6%, respectively). Segmental lordosis at each level varied based on the approach, with greater increases reported using ALIF, especially at L4-5 (9.2°) and L5-S1 (5.3°). A substantial increase in lordosis was achieved with ACR at L2-3 (10.9°) and L3-4 (10.4°). Lateral interbody arthrodesis without the use of an ACR did not generally result in significant lordosis restoration. There were statistically significant improvements in lumbar lordosis (LL), pelvic incidence-LL mismatch, coronal Cobb angle, and Oswestry Disability Index at the 2-year follow-up. CONCLUSIONS The use of the MIISA provides consistent guidance for surgeons who plan to perform MIS for deformity. For L1-4, the surgeons preferred lateral approaches to TLIF and reserved ACR for patients who needed the greatest increase in segmental lordosis. For L4-5, the surgeons' order of preference was LLIF, TLIF, and ALIF, but TLIF failed to demonstrate any significant lordosis restoration. At L5-S1, the surgical team typically preferred an ALIF when segmental lordosis was desired and preferred a TLIF if preoperative segmental lordosis was adequate.
Collapse
Affiliation(s)
- Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Ibrahim Hussain
- 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher I Shaffrey
- 3Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Robert K Eastlack
- 4Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California
| | - Gregory M Mundis
- 4Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California
| | - Juan S Uribe
- 5Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | - Paul Park
- 7Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | | | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Adam S Kanter
- 10Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David O Okonkwo
- 10Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pierce D Nunley
- 11Department of Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, Louisiana
| | - Michael Y Wang
- 2Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Frank La Marca
- 12Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan; and
| | - Khoi D Than
- 3Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Kai-Ming Fu
- 13Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | | |
Collapse
|
23
|
Walker CT, Godzik J, Angel S, Giraldo JP, Turner JD, Uribe JS. Coronal balance with circumferential minimally invasive spinal deformity surgery for the treatment of degenerative scoliosis: are we leaning in the right direction? J Neurosurg Spine 2021:1-9. [PMID: 33711801 DOI: 10.3171/2020.8.spine201147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/31/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Coronal malalignment (CM) in adult spinal deformity is associated with poor outcomes and remains underappreciated in the literature. Recent attempts at classifying CM indicate that some coronal shifts may be more difficult to treat than others. To date, outcomes for circumferential minimally invasive surgery (cMIS) of the spine in the context of these new CM classifications are unreported. METHODS A retrospective evaluation of patients with degenerative scoliosis (Cobb angle > 20°) consecutively treated with cMIS at a single institution was performed. Preoperative and 1-year postoperative standing radiographs were used to make the comparisons. Clinical outcome measures were compared. Patients were subgrouped according to the preoperative distance between their C7 plumb line and central sacral vertical line (C7-CSVL) as either coronally aligned (type A, C7-CSVL < 3 cm); shifted ≥ 3 cm toward the concavity (type B); or shifted ≥ 3 cm toward the convexity (type C) of the main lumbar curve. RESULTS Forty-two patients were included (mean age 67.7 years). Twenty-six patients (62%) were classified as type A, 5 patients (12%) as type B, and 11 patients (26%) as type C. An average of 4.9 segments were treated. No type A patients developed postoperative CM. All type B patients had CM correction. Six of the 11 type C patients had CM after surgery. Overall, there was an improvement in the C7-CSVL (from 2.4 to 1.8 cm, p = 0.04). Among subgroups, only type B patients improved (from 4.5 to 0.8 cm, p = 0.002); no difference was seen for type A patients (from 1.2 to 1.4 cm, p = 0.32) or type C patients (from 4.3 to 3.1 cm, p = 0.11). Comparing type C patients with postoperative CM versus those without postoperative CM, patients with CM had worse visual analog scale back scores at 1 year (5 vs 1, p = 0.01). Moreover, they had higher postoperative L4 tilt angles (11° vs 5°, p = 0.01), indicating inadequate correction of the lumbosacral fractional curve. CONCLUSIONS cMIS improved coronal alignment, curve magnitudes, and clinical outcomes among patients with degenerative scoliosis. It did not result in CM in type A patients and was successful at improving the C7-CSVL in type B patients. Type C patients remain the most difficult to treat coronally, with worse visual analog scale back pain scores in those with postoperative CM. Regional coronal restoration of the lumbosacral fracture curve should be the focus of correction in cMIS for these patients.
Collapse
|
24
|
Hong JT, Koller H, Abumi K, Yuan W, Falavigna A, Lee HJ, Lee JB, Le Huec JC, Park JH, Kim IS. A new nomenclature system for the surgical treatment of cervical spine deformity, developing, and validation of SOF system. 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 2021; 30:1670-1680. [PMID: 33547943 DOI: 10.1007/s00586-021-06751-1] [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: 05/19/2020] [Revised: 12/08/2020] [Accepted: 01/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To develop and assess the reliability of new nomenclature system that systematically organizes osteotomy techniques and briefly describes the surgical approach, the surgical sequence, and the fixation technique for cervical spine deformity (CSD). METHODS We developed a new classification system (SOF system) for CSD surgery that describes the sequence of surgical approach (S), the grade of osteotomy (O), and the information of fixation (F) using alphanumeric codes. Twenty CSD osteotomies (8 anterior osteotomies, 12 posterior osteotomies) were included in this study to evaluate the inter- and intra-observer agreement based on operation records. Six observers performed independent evaluations of the operation records in random order. Each observer described 20 CSD surgeries using the SOF system twice (> 30 days between assessments) based on operation records to validate SOF system. RESULTS Overall agreement (among all six observers at the initial assessment) on the anterior and posterior osteotomy was ICC = 0.96 and ICC = 0.91, respectively. Overall agreement (repeat observations after at least 30 days) on the anterior and posterior osteotomy was ICC = 0.96 and ICC = 0.91, respectively. This data showed that both inter- and intra-observer agreement revealed 'excellent'. CONCLUSION This study introduces the SOF system of the CSD surgery to understand the surgical sequence, the type of osteotomy and the fixation techniques. The investigation of the inter- and intra-observer agreement revealed 'excellent agreement' for both anterior and posterior osteotomies. Thus, SOF system can provide a consistent description of the various CSD surgeries and its use will provide a common frame for CSD surgery and help communicate between surgeons.
Collapse
Affiliation(s)
- Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| | - Heiko Koller
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Kuniyoshi Abumi
- Department of Orthopedic Surgery, Sapporo Orthopedic Hospital, Sapporo, Japan
| | - Wen Yuan
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Asdrubal Falavigna
- Department of Neurosurgery, University of Caxias Do Sul, Caxias Do Sul, RS, Brazil
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jong Beom Lee
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Jong-Hyeok Park
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| |
Collapse
|
25
|
Hussain I, Fu KM, Uribe JS, Chou D, Mummaneni PV. State of the art advances in minimally invasive surgery for adult spinal deformity. Spine Deform 2020; 8:1143-1158. [PMID: 32761477 DOI: 10.1007/s43390-020-00180-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/27/2020] [Indexed: 12/21/2022]
Abstract
Adult spinal deformity (ASD) can be associated with substantial suffering due to pain and disability. Surgical intervention for achieving neural decompression and restoring physiological spinal alignment has shown to result in significant improvement in pain and disability through patient-reported outcomes. Traditional open approaches involving posterior osteotomy techniques and instrumentation are effective based on clinical outcomes but associated with high complication rates, even in the hands of the most experienced surgeons. Minimally invasive techniques may offer benefit while decreasing associated morbidity. Minimally invasive surgery (MIS) for ASD has evolved over the past 20 years, driven by improved understanding of open procedures along with novel technique development and technologic advancements. Early efforts were hindered due to suboptimal outcomes resulting from high pseudarthrosis, inadequate correction, and fixation failure rates. To address this, multi-center collaborative groups have been established to study large numbers of ASD patients which have been vital to understanding optimal patient selection and individualized management strategies. Different MIS decision-making algorithms have been described to better define appropriate candidates and interbody selection approaches in ASD. The purpose of this state of the review is to describe the evolution of MIS surgery for adult deformity with emphasis on landmark papers, and to discuss specific MIS technology for ASD, including percutaneous pedicle screw instrumentation, hyperlordotic grafts, three-dimensional navigation, and robotics.
Collapse
Affiliation(s)
- Ibrahim Hussain
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kai-Ming Fu
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY, USA.
| | - Juan S Uribe
- Department of Neurological Surgery, Barrow Neurologic Institute, Phoenix, AZ, USA
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| |
Collapse
|
26
|
Sharma M, Dietz N, John K, Aljuboori Z, Wang D, Ugiliweneza B, Boakye M, Drazin D. Impact of Surgical Approaches on Complications, Emergency Room Admissions, and Health Care Utilization in Patients Undergoing Lumbar Fusions for Degenerative Disc Diseases: A MarketScan Database Analysis. World Neurosurg 2020; 145:e305-e319. [PMID: 33068804 DOI: 10.1016/j.wneu.2020.10.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify the impact of different surgical approaches for lumbar degenerative disc disease (DDD) on complications, reoperations/readmissions, and health care utilization. METHODS We used International Classification of Diseases, Ninth Revision and Tenth Revision and Current Procedural Terminology codes to extract data from MarketScan. Patients were divided into 6 groups: single-level anterior only (sA), single-level anterior + posterior (sAP), single-level posterior (sP), multilevel anterior (mA), multilevel anterior + posterior (mAP), and multilevel posterior only (mP). Outcomes of interest were cumulative complication rates, reoperation rates, readmission, and health care utilization at 6, 12, and 24 months. RESULTS Of 148,499 patients, 3% had sA fusion and 54% had mP procedures. Patients in the mAP cohort incurred higher cumulative complication rates (21%) compared with sA (13%), sAP (15%), sP (14%), mA (18%), and mP (18%). Emergency room admissions within 30 days were highest in the mA cohort (14%) followed by mAP (11%) and mP (8%). At 12 and 24 months, patients with mA procedures were most likely to have either new fusion or refusion (8% and 12%) followed by sA (7% and 10%), sAP (4% and 7%), mAP (4% and 8%) mP (4% and 7%), and sP (3% and 7%). Compared with the mP cohort, patients in the mA cohort incurred 1.2 times the overall median payments, whereas mAP and sA incurred 1.1 times the payments at 12 months. This difference was further reduced at 24 months. CONCLUSIONS mAP procedures are associated with higher cumulative complications and health care utilization compared with other procedures and the difference in health care utilization tends to decrease over 12 and 24 months.
Collapse
Affiliation(s)
- Mayur Sharma
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Nicholas Dietz
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Kevin John
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Zaid Aljuboori
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Dengzhi Wang
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Beatrice Ugiliweneza
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Maxwell Boakye
- Departments of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Doniel Drazin
- Department of Neurosurgery, Pacific Northwest University of Health Sciences, Yakima, Washington, USA.
| |
Collapse
|
27
|
Walker CT, Uribe JS. Commentary: Anterior Column Realignment: Analysis of Neurological Risk and Radiographic Outcomes. Neurosurgery 2020; 87:E355-E356. [PMID: 32294215 DOI: 10.1093/neuros/nyaa070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
28
|
Cristante AF, Silva RTE, Costa GHRD, Marcon RM. Adult Degenerative Scoliosis. Rev Bras Ortop 2020; 56:1-8. [PMID: 33627892 PMCID: PMC7895612 DOI: 10.1055/s-0040-1709736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/10/2020] [Indexed: 11/04/2022] Open
Abstract
Populational aging increases the incidence of musculoskeletal degenerative processes, such as adult scoliosis (AS). Adult scoliosis is defined as a spinal deformity in the coronal plane with a Cobb angle > 10°. Adult scoliosis may be iatrogenic or result from a degenerative process (scoliosis
de novo
) or a pre-existing scoliosis.
Adult scoliosis is a potentially limiting condition that affects a heterogeneous group of patients. Clinical treatment proved to be ineffective and surgery is often indicated. The present paper reviews AS pathophysiology, clinical presentation and diagnosis, in addition to surgical indications and the main techniques currently used.
Collapse
Affiliation(s)
- Alexandre Fogaça Cristante
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ricardo Teixeira E Silva
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Raphael Martus Marcon
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
29
|
Wang H, Li W. Multilevel extended posterior column osteotomy plus unilateral cage strutting for degenerative lumbar kyphoscoliosis. INTERNATIONAL ORTHOPAEDICS 2020; 44:1375-1383. [PMID: 32440815 DOI: 10.1007/s00264-020-04632-8] [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: 01/21/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the surgical outcome of patients with degenerative lumbar kyphoscoliosis who underwent multilevel extended posterior column osteotomy (PCO) plus unilateral cage strutting (UCS). METHODS From Jan 2012 to Aug 2017, 23 patients with degenerative lumbar kyphoscoliosis who underwent multilevel extended PCO plus UCS technique (study group) and 13 patients who underwent asymmetrical pedicle subtraction osteotomy (PSO) technique (control group) were retrospectively reviewed; the radiological features, including coronal/sagittal deformity, and clinical evaluation including Oswestry Disability Index (ODI), visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores-lumbar were assessed before surgery and at follow-up. RESULTS All patients underwent the operation successfully. There was no difference in fusion level, blood loss, and follow-up duration between the two groups; the operation time and length of hospital stay were shorter in study group than that in control group. All patients achieved significant correction of both scoliotic and kyphotic deformity and maintained the correction at minimum of two year follow-up, without any difference in deformity correction and correction loss between the two groups. All patients got back pain and leg pain alleviation and neurological function improvement at two year follow-up, without any difference between the two groups. The incidence of complications was lower in study group than that in control group. CONCLUSION Multilevel extended PCO plus UCS procedure could achieve significant correction of scoliosis and kyphosis in the treatment of degenerative lumbar kyphoscoliosis, presenting less surgery time, lower incidence of complication, and shorter hospital stay when compared with the asymmetric PSO technique.
Collapse
Affiliation(s)
- Hui Wang
- From the orthopedic of Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Weishi Li
- From the orthopedic of Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
| |
Collapse
|
30
|
Godzik J, Pereira BDA, Hemphill C, Walker CT, Wewel JT, Turner JD, Uribe JS. Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment. Global Spine J 2020; 10:101S-110S. [PMID: 32528793 PMCID: PMC7263342 DOI: 10.1177/2192568219880178] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
STUDY DESIGN Review of the literature. OBJECTIVES Anterior column realignment (ACR) is a powerful but relatively new minimally invasive technique for deformity correction. The purpose of this study is to provide a literature review of the ACR surgical technique, reported outcomes, and future directions. METHODS A review of the literature was performed regarding the ACR technique. A review of patients at our single center who underwent ACR was performed, with illustrative cases selected to demonstrate basic and nuanced aspects of the technique. RESULTS Clinical and cadaveric studies report increases in segmental lordosis in the lumbar spine by 73%, approximately 10° to 33°, depending on the degree of posterior osteotomy and lordosis of the hyperlordosis interbody spacer. These corrections have been found to be associated with a similar risk profile compared with traditional surgical options, including a 30% to 43% risk of proximal junctional kyphosis in early studies. CONCLUSIONS ACR represents a powerful technique in the minimally invasive spinal surgeon's toolbox for treatment of complex adult spinal deformity. The technique is capable of significant sagittal plane correction; however, future research is necessary to ascertain the safety profile and long-term durability of ACR.
Collapse
Affiliation(s)
- Jakub Godzik
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Courtney Hemphill
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Corey T. Walker
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Joshua T. Wewel
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Jay D. Turner
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Juan S. Uribe
- Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| |
Collapse
|
31
|
Park JH, Lee JB, Kim IS, Hong JT. Transdiscal C7 Pedicle Subtraction Osteotomy With a Strut Graft and the Correction of Sagittal and Coronal Imbalance of the Cervical Spine. Oper Neurosurg (Hagerstown) 2020; 18:271-277. [PMID: 31173133 DOI: 10.1093/ons/opz142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/24/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cervical spine deformity negatively affects patients' quality of life. Pedicle subtraction osteotomy (PSO) has reported to correct cervical deformity but it is challenging and carries a significant risk of morbidity. OBJECTIVE To report transdiscal C7 PSO with a strut graft for the correction of sagittal and coronal imbalance in patients with fixed cervical deformity. METHODS After standard exposure, the spine was instrumented from C2 to T3. T1 subtotal laminectomy, and C6 to C7 total laminectomies were necessary for C7 PSO. Osteotomy was initiated with removal of C6-7 and C7-T1 facet joints to isolate C7 pedicles and identify bilateral C7/C8 roots. Bilateral C7 pediculectomies and transdiscal PSO were performed. A rectangular strut allograft was then inserted into the PSO site. The location of the strut graft was used as a fulcrum of sagittal and coronal correction. The head fixator was released and the head was extended under intraoperative neuromonitoring, and then detailed sagittal and coronal balances were controlled by compressing or distracting between the pedicle screws above and below the osteotomy. RESULTS This technique was applied in 2 patients with fixed subaxial cervical deformities. Transdiscal PSO could add more amount of correction and provide the additional fusion surface. The strut graft prevented sagittal translation, foraminal narrowing, and excessive focal cord kinking during PSO. Both patients showed radiologic and clinical improvements after surgery, and no neurovascular complication occurred after the surgery. CONCLUSION Transdiscal C7 PSO with a strut graft placement provided a safe way of correcting sagittal and coronal imbalance simultaneously and reduced neurological complication by preventing sagittal translation, foraminal narrowing and spinal cord kinking.
Collapse
Affiliation(s)
- Jong-Hyeok Park
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Jong Beom Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
32
|
Wewel JT, Uribe JS. Commentary: Surgical Treatment of Flat Back Syndrome With Anterior Hyperlordotic Cages. Oper Neurosurg (Hagerstown) 2020; 18:E64-E65. [PMID: 31406998 DOI: 10.1093/ons/opz198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joshua T Wewel
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| |
Collapse
|
33
|
Ohiorhenuan I, Deviren V, Uribe JS. MIS lateral ACR for spinal deformity correction: technique and complication avoidance. NEUROSURGICAL FOCUS: VIDEO 2020; 2:V1. [PMID: 36284698 PMCID: PMC9521216 DOI: 10.3171/2020.1.focusvid.19715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 12/04/2022]
Abstract
Deformity correction using minimally invasive surgical (MIS) techniques can be challenging. Here the authors present a case in which an anterior column resection was performed using an MIS lateral approach to restore lumbar lordosis and improve sagittal balance. The authors demonstrate the technique and discuss potential complications and how they may be avoided. The video can be found here: https://youtu.be/XjOdDeKrKEE.
Collapse
Affiliation(s)
- Ifije Ohiorhenuan
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; and
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Juan S. Uribe
- Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; and
| |
Collapse
|
34
|
Evolution of the Anterior Approach in Lumbar Spine Fusion. World Neurosurg 2019; 131:391-398. [DOI: 10.1016/j.wneu.2019.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 01/27/2023]
|
35
|
La Barbera L, Wilke HJ, Liebsch C, Villa T, Luca A, Galbusera F, Brayda-Bruno M. Biomechanical in vitro comparison between anterior column realignment and pedicle subtraction osteotomy for severe sagittal imbalance correction. 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; 29:36-44. [PMID: 31414289 DOI: 10.1007/s00586-019-06087-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/14/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the biomechanical effects of anterior column realignment (ACR) and pedicle subtraction osteotomy (PSO) on local lordosis correction, primary stability and rod strains. METHODS Seven cadaveric spine segments (T12-S1) underwent ACR at L1-L2. A stand-alone hyperlordotic cage was initially tested and then supplemented with posterior bilateral fixation. The same specimens already underwent a PSO at L4 stabilized by two rods, a supplemental central rod (three rods) and accessory rods (four rods) with and without adjacent interbody cages (La Barbera in Eur Spine J 27(9):2357-2366, 2018). In vitro flexibility tests were performed under pure moments in flexion/extension (FE), lateral bending (LB) and axial rotation (AR) to determine the range of motion (RoM), while measuring the rod strains with strain gauge rosettes. RESULTS Local lordosis correction with ACR (24.7° ± 3.7°) and PSO (25.1° ± 3.9°) was similar. Bilateral fixation significantly reduced the RoM (FE: 31%, LB: 2%, AR: 18%), providing a stability consistent with PSO constructs (p > 0.05); however, it demonstrates significantly higher rod strains compared to PSO constructs with lateral accessory rods and interbody cages in FE and AR (p < 0.05), while being comparable in FE or slightly higher in AR compared to PSO constructs with two and three rods. CONCLUSION Bilateral posterior fixation is highly recommended following ACR to provide adequate primary stability. However, primary rod strains in ACR were found comparable or higher than weak PSO construct associated with frequent rod failure; therefore, caution is recommended. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Luigi La Barbera
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milan, Italy.
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, University of Ulm, Ulm, Germany
| | - Christian Liebsch
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, University of Ulm, Ulm, Germany
| | - Tomaso Villa
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milan, Italy
| | - Andrea Luca
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | | |
Collapse
|
36
|
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
|