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Park Y, Kim J, Kim HJ, Oh S, Park JH, Shim D, Park JH. Comparative Study of Post-Surgical Outcomes in Pain, Disability, and Health-Related Quality of Life for Adult Spinal Deformity in Patients Aged above and below 75 Years. Life (Basel) 2023; 13:2329. [PMID: 38137930 PMCID: PMC10745042 DOI: 10.3390/life13122329] [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: 11/07/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Adult spinal deformity (ASD) surgery is known to improve clinical and radiological parameters; however, it may also cause more complications in elderly patients. The purpose of this study was to compare the outcomes of ASD surgery, specifically regarding pain, disability, and health-related quality of life (HRQOL) in patients aged 75 years and over and patients aged under 75 years; (2) Methods: A total of 151 patients who underwent ASD surgery between August 2014 and September 2020 were included. Patients were divided into two groups based on whether they are 75 years and over or under. Radiological parameters measured included sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI)- lumbar lordosis (LL). Data were collected 3, 6, and 12 months after surgery; (3) Results: At 12 months postoperatively, visual analog scale (VAS) for low back pain (p = 0.342), Oswestry disability index (ODI) (p = 0.087), and EuroQol 5-Dimensions (EQ-5D) (p = 0.125) did not differ between patients under 75 years and those 75 and above 75 group. PT (p = 0.675), PI-LL (p = 0.948), and SVA (p = 0.108) did not differ significantly 12 months after surgery in the two groups. In the entire patient group, compared to preoperative data, significant improvements were demonstrated for clinical and radiological parameters 12 months after surgery (all p < 0.001). The rate of medical complications did not correlate with age, but the rates of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) did (p = 0.638, p < 0.001, and p = 0.001, respectively); (4) Conclusions: In terms of clinical and radiological improvements, ASD surgery should be considered for patients regardless of whether they are younger than or older than 75 years. The clinical and radiological improvements and the risk of complications and revision surgeries must be considered in ASD patients who are 75 years or older.
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Affiliation(s)
- Yeonsu Park
- College of Medicine, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Jiyoon Kim
- College of Medicine, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 gumiro, Bundang-gu, Sungnam-si 13620, Republic of Korea;
| | - Seungtak Oh
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 gumiro, Bundang-gu, Sungnam-si 13620, Republic of Korea;
| | - Joon-Hee Park
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 18, Cheonho-daero 173-gil, Gangdong-gu, Seoul 05355, Republic of Korea; (J.-H.P.); (D.S.)
| | - Daechul Shim
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 18, Cheonho-daero 173-gil, Gangdong-gu, Seoul 05355, Republic of Korea; (J.-H.P.); (D.S.)
| | - Jin-Ho Park
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 gumiro, Bundang-gu, Sungnam-si 13620, Republic of Korea;
- Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 18, Cheonho-daero 173-gil, Gangdong-gu, Seoul 05335, Republic of Korea
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Librianto D, Hadisoebroto Dilogo I, Fauzi Kamal A, Saleh I, Ipang F, Aprilya D. Effectiveness of Kyphosis Reduction Using Cantilever Method in Thoracolumbar Spondylitis Tuberculosis: A Short-Term Follow-Up. Orthop Res Rev 2021; 13:275-280. [PMID: 34887687 PMCID: PMC8651210 DOI: 10.2147/orr.s342365] [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: 10/22/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Kyphosis in spondylitis tuberculosis (STb) is more than just a cosmetic issue. It has a potentially detrimental effect on both spine-associated structures and cardiopulmonary function. It can be corrected in any stage of STb; however, the corrective surgery is challenging, especially in the late case, in which the additional stiffness of the spine can come into consideration. To date, the cantilever technique is still a gold standard for sagittal plane deformity correction. However, no study to date has explored its effectiveness for thoracolumbar kyphotic deformity, especially that caused by spondylitis tuberculosis. Methods This is a retrospective study of 16 consecutive cases of spondylitis tuberculosis with thoracolumbar kyphosis that underwent corrective surgery in our center in the period of 2020–2021. We aim to evaluate the effectiveness of the cantilever technique that we use for kyphotic correction in thoracolumbar STb patients. Results At the 3-months follow-up, the mean Cobb angle was 14.6°±10.27°, with the mean gain of 20.90°±12.00° and positively correlate with the thoracolumbar kyphosis (TLK) correction (68.69%, r = 0.654, p = 0.001). The mean thoracic kyphosis, lumbar lordosis, and sagittal vertebral axis were 30.6°±13.08°, 39.4°±16.02°, and 1.4±4.09 cm, respectively, with sagittal Cobb difference of 12.70±9.85. Conclusion The kyphotic Cobb angle reduction by cantilever technique in the thoracolumbar area significantly improved the thoracolumbar kyphosis and realign the spinal sagittal axis. Thus, the cantilever technique remains the gold standard for sagittal plane deformity correction which can be applied for kyphotic deformity correction in thoracolumbar STb cases.
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Affiliation(s)
- Didik Librianto
- Orthopedic Spine Surgeon, Fatmawati General Hospital, Jakarta, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Achmad Fauzi Kamal
- Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ifran Saleh
- Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fachrisal Ipang
- Orthopedic Spine Surgeon, Fatmawati General Hospital, Jakarta, Indonesia
| | - Dina Aprilya
- Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Kim HJ, Chang DG. Clinical and radiographic parameters for patients with adult spinal deformity. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.11.743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Improved medical care and increased life expectancy have led to a focus on the impact of adult spinal deformity (ASD) on health-related quality of life (HRQoL) in the field of the spine. Recently, there has been a paradigm shift in the evaluation and management of ASD regarding the important correlation between sagittal imbalance and clinical outcomes.Current Concepts: Loss of lumbar lordosis is recognized as a key driver of ASD followed by forward-leaning of the trunk, reducing thoracic kyphosis, pelvic retroversion, and knee flexion. Radiological assessment has been critical for evaluating ASD from the anteroposterior and lateral view of the whole spine radiograph. Important parameters include coronal, regional, global, and sagittal spinopelvic parameters. Especially, sagittal spinopelvic parameters significantly correlate with disability and HRQoL in patients with ASD, which can influence the process of decision-making with respect to the choice between conservative treatment and surgery.Discussion and Conclusion: Sagittal imbalance has been recently emphasized in patients with ASD. Therefore, the decision-making of ASD treatment should be focused on restoring harmonious alignment to prevent catastrophic complications and improvement of HRQoL.
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