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Quarto E, Zanirato A, Vitali F, Spatuzzi M, Bourret S, Le Huec JC, Formica M. Adult spinal deformity correction surgery using age-adjusted alignment thresholds: clinical outcomes and mechanical complication rates. A systematic review of the literature. Eur Spine J 2024; 33:553-562. [PMID: 37740115 DOI: 10.1007/s00586-023-07949-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE Adult spinal deformity (ASD) surgery gives good clinical outcomes but has a high rate of mechanical complications (MC). In 2016, Lafage described the age-adjusted alignment thresholds (AAAT) to adapt the correction in relation to patient's age proposing less aggressive corrections for the elderly population. The aim of this review was to clarify the effectiveness of AAAT to achieve good health-related quality of life (HRQoL) and their relationship with post-operative MC. MATERIALS AND METHODS We performed a review of the literature, including articles reporting data on post-operative HRQoL and MC rates in relation to the AAAT. Data were stratified according to whether they matched the AAAT, dividing the population in undercorrected (U), matched (M) and overcorrected (O). The quality of the included studies was assessed using the GRADE and MINORS systems. RESULTS Six articles reporting data from 1,825 patients were included. The different categories (U, M and O) had homogeneous pre-operative sagittal parameters (p > 0.05) that became statistically different after surgeries (p < 0.05). Proximal junctional kyphosis (PJK) was more frequent in the O group compared to U (p = 0.05). Post-operative HRQoL parameters were similar in the 3 groups (p > 0.05). The quality of the included studies was generally low with a high bias risk. CONCLUSION The results extrapolated from this review are interesting, as for the same HRQoL the U group had a lower MC rate. Unfortunately, the results are inconsistent, mainly because of the low quality of the included studies and the lack of reporting of some important patient- and surgery-related factors.
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Affiliation(s)
- E Quarto
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy.
| | - A Zanirato
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - F Vitali
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - M Spatuzzi
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
| | - S Bourret
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - J C Le Huec
- Vertebra, Polyclinique Bordeaux Nord Aquitaine, 15 Rue Boucher, 33300, Bordeaux, France
| | - M Formica
- IRCCS Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy
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Saad M, Arfa M, Attia A, Lamas V, Sauleau EA, Charles YP. Proximal and distal mechanical repercussions of instrumentation by double rods and interbody grafts in adult scoliosis. Orthop Traumatol Surg Res 2023; 109:103544. [PMID: 36621636 DOI: 10.1016/j.otsr.2023.103544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/08/2022] [Accepted: 09/22/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Correction of adult scoliosis by instrumentation with double rods and interbody grafts aims to reduce the risk of pseudarthrosis with rod fracture. An increase in instrumentation rigidity can lead to an increase in stresses at the proximal and distal ends of the construct. The aim of this study was to analyze the incidence and clinical repercussions of proximal junctional kyphosis (PJK), proximal junctional failure (PJF) and iliac screw loosening. MATERIEL AND METHODS An analysis of patients operated on for adult scoliosis with instrumentation to the pelvis using 4 rods and interbody cages was carried out from a prospective register. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Scoliosis Research Society 22 (SRS-22) clinical scores and radiological parameters were collected preoperatively, postoperatively at 3 months, 1 year and 2 years. The appearance of PJK, PJF or distal screw loosening was sought; the clinical impact and the risk factors were analyzed by Bayesian inference. RESULTS Fifty-one patients with a mean age of 64.5 years were included. The clinical scores improved significantly (Pr>0.95) at 2 years: VAS back 6.9 versus 2.6, VAS leg 4.9 versus 2.5, ODI 48.2 versus 25.4, SRS-22 2.4 versus 3.5. The radiological parameters were corrected (Pr>0.95): Cobb angle 63.9° versus 22.8°, spinosacral angle (SSA) 112.4° versus 118.8°, T1-pelvic angle (TPA) 24, 8° versus 20.8°, lumbar lordosis 43.8° versus 51.0°, thoracic kyphosis 45.2° versus 53.6°. Thirteen patients (25.5%) presented with PJK and 11 (21.6%) with PJF. Seven patients (13.7%) presented with iliac screw loosening. None of these complications was associated with a significant deterioration in clinical scores. Cranial migration of the lumbar apex increased the risk of distal screw loosening: Odds-Ratio 10.31 (Pr>0.999). Two patients were re-operated on for PJF and one patient for iliac screw loosening (5.9%). No rod fracture with pseudarthrosis was found. CONCLUSION Instrumentation with double rods and interbody grafts was associated with a rate of 47.1% of mechanical repercussions at the extremity of the construct. However, these complications were not associated with a significant deterioration in clinical scores. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Maxime Saad
- Service de chirurgie orthopédique et traumatologique, CHU de Grenoble, hôpital Nord, boulevard de la Chantourne, université Grenoble Alpes, 38700 la Tronche, Grenoble, France.
| | - Maher Arfa
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Aymen Attia
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Vincent Lamas
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - Erik André Sauleau
- Service de santé publique, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, Place de l'hôpital, 67091 Strasbourg cedex, France
| | - Yann Philippe Charles
- Service de chirurgie du Rachis, hôpitaux universitaires de Strasbourg, faculté de médecine, maïeutique et sciences de la santé, université de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
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Archer JE, Baird C, Gardner A, Rushton AB, Heneghan NR. Evaluating measures of quality of life in adult scoliosis: a systematic review and narrative synthesis. Spine Deform 2022; 10:991-1002. [PMID: 35349122 DOI: 10.1007/s43390-022-00498-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To systematically review and synthesise the evidence on the measurement properties of patient-reported outcome measure (PROMs) used to assess the quality of life in patients with adult scoliosis. METHOD Based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and a published protocol, a two-stage search was conducted and reported in line with the Preferred Reporting Items for Systematic review and Meta-analysis (PRISMA). Stage one identified all studies of patients with adult scoliosis which included PROMs of health-related quality of life (HR-QOL). Databases including AMED, CINAHL, EMBASE, Medline, PsychINFO and Pubmed were searched from inception until 31st December 2020. This derived list of PROMs, was then utilised for a stage 2 search to identify studies which evaluated the measurement properties of the PROMs. Two reviewers independently performed the searches, study screening, selection and risk of bias assessment using the COSMIN tool. The overall quality of the evidence was assessed using a modified Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Stage one yielded 16 PROMs of HR-QOL with the Oswestry Disability Index (ODI) and Scoliosis Research Society-22 (SRS-22) the most used. Stage two identified three stage one PROMs that fulfilled eligibility criteria: SRS-22, ODI and SRS-22r; with five studies investigating measurement properties in an adult scoliosis population. The SRS-22 was the most comprehensively evaluated PROM in this cohort with very low-quality evidence indicating indeterminate reliability, sufficient construct validity and sufficient responsiveness of the SRS-22. There is very low-quality evidence indicating sufficient responsiveness of the ODI. There is very low-quality evidence indicating indeterminate cross-cultural validity for the SRS-22r. All other measurement properties in the SRS-22, ODI and SRS-22r have not been evaluated. CONCLUSION A large number of PROMs are being utilised in the adult scoliosis population and of these, the most commonly utilised are the ODI and SRS-22. The SRS-22, ODI and SRS-22r are the only PROMs to have had their measurement properties evaluated in the adult scoliosis population. The findings of this systematic review are that there currently is not sufficient evidence on the measurement properties of any PROMs in adult scoliosis. Further research is now urgently required to assess the measurement properties of these PROMs.
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Affiliation(s)
- James E Archer
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Charles Baird
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK. .,Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK.
| | - Alison B Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Shu S, Jing W, Zhu Z, Bao M, Qiu Y, Bao H. Risk factors for postoperative coronal decompensation in adult lumbar scoliosis after posterior correction with osteotomy. Arch Orthop Trauma Surg 2022; 142:211-7. [PMID: 33063125 DOI: 10.1007/s00402-020-03633-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION To determine potential risk factors for postoperative coronal imbalance following posterior osteotomy for adult scoliosis. MATERIALS AND METHODS A total of 74 patients underwent osteotomy for rigid adult lumbar scoliosis. A group of 20 patients with postoperative coronal imbalance was identified. Clinical data and surgical strategies were compared to determine the risk factors, including age, gender, etiology, Cobb angle, preoperative coronal balance distance, direction of preoperative imbalance, T1 tilt, tilt of upper instrumented vertebra (UIV), UIV translation, location of UIV (T6 above or below), fusion to L5 or S1, lower instrumented vertebra (LIV) tilt, LIV rotation, screw density, osteotomy procedure (PSO or SPOs) and use of iliac screws. RESULTS Comparison between patients with and without postoperative coronal imbalance showed that postoperative coronal imbalance occurred in older patients and those with degenerative scoliosis as the etiology, UIV above T6, preoperative LIV rotation, preoperative LIV tilt and preoperative coronal imbalance towards the convex side and who underwent Smith-Petersen osteotomy. All seven parameters were included in the logistic regression analysis. UIV above T6 (P = 0.010), LIV rotation (P = 0.012) and preoperative coronal imbalance towards the convex side (P = 0.005) were identified as risk factors for postoperative coronal imbalance after osteotomy. CONCLUSIONS Patients with preoperative coronal imbalance towards the convex side (UIV above T6) and LIV rotation were more likely to develop coronal imbalance than those without risk factors. Older patients and those with degenerative scoliosis were also at a relatively higher risk of postoperative coronal imbalance.
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Archer JE, Baird C, Gardner A, Rushton AB, Heneghan NR. Evaluating measures of quality of life in adult scoliosis: a protocol for a systematic review and narrative synthesis. Syst Rev 2021; 10:259. [PMID: 34565462 PMCID: PMC8474779 DOI: 10.1186/s13643-021-01811-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adult scoliosis represents a distinct subgroup of scoliosis patients for whom the diagnosis can have a large impact on their health-related quality of life (HR-QOL). Therefore, HR-QOL patient-reported outcome measures (PROMs) are essential to assess disease progression and the impact of interventions. The objective of this systematic review is to evaluate the measurement properties of HR-QOL PROMs in adult scoliosis patients. METHODS We will conduct a literature search, from their inception onwards, of multiple electronic databases including AMED, CINAHL, EMBASE, Medline, PsychINFO and PubMed. The searches will be performed in two stages. For both stages of the search, participants will be aged 18 and over with a diagnosis of scoliosis. The primary outcome of interest in the stage one searches will be studies which use PROMs to investigate HR-QOL as defined by the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy, the secondary outcome will be to assess the frequency of use of the various PROMs. In stage two, the primary outcome of interest will be studies which assess the measurement properties of the HR-QOL PROMs identified in stage one. No specific measurement property will be given priority. No planned secondary outcomes have been identified but will be reported if discovered. In stage one, the only restriction on study design will be the exclusion of systematic reviews. In Stage two the only restriction on study design will be the exclusion of full-text articles not available in the English language. Two reviewers will independently screen all citations and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or risk of bias) will be appraised using the Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) checklist. The overall strength of the body of evidence will then be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A narrative synthesis will be provided with information presented in the main text and tables to summarise and explain the characteristics and findings of the included studies. The narrative synthesis will explore the evidence for currently used PROMs in adult scoliosis patients and any areas that require further study. DISCUSSION The review will help clinicians and researchers identify a HR-QOL PROM for use in patients with adult scoliosis. Findings from the review will be published and disseminated through a peer-reviewed journal and conference presentations. SYSTEMATIC REVIEW REGISTRATION This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), reference number: CRD42020219437.
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Affiliation(s)
- James E. Archer
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - Charles Baird
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, UK
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Alison B. Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Nicola R. Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Proietti L, Perna A, Velluto C, Smakaj A, Bocchi MB, Fumo C, Fresta L, Tamburrelli FC. Correction of a severe coronal malalignment in adult spinal deformity using the "kickstand rod" technique as primary surgery. J Orthop 2021; 25:252-8. [PMID: 34099955 DOI: 10.1016/j.jor.2021.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/16/2021] [Indexed: 01/05/2023] Open
Abstract
Objective Adult spinal deformity (ASD) is a growing healthcare issue due to the aging population. A satisfying spine balance in both sagittal and coronal planes is achieved through surgery. Only few studies about the coronal alignment correction with the kickstand rod were reported in the literature, until now. The aim of the present study was to describe clinical and radiological outcomes of the Kickstand rod (KR) technique in a series of ASD patients with severe coronal malalignment after 1 year of follow-up. Material and methods Six patients affected by ASD with severe CM who underwent surgery between 2018 and 2019 were retrospectively analyzed. The mean follow up was 14 months. All patients had posterior-only approach with long pelvic-thoracic fixation according to the Kickstand rod technique. Results Postoperative alignment and pain numerical rating scale scores significantly improved. No instrumentation complications occurred. A coronal alignment improvement from a mean of 163 mm preoperatively to a mean of 32 mm postoperatively was observed. Conclusion KR technique appears to be a safe and efficient way for coronal and sagittal imbalance correction in ASD patients. Although technically demanding, by using this technique good and stable radiological and functional outcomes are achieved especially in selected patients.
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Adeyemo EA, Aoun SG, Barrie U, Nguyen ML, Johnson ZD, Hall K, Peinado Reyes V, El Ahmadieh TY, Adogwa O, McDonagh DL, Bagley CA. Comparison of the effect of epidural versus intravenous patient controlled analgesia on inpatient and outpatient functional outcomes after adult degenerative scoliosis surgery: a comparative study. Spine J 2021; 21:765-771. [PMID: 33352321 DOI: 10.1016/j.spinee.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Perioperative pain can negatively impact patient recovery after spine surgery and be a contributing factor to increased hospital length of stay and cost. Most data currently available is extrapolated from adolescent idiopathic cases and may not apply to adult and geriatric populations with thoracolumbar spine degeneration. PURPOSE Study the impact of epidural analgesia on pain control and outcomes after adult degenerative scoliosis surgery in a large single-institution series of adult patients undergoing thoraco-lumbar-pelvic fusion. STUDY DESIGN/SETTING Retrospective single-center review of prospectively collected data. PATIENT SAMPLE Patients undergoing thoracolumbar fusion with pelvic fixation. OUTCOME MEASURES Self-reported measures: Visual analog scale for pain. Physiologic Measures: Oral pain control requirements converted into daily morphine equivalents. Functional Measures: Ambulation perimeter after surgery, urinary retention and constipation rates. METHODS We retrospectively reviewed patient data for the years 2016 and 2017 before the use of patient controlled epidural analgesia (PCEA), and then 2018 and 2019 after its implementation, for all thoracolumbar degenerative procedures, and compared their postoperative outcomes measures. RESULTS There were 46 patients in the PCEA group and 37 patients in the intravenous PCA (IVPCA) groups. All patients underwent long segment posterolateral thoracolumbar spinal fusion with pelvic fixation. Patients in the PCEA group had lower pain scores and ambulated greater distances compared with those in the IVPCA group. PCEA patients also had lower urinary retention and constipation rates, but no increased intraoperative or postoperative complications related to catheter placement. CONCLUSIONS PCEA can provide optimal pain control after adult degenerative scoliosis spine surgery, and may promote greater early ambulation, while decreasing postoperative constipation and urinary retention rates.
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Affiliation(s)
- Emmanuel A Adeyemo
- Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA
| | - Salah G Aoun
- Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA.
| | - Umaru Barrie
- Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA
| | - Madelina L Nguyen
- Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA
| | - Zachary D Johnson
- Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA
| | - Kristen Hall
- Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA
| | - Valery Peinado Reyes
- Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA
| | - Owoicho Adogwa
- Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA
| | - David L McDonagh
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA
| | - Carlos A Bagley
- Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA; Department of Orthopedic Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA
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Zaina F, Poggio M, Di Felice F, Donzelli S, Negrini S. Bracing adults with chronic low back pain secondary to severe scoliosis: six months results of a prospective pilot study. Eur Spine J 2021; 30:2962-2966. [PMID: 33733328 DOI: 10.1007/s00586-021-06808-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 01/13/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Adult scoliosis is sometimes associated with back pain and severe curves can progress over time. Despite scoliosis has been estimated to affect up to 68% of the population over 60, there is scant literature about conservative treatment for adult scoliosis. Recently, we tested a new brace designed to alleviate pain for adult patients with chronic pain secondary to scoliosis. The study aims to test the efficacy of a prefabricated brace in reducing pain in adult scoliosis patients. METHODS Twenty adults (age 67.8 ± 10.5, curve 61.9 ± 12.6° Cobb) with chronic low back pain (cLBP) secondary to Idiopathic Scoliosis (IS) were included. Patients were evaluated at baseline immediately before starting with the brace and after 6 months. Outcome measures were GRS, Oswestry Disability Index (ODI), Roland Morris Questionnaire (RM), COMI. The paired t test, ANOVA and Wilcoxon tests were used for statistical analysis RESULTS: At six months, worst pain, leg pain and back pain were significantly improved: from 7.15 to 5.60, from 5.65 to 4.35 and from 6.55 to 5.25 (p < 0.05). Sixty-five percent of patients achieved the minimal clinically important difference of 2 points for worst pain and leg pain, 55% for back pain. RM and COMI improved (p < 0.05), no differences for ODI. CONCLUSION The prefabricated brace showed a significant improvement at 6 months of worst, leg and back pain in most patients in a group of adult women with IS and cLBP. The quality of life didn't change in a clinically significant way even if the patients reported satisfaction with the treatment. Trial registration number and date of registration: ClinicalTrials.gov Identifier: NCT02643290, December 31, 2015.
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Affiliation(s)
- F Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy.
| | - M Poggio
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - F Di Felice
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - S Donzelli
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - S Negrini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan La Statale, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Cazzulino A, Gandhi R, Woodard T, Ackshota N, Janjua MB, Arlet V, Saifi C. Soft Landing technique as a possible prevention strategy for proximal junctional failure following adult spinal deformity surgery. J Spine Surg 2021; 7:26-36. [PMID: 33834125 DOI: 10.21037/jss-20-622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This cross sectional study describes a "Soft Landing" strategy utilizing hooks for minimizing proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). The technique creates a gradual transition from a rigid segmental construct to unilateral hooks at the upper instrumented level and preservation of the soft tissue attachments on the contralateral side of the hooks. Authors devise a novel classification system for better grading of PJK severity. Methods Thirty-nine consecutive adult spinal deformity (ASD) patients at a single institution received the "Soft Landing" technique. The proximal junctional angle was measured preoperatively and at last follow-up using standing 36-inch spinal radiographs. Changes in proximal junctional angle and rates of PJK and PJF were measured and used to create a novel classification system for evaluating and categorizing ASD patients postoperatively. Results The mean age of the cohort was 61.4 years, and 90% of patients were women. Average follow up was 2.2 years. The mean change in proximal junctional angle was 8° (SD 7.4°) with the majority of patients (53%) experiencing less than 10° and only 1 patients with proximal junctional angle over 20°. Four patients (10%) needed additional surgery for proximal extension of the uppermost instrumented vertebra (UIV) secondary to PJF. Conclusions Soft Landing technique is a possibly effective treatment strategy to prevent PJK and PJF following ASD that requires further evaluation. The described classification system provides management framework for better grading of PJK. The "Soft Landing" technique warrants further comparison to other techniques currently used to prevent both PJK and failure.
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Affiliation(s)
- Alejandro Cazzulino
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Rikesh Gandhi
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Thaddeus Woodard
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Nissim Ackshota
- Department of Orthopedic Surgery, The Chaim Sheba Medical Center at Tel-Hashomer, Tel-Aviv, Israel
| | | | - Vincent Arlet
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Comron Saifi
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Hori Y, Matsumura A, Namikawa T, Kato M, Iwamae M, Nakamura H. Comparative Study of the Spinopelvic Alignment in Patients With Idiopathic Lumbar Scoliosis Between Adulthood and Adolescence. World Neurosurg 2021; 149:e309-15. [PMID: 33601080 DOI: 10.1016/j.wneu.2021.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Understanding the natural history of the spinopelvic alignment in adolescent idiopathic scoliosis (AIS) is important in developing surgical strategies for patients with adult idiopathic lumbar scoliosis (AdLS). Because it is challenging to follow individuals without any treatments, we sought to estimate its natural history by comparing radiographic characteristics of patients with AIS and AdLS. METHODS We included patients with Lenke 5 AIS and patients with AdLS who were diagnosed with Lenke 5 AIS in adolescence. The Cobb angle of the curve and spinopelvic parameters were measured by whole spine radiographs. The AdLS patients were divided into 2 groups according to age <50 years (AdLS<50) or ≥50 years (AdLS≥50). Radiographic parameters were compared among the AIS, AdLS<50, and AdLS≥50 groups. The relationship between age and each parameter was analyzed using nonlinear regression analysis. RESULTS We analyzed 40 patients with AIS (all female, mean age 16.8 ± 3.2 years) and 35 patients with AdLS (34 female and 1 male, mean age 55.4 ± 12.1 years). Thoracolumbar/lumbar curve and thoracolumbar kyphosis was significantly greater in the AdLS<50 group compared with the AIS group, without progression after age 50 years. Lumbar lordosis and pelvic tilt deteriorated linearly with age. AIS and AdLS<50 patients maintained sagittal balance, which deteriorated in AdLS≥50 patients. CONCLUSIONS Our results may predict the following natural course of Lenke 5 AIS: (1) progression of scoliotic deformity of thoracolumbar/lumbar curve with increased thoracolumbar kyphosis; (2) subsequent lumbar hypolordosis followed by pelvic retroversion; and (3) sagittal imbalance after failure of compensation.
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11
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Koller H, Koller J, Stengel F, Meyer B. [Surgical challenges with spinal balance in adult spinal deformities-the forgotten coronal plane]. Orthopade 2020; 49:883-892. [PMID: 32880703 DOI: 10.1007/s00132-020-03993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article gives a brief overview of the importance, planning and correction of coronal spinal imbalance in patients with adult and pediatric spinal deformity.
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Affiliation(s)
- Heiko Koller
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland. .,Universitätsklinik für Orthopädie und Traumatologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
| | | | - Felix Stengel
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Bernhard Meyer
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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12
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Piazzolla A, Bizzoca D, Berjano P, Balsano M, Buric J, Carlucci S, Formica C, Formica M, Lamartina C, Musso C, Tamburrelli F, Damilano M, Tartara F, Sinigaglia A, Bassani R, Neroni M, Casero G, Lovi A, Garbossa D, Nicola Z, Moretti B. Major complications in extreme lateral interbody fusion access: multicentric study by Italian S.O.L.A.S. group. Eur Spine J 2020; 30:208-216. [PMID: 32748257 DOI: 10.1007/s00586-020-06542-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/22/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The eXtreme Lateral Interbody Fusion (XLIF) approach has gained increasing importance in the last decade. This multicentric retrospective cohort study aims to assess the incidence of major complications in XLIF procedures performed by experienced surgeons and any relationship between the years of experience in XLIF procedures and the surgeon's rate of severe complications. METHODS Nine Italian members of the Society of Lateral Access Surgery (SOLAS) have taken part in this study. Each surgeon has declared how many major complications have been observed during his surgical experience and how they were managed. A major complication was defined as an injury that required reoperation, or as a complication, whose sequelae caused functional limitations to the patient after one year postoperatively. Each surgeon was finally asked about his years of experience in spine surgery and XLIF approach. Pearson correlation test was used to evaluate the association between the surgeon's years of experience in XLIF and the rate of major complications; a p-value of last than 0.05 was considered significant. RESULTS We observed 14 major complications in 1813 XLIF procedures, performed in 1526 patients. The major complications rate was 0.7722%. Ten complications out of fourteen needed a second surgery. Neither cardiac nor respiratory nor renal complications were observed. No significant correlation was found between the surgeon's years of experience in the XLIF procedure and the number of major complications observed. CONCLUSION XLIF revealed a safe and reliable surgical procedure, with a very low rate of major complications, when performed by an expert spine surgeon.
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Affiliation(s)
- Andrea Piazzolla
- School of Medicine, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic, Trauma and Spine Unit, University of Bari "Aldo Moro"-AOU Policlinico Consorziale, Bari, Italy
| | - Davide Bizzoca
- School of Medicine, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic, Trauma and Spine Unit, University of Bari "Aldo Moro"-AOU Policlinico Consorziale, Bari, Italy
| | | | - Massimo Balsano
- Ortopedia e Traumatologia A, Centro Regionale Specializzato in Chirurgia Vertebrale, Azienda Ospedaliera Universitaria Integrata Verona (AOUI), Ospedale Borgo Trento, Verona, Italy
| | | | - Stefano Carlucci
- Department of Orthopaedics and Traumatology, SS Annunziata, Taranto, Italy
| | | | - Matteo Formica
- Clinica Ortopedica, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | | | - Corrado Musso
- Unità Operativa Chirurgia della Colonna 2, Humanitas Gavazzeni, Bergamo, Italy
| | - Francesco Tamburrelli
- Department of Orthopedic Science and Traumatology. Spine Surgery Division, Catholic University Rome, Rome, Italy
| | | | - Fulvio Tartara
- Azienda Ospedaliera "Istituti Ospitalieri Di Cremona"-U.O.C. Di Neurochirurgia, Cremona, Italy
| | | | | | | | | | - Alessio Lovi
- GSpine 3, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Diego Garbossa
- Clinica Neurochirurgica, Città della Salute e della Scienza, "Molinette", Turin, Italy
| | - Zullo Nicola
- Unità Operativa Chirurgia della Colonna 2, Humanitas Gavazzeni, Bergamo, Italy
| | - Biagio Moretti
- School of Medicine, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic, Trauma and Spine Unit, University of Bari "Aldo Moro"-AOU Policlinico Consorziale, Bari, Italy
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13
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Guevara-Villazón F, Boissiere L, Hayashi K, Larrieu D, Ghailane S, Vital JM, Gille O, Pointillart V, Obeid I, Bourghli A. Multiple-rod constructs in adult spinal deformity surgery for pelvic-fixated long instrumentations: an integral matched cohort analysis. Eur Spine J 2020; 29:886-95. [PMID: 31993784 DOI: 10.1007/s00586-020-06311-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 09/12/2019] [Accepted: 01/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Multiple-rod constructs (Multi-Rod: extra rods for additional pillar support) are occasionally used in adult spinal deformity (ASD) surgery. We aimed to compare and analyze the general outcome of multi-rod constructs with a matched two-rod cohort, to better understand the differences and the similitudes. METHODS This is a retrospective matched cohort study including patients with ASD that underwent surgical correction with long posterior instrumentation (more than five levels), pelvic fixation and a minimum 1-year follow-up. Matching was considered with demographical data, preoperative radiographical parameters, preoperative clinical status [health-related quality-of-life (HRQoL) scores] and surgical characteristics (anterior fusion, decompression, rod material, osteotomies). Postoperative radiographical and clinical parameters, as well as complications, were obtained. Univariate and multivariate analysis was performed regarding postoperative improvement, group variables comparison and parameters correlation. RESULTS Thirty-three patients with multi-rod construct and 33 matched with a two-rod construct were selected from a database with 346 ASD-operated patients. Both groups had a significant improvement with surgical management in the radiographical and HRQoL parameters (p < 0.001). Differences between groups for the postoperative radiographical, clinical and perioperative parameters were not significant. Rod breakage was more frequent in the two-rod group (8 vs 4, p = 0.089), as well as the respective revision surgery for those cases (6 vs 1 p = 0.046). Risk factors related to revision surgery were greater kyphosis correction (p = 0.001), longer instrumentation (p = 0.037) and greater sagittal vertical axis correction (p = 0.049). CONCLUSION No major disadvantage on the use of multi-rod construct was identified. This supports the benefit of using multi-rod constructs to avoid implant failure. These slides can be retrieved under Electronic Supplementary Material.
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14
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Redaelli A, Langella F, Dziubak M, Cecchinato R, Damilano M, Peretti G, Berjano P, Lamartina C. Useful and innovative methods for the treatment of postoperative coronal malalignment in adult scoliosis: the "kickstand rod" and "tie rod" procedures. Eur Spine J 2020; 29:849-859. [PMID: 31907658 DOI: 10.1007/s00586-019-06285-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/21/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Surgical technique description and case series. OBJECTIVE To describe the use of two techniques for the correction of postoperative coronal imbalance after surgical treatment for adult spine deformity (ASD). Sagittal and coronal spinal malalignments are often present in patients with ASD or in patients who have undergone spine surgery. Surgical correction of coronal imbalance is insufficiently investigated, and the literature provides a limited spectrum of surgical options when compared to sagittal imbalance. Nevertheless, this deformity can compromise the surgical outcome and can increase the risk of hardware failure. METHODS The kickstand (KR) and tie rod (TR) techniques utilize an accessory rod, linking the previous instrumentation to an independent iliac screw. After a proper release of the lumbar spine with anterior release or posterior osteotomies, the KR technique pushes with distraction on the concave side, whereas the TR technique pulls with compression on the convex side. Four patients (mean age, 64 years; SD 5.7) affected by severe postoperative coronal imbalance were treated. C7-PL ranges from 39 to 76 mm. The mean preoperative ODI was 70/100 (range from 55 to 82). All patients had previous spinopelvic fixation as a consequence of corrective surgery for adult spine deformity. The patients were surgically treated with the addition of supplementary rods connected to the ilium. The rods were used in the concavity or convexity of the deformity functioning as "kickstand" or "tie" or a combination of both. RESULTS The mean surgical correction of C7-PL was 35 mm (range from 20 to 52 mm). In particular, the mean correction for kickstand rod technique was 26 mm and for tie rod technique was 43 mm. All of the patients improved their preoperative disability, and mean ODI was 30/100 (range from 10 to 60) at median 19-month follow-up. All postoperative imaging showed implants were in proper position without hardware failure. All of the patients treated demonstrated an immediate postoperative improvement in terms of coronal displacement of the spine. No complications were observed. At 1-year follow-up, all of the patients remained satisfactory in terms of clinical outcomes. CONCLUSION The kickstand and tie rod techniques are effective in the treatment of postoperative coronal malalignment. Further studies are needed to confirm these findings. LEVEL OF EVIDENCE V: Case report. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Andrea Redaelli
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy
| | - Francesco Langella
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy
| | - Michal Dziubak
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Riccardo Cecchinato
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy
| | - Marco Damilano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy
| | - Giuseppe Peretti
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Pedro Berjano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy.
| | - Claudio Lamartina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy
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15
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Abstract
Adolescent idiopathic scoliosis that has progressed over time, de novo scoliosis, and degenerative scoliosis represent different types of adult spinal deformity (ASD). Functional impairment and muscular fatigue are due to sagittal and coronal imbalance of the trunk. Surgical treatment can provide a significant improvement of three-dimensional (3D) thoracolumbar alignment, function, and health-related quality of life (QoL). A patient-specific benefit-risk assessment, including clinical expectations, comorbidities, and the spinal deformity itself, has to be done preoperatively since the risk for mechanical complications is relatively high. Minimal invasive techniques combine posterior percutaneous instrumentation and lateral interbody fusion cages which enables vertebral realignment and indirect foraminal stenosis decompression. This strategy seems appropriate in mild and moderate ASD with a limited number of degenerated segments in the lumbar spine and remaining curve flexibility. Severe ASD needs to be addressed by open surgery, which combines posterior instrumentation, interbody fusion, and osteotomies in stiff deformities. Longer posterior instrumentation of the thoracolumbar spine, the sacrum, and the pelvis carries a risk for mechanical complications such as non-union and proximal junctional kyphosis (PJK). Modern surgical techniques including circumferential lumbosacral fusion and double rods might lower the risk for non-union. Accurate sagittal alignment planning, setting the lumbar sagittal apex according to pelvic incidence, and segmental lordosis distribution, are mandatory for minimizing the risk of PJK.
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Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Yves Ntilikina
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
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16
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Pizones J, Moreno-Manzanaro L, Sánchez Pérez-Grueso FJ, Vila-Casademunt A, Yilgor C, Obeid I, Alanay A, Kleinstück F, Acaroglu ER, Pellisé F. Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications. Eur Spine J 2019; 29:54-62. [PMID: 31641904 DOI: 10.1007/s00586-019-06176-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/06/2019] [Accepted: 10/05/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE There are still no data proving whether restoring the ideal sagittal profile (according to Roussouly classification) in adult scoliosis (AS) patients leads to any additional benefit, especially regarding mechanical complications. METHODS Retrospective analysis of operated AS patients recorded in a prospective multicenter database. Demographic and radiographic (preoperative and 6-week postoperative) data were analyzed. Patients with and without mechanical complications were compared looking especially at the surgical restoration of the ideal (based on Pelvic Incidence) sagittal profile. Univariate and multivariate analysis was performed to identify causes of mechanical complications at 2-year minimum follow-up. RESULTS Ninty-six AS patients were analyzed. Thirty-nine patients suffered a mechanical complication (18 PJK, 11 pseudoarthrosis, 10 screw pull-out), and 57 patients had no mechanical complications. Postoperatively, 72% of patients not matching the ideal Roussouly-type suffered mechanical complications compared to 15% of matched patients (P < 0.001). Univariate analysis showed that older patients 64.9 ± 13 versus 40.7 ± 15.6 years (P < 0.001), higher postoperative Global Tilt (27° vs. 14.7°) and Pelvic Tilt (25° vs. 16°) (P < 0.001), upper instrumented vertebra at the thoracolumbar junction (62% vs. 21%) (P < 0.001), fixation to the Iliac (76% vs. 6%) (P < 0.001), and postoperative Roussouly-type mismatch (72% vs. 15%) (P < 0.001) significantly increased the rate of mechanical complications. Multivariate logistic regression analysis selected: postoperative Roussouly-type mismatch (OR = 41.9; 95%CI = 5.5-315.7; P < 0.001), iliac instrumentation (OR = 19.4; 95%CI = 2.6-142.5; P = 0.004), and age (OR = 1.1; 95%CI = 1.02-1.16; P = 0.004), as the most important variables. CONCLUSIONS Adult scoliosis surgery should restore the ideal Roussouly sagittal profile to decrease the rate of mechanical complications, especially in patients older than 65, instrumented to the pelvis. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | | | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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17
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Fujishiro T, Boissière L, Cawley DT, Larrieu D, Gille O, Vital JM, Pellisé F, Pérez-Grueso FJS, Kleinstück F, Acaroglu E, Alanay A, Obeid I. Adult spinal deformity surgical decision-making score. Part 2: development and validation of a scoring system to guide the selection of treatment modalities for patients above 40 years with adult spinal deformity. Eur Spine J 2019; 29:45-53. [PMID: 31317308 DOI: 10.1007/s00586-019-06068-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/01/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We aimed to develop and internally validate a scoring system, the adult spinal deformity surgical decision-making (ASD-SDM) score, to guide the decision-making process for ASD patients aged above 40 years. METHODS A multicentre prospective ASD database was retrospectively reviewed. The scoring system was developed using data from a derivation set and was internally validated in a validation set. The performance of the ASD-SDM score for predicting surgical management was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS A total of 702 patients were included for analysis in the present study. The scoring system developed based on 562 patients, ranging from 0 to 12 points, included five parameters: leg pain scored by the numerical rating scale; pain and self-image domains in the Scoliosis Research Society-22 score; coronal Cobb angle; and relative spinopelvic alignment. Surgical indication was graded as low (score 0 to 4), moderate (score 5 to 7), and high (score 8 to 12) groups. In the validation set of 140 patients, the AUC for predicting surgical management according to the ASD-SDM score was 0.797 (standard error = 0.037, P < 0.001, 95% confidence interval = 0.714 to 0.861), and in the low, moderate, and high surgical indication groups, 23.7%, 43.5%, and 80.4% of the patients, respectively, were treated surgically. CONCLUSIONS The ASD-SDM score demonstrated reliability, with higher scores indicating a higher probability of surgery. This index could aid in the selection of surgery for ASD patients in clinical settings. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki-shi, Osaka, 569-8686, Japan. .,L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France.
| | - Louis Boissière
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Derek Thomas Cawley
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Daniel Larrieu
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Gille
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Marc Vital
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ibrahim Obeid
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France
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Abstract
PURPOSE OF REVIEW Minimally invasive approaches to adult spinal deformity (ASD) surgery have seen a large increase in popularity over the last decade, largely because these techniques are viewed as a potential improvement to the lengthy recovery and high complication rates observed after traditional open surgery for this pathology. The purpose of this review is to present a summary of the latest minimally invasive techniques used in adult spinal deformity surgery, examine whether MIS surgery can accomplish the goals of ASD surgery, and investigate whether MIS surgery is safer than traditional approaches. RECENT FINDINGS While minimally invasive approaches have been able to achieve similar patient-reported outcomes as open approaches, they are associated with their own unique complications. Furthermore, they are limited in their ability to correct severe sagittal imbalance. Emerging techniques, such as anterior column realignment and mini-open posterior column osteotomy, have been developed to address these limitations. The minimally invasive spinal deformity surgery algorithm (MISDEF) can help guide surgeons on which approaches may be appropriate for a particular case. To maximize the benefits of a minimally invasive approach without compromising the goals of ASD surgery, surgeons must be selective in choosing which cases are amenable to an MIS approach. Leading experts continue to develop algorithms to guide surgical decision-making. As we learn to better define our indications, understand treatment goals, and refine our techniques, MIS approaches will likely play an even larger role in a comprehensive ASD treatment strategy.
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Affiliation(s)
- Francis Lovecchio
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10017 USA
| | - Sheeraz A. Qureshi
- Hospital for Special Surgery, 535 E. 70th St, New York, NY 10017 USA
- Weill Cornell Medical College, New York, NY USA
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19
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Arima H, Carreon LY, Glassman SD, Yamato Y, Hasegawa T, Togawa D, Kobayashi S, Yoshida G, Yasuda T, Banno T, Oe S, Mihara Y, Ushirozako H, Matsuyama Y. Cultural Variations in the Minimum Clinically Important Difference Thresholds for SRS-22R After Surgery for Adult Spinal Deformity. Spine Deform 2019; 7:627-32. [PMID: 31202381 DOI: 10.1016/j.jspd.2018.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 10/10/2018] [Accepted: 10/14/2018] [Indexed: 11/22/2022]
Abstract
STUDY DESIGN Longitudinal cohort. OBJECTIVE To calculate the minimum clinically important difference (MCID) threshold values for the Scoliosis Research Society-22R (SRS-22R) in Japanese patients with adult spinal deformity (ASD) and to compare the results with previously reported values in a North American population. SUMMARY OF BACKGROUND DATA The SRS-22R has been shown to be reliable, valid, and responsive to change in patients with ASD undergoing surgery. The MCID quantifies a threshold value of improvement that is clinically relevant to the patient. We hypothesize that MCID threshold values of SRS-22R differ between different cultural groups. METHODS We identified ASD patients who completed the SRS-22R preoperatively and the SRS-30 at minimum two years after surgery. Answers to the last seven questions of the SRS-30 were used as anchors to determine the MCID for the SRS-22R Activity, Pain, Appearance, Mental domains, and Total score using receiver operating characteristic (ROC) curve analysis. RESULTS A total of 122 (16 male, 106 female) patients were included in the analysis. There was a statistically significant improvement in all domain scores from preoperation to two years postoperation. There was a statistically significant difference in change in domain score among the responses to the anchors (p < .05). The ROC curve analysis yielded MCID values of 0.90 for Activity (area under the curve [AUC] = 0.766), 0.85 for Pain (AUC = 0.637), 1.05 for Appearance (AUC = 0.764), and 0.70 for Mental (AUC = 0.641) domain, 1.05 for Total score (AUC = 0.670). Except for Appearance, these MCID thresholds were higher compared with values reported in patients from North America (Activity = 0.60, Pain = 0.40, Appearance = 1.23, Total = 0.71). CONCLUSIONS Results of this study showed that cultural variations exist for MCID threshold values for SRS-22 Activity, Pain, Mental domains, and Total score after surgical treatment of ASD.
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20
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Nazarali R, Lyon K, Cleveland J, Garrett D. Split cord malformation associated with scoliosis in adults. Proc (Bayl Univ Med Cent) 2019; 32:274-276. [PMID: 31191152 DOI: 10.1080/08998280.2019.1573624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/13/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022] Open
Abstract
Split cord malformations (SCMs) are rare congenital abnormalities arising from a primary neurulation defect during embryological development of the spinal cord. SCMs can lead to progressively worsening scoliosis and gait difficulties if left untreated. We report on two patients who atypically presented with SCM in adulthood and review previous reports.
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Affiliation(s)
- Rizwan Nazarali
- Department of Neurosurgery, Baylor Scott & White Health, Scott & White Medical CenterTempleTexas.,Department of Surgery, Texas A&M University College of MedicineTempleTexas
| | - Kristopher Lyon
- Department of Neurosurgery, Baylor Scott & White Health, Scott & White Medical CenterTempleTexas.,Department of Surgery, Texas A&M University College of MedicineTempleTexas
| | - Joseph Cleveland
- Department of Neurosurgery, Baylor Scott & White Health, Scott & White Medical CenterTempleTexas.,Department of Surgery, Texas A&M University College of MedicineTempleTexas
| | - David Garrett
- Department of Neurosurgery, Baylor Scott & White Health, Scott & White Medical CenterTempleTexas.,Department of Surgery, Texas A&M University College of MedicineTempleTexas
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21
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Arima H, Glassman SD, Dimar JR, Matsuyama Y, Carreon LY. Neurologic Comorbidities Predict Proximal Junctional Failure in Adult Spinal Deformity. Spine Deform 2019; 6:576-586. [PMID: 30122394 DOI: 10.1016/j.jspd.2018.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/21/2018] [Accepted: 01/27/2018] [Indexed: 10/28/2022]
Abstract
STUDY DESIGN Retrospective case-control matched cohort from a single institution. OBJECTIVE To examine the contribution of nonmechanical factors to the incidence of proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA Multiple studies have reported on the prevalence of PJF following surgery for ASD. However, little is known about the contribution of nonmechanical factors to the incidence of PJF. METHODS We identified a consecutive series of ASD patients who required revision surgery for PJF between 2013 and 2015. A matched cohort of ASD patients who did not develop PJF after surgical correction was identified based on age, gender, preoperative deformity type, number of fusion levels, and the lower instrumented vertebra level. We compared medical and surgical histories in the matched cohorts, with particular attention to the prevalence of preoperative neurologic comorbidities that might affect standing balance. Preoperative, immediate postoperative, and follow-up radiographs were reviewed to document specific characteristics of mechanical failure that resulted in PJF and required revision surgery. RESULTS Twenty-eight cases of PJF requiring revision surgery were identified. The prevalence rates of preoperative neurologic comorbidities in PJF cohort were significantly higher than in non-PJF cohort (75% vs. 32%, p < .001). Neurologic comorbidities included prior stroke (4), metabolic encephalopathy (2), Parkinson disease (1), seizure disorder (1), cervical and thoracic myelopathy (7), diabetic neuropathy (4), and other neuropathy (4). The mean preoperative sagittal vertical axis in PJF cohort was more positive compared with the non-PJF cohort (144 mm vs. 65 mm, p = .009) There were no significant differences in immediate postoperative or follow-up radiographic parameters between cohorts. CONCLUSIONS In this study, risk factors identified for the development of PJF included nonmechanical neurologic comorbidities, emphasizing the need to look beyond radiographic alignment in order to reduce the incidence of PJF. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Hideyuki Arima
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA; Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA
| | - John R Dimar
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA; Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 S. Jackson Street, 1st Floor ACB, Louisville, KY 40202, USA
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40204, USA
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22
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Obeid I, Berjano P, Lamartina C, Chopin D, Boissière L, Bourghli A. Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline. Eur Spine J 2018; 28:94-113. [PMID: 30460601 DOI: 10.1007/s00586-018-5826-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/06/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. METHODS This is an expert's opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. RESULTS Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. CONCLUSION Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
| | | | | | - Daniel Chopin
- Neuro-Orthopedic Spine Unit, Lille University Hospital, Lille, France
| | - Louis Boissière
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
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Yan C, Gao X, Sun Y, Dong Z, Shen Y. The preoperative predictors for subsequent degeneration in L5-S1 disc after long fusion arthrodesis terminating at L5 in patients with adult scoliosis: focus on spinopelvic parameters. J Orthop Surg Res 2018; 13:285. [PMID: 30424794 PMCID: PMC6234676 DOI: 10.1186/s13018-018-0987-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The subsequent L5-S1 disc degeneration associated with long fusion arthrodesis terminating at L5 in patients with adult scoliosis has been a common concern. However, few studies paid attention to its preoperative predictors, especially in spinopelvic parameters. The purpose of the present study was to clarify the preoperative predictors of subsequent L5-S1 disc degeneration after long fusion arthrodesis terminating at L5 in patients with adult scoliosis on spinopelvic parameters. METHODS In this retrospective study, we enrolled 67 patients with adult scoliosis, and the patients were divided into disc degeneration group (DD) and no disc degeneration group (NDD), based on the presence or absence of subsequent L5-S1 disc degeneration. The status of L5-S1 disc was evaluated by a modified version of radiographic classification. Characteristics and spinopelvic parameters of preoperative patients were collected as potential predictors for subsequent lumbosacral disc degeneration after long fusion arthrodesis terminating at L5 in patients with adult scoliosis. Multivariate logistic regression analysis and the receiver operating characteristic curve were used to identify the preoperative predictors, with an adjusted odds ratio (OR) and 95% confidence intervals (CI). RESULTS Thirty-six patients (53.73%) with subsequent L5-S1 disc degeneration were divided into group DD (preoperative score 0.81 ± 0.57, last follow-up score 1.83 ± 0.60, P < 0.001), and the other 31 patients were divided into group NDD (preoperative and last follow-up score 0.87 ± 0.49). There was no statistical difference in preoperative score (P = 0.583) of lumbosacral disc between two groups; however, significant statistical difference showed in last follow-up score (P < 0.001). Multivariate logistic regression identified three preoperative predictors: pelvic incidence (PI) (P = 0.018), sagittal vertical axis (SVA) (P = 0.024), and sacrum-femoral distance (SFD) (P = 0.023). PI < 48.5° (OR = 0.911, 95% CI = 0.843-0.984), SVA > 4.43 cm (OR = 1.308, 95% CI = 1.036-1.649), and SFD > 5.65 cm (OR = 1.337, 95% CI = 1.041-1.718) showed satisfied accuracy for predicting subsequent L5-S1 disc degeneration. CONCLUSION The prevalence of the subsequent L5-S1 disc degeneration after long fusion arthrodesis terminating at L5 in patients with adult scoliosis was 57.3% (36 of 67 patients). PI < 48.5°, SVA > 4.43 cm, and SFD > 5.65 cm were preoperative predictors for the subsequent L5-S1 disc degeneration. More attention should be paid to prevent the L5-S1 disc from degeneration when these preoperative predictors exist, especially with two or more.
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Affiliation(s)
- Changzhi Yan
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Xianda Gao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Yadong Sun
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Zhen Dong
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China
| | - Yong Shen
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China.
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Ailon T, Smith JS, Shaffrey CI, Soroceanu A, Lafage V, Schwab F, Burton D, Hart R, Kim HJ, Gum J, Hostin R, Kelly MP, Glassman S, Scheer JK, Bess S, Ames CP. Patients with Adult Spinal Deformity with Previous Fusions Have an Equal Chance of Reaching Substantial Clinical Benefit Thresholds in Health-Related Quality of Life Measures but Do Not Reach the Same Absolute Level of Improvement. World Neurosurg 2018; 116:e354-e361. [PMID: 29751181 DOI: 10.1016/j.wneu.2018.04.204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Substantial clinical benefit (SCB) represents a threshold above which patients recognize substantial improvement and represents a rational target for defining clinical success. In adult spinal deformity (ASD) surgery, previous fusions may impact outcomes after deformity correction. OBJECTIVE To investigate the impact of previous spinal fusion on the likelihood of reaching SCB thresholds for 2-year health-related quality of life (HRQOL) after ASD surgery. METHODS We conducted a retrospective review comparing baseline demographic, HRQOL, and radiographic features for patients with ASD undergoing primary versus revision procedures. The primary outcome measure was reaching SCB threshold in Oswestry Disability Index (ODI), SF-36 Physical Component Summary (PCS), and back and leg pain (numeric rating scale). Secondary outcomes included absolute and change scores in ODI, PCS, and back and leg pain. RESULTS In total, 332 patients achieved 2-year follow-up (228 primary; 104 revision cases). Those undergoing revision surgery had similar demographic features (age 58.3/55.9, female 80.8%/82.9%) to patients undergoing primary surgery. They had worse baseline HRQOL (ODI 48.5/41.2, PCS 29.5/33.4, back 7.5/7.0, and leg pain 4.9/4.3; P < 0.001) and radiographic deformity (sagittal vertical axis 111.4/45.1, lumbopelvic mismatch 26.7/11.0, pelvic tilt 29.5/21.0; P < 0.0001). Nevertheless, the number of patients who reached SCB for ODI (38.3/36.3%), PCS (48.5/53.4%), back (53.1/60.5%), and leg pain numeric rating scale (28.6/36.9%) did not significantly differ. Revision patients had worse 2-year HRQOL for all measures. CONCLUSIONS Patients undergoing revision surgery have worse baseline HRQOL and deformity. Although they do not achieve the same absolute level of 2-year HRQOL outcome, they have a similar likelihood of reaching SCB threshold for improvement in 2-year HRQOL.
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Affiliation(s)
- Tamir Ailon
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia.
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Alex Soroceanu
- Department of Orthopedics, University of Calgary, Calgary, Alberta
| | - Virginie Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Frank Schwab
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Douglas Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert Hart
- Department of Orthopedics, Swedish Medical Center, Seattle, Washington
| | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jeffrey Gum
- Norton Leatherman Spine Center, Louisville, Kentucky
| | - Richard Hostin
- Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | | | - Justin K Scheer
- Department of Neurosurgery, University of Illinois, Chicago, Illinois
| | - Shay Bess
- Presbytarian/St. Luke's Medical Center, Denver, Colorado
| | - Christopher P Ames
- Department of Neurosurgery, University of California-San Francisco, San Francisco, California
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García-Ramos CL, Obil-Chavarría CA, Molina-Choez DD, Reyes-Sánchez A. Epidemiological and radiological profile of patients with degenerative scoliosis: 20 year experience at a referral institute. Acta Ortop Mex 2018; 32:60-64. [PMID: 30182549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Adult degenerative scoliosis is a complex three-dimensional rotational deformity, in a previously straight spine, resulting in sagittal and axial disbalance. MATERIAL AND METHODS This retrospective study presents the casuistry of patients 40 to 80 years old with adult degenerative scoliosis who underwent surgery in a referral institute from January 1994 to December 2013. RESULTS The prevalence was 0.087% (CI 95% 67.8-111), with a median age of 64.9 ± 9.4 years old, increased frequency in women and older adults. The prevalence of spondylolisthesis associated with degenerative scoliosis was 21%. The estimated risk for scoliosis in women was OR = 2.37 (CI 95% 1.35-4.15), while men showed OR = 0.4 (CI95% 0.24-0.73). The risk for spondylolisthesis associated to degenerative scoliosis was in men OR = 1.87. CONCLUSIONS The prevalence in our experience is low and the sample age was higher; while gender, severity of the curve and presence of spondylolisthesis and olistesis were similar to the reviewed literature.
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Affiliation(s)
- C L García-Ramos
- Spine Surgery Division. National Institute of Rehabilitation. Mexico City
| | - C A Obil-Chavarría
- Spine Surgery Division. National Institute of Rehabilitation. Mexico City
| | - D D Molina-Choez
- Spine Surgery Division. National Institute of Rehabilitation. Mexico City
| | - A Reyes-Sánchez
- Spine Surgery Division. National Institute of Rehabilitation. Mexico City
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Bettany-Saltikov J, Turnbull D, Ng SY, Webb R. Management of Spinal Deformities and Evidence of Treatment Effectiveness. Open Orthop J 2017; 11:1521-1547. [PMID: 29399227 PMCID: PMC5759105 DOI: 10.2174/1874325001711011521] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/02/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The review evaluates the up-to-date evidence for the treatment of spinal deformities, including scoliosis and hyperkyphosis in adolescents and adults. MATERIAL AND METHODS The PubMed database was searched for review articles, prospective controlled trials and randomized controlled trials related to the treatment of spinal deformities. Articles on syndromic scoliosis were excluded and so were the articles on hyperkyphosis of the spine with causes other than Scheuermann's disease and osteoporosis. Articles on conservative and surgical treatments of idiopathic scoliosis, adult scoliosis and hyperkyphosis were also included. For retrospective papers, only studies with a follow up period exceeding 10 years were included. RESULTS The review showed that early-onset idiopathic scoliosis has a worse outcome than late-onset idiopathic scoliosis, which is rather benign. Patients with AIS function well as adults; they have no more health problems when compared to patients without scoliosis, other than a slight increase in back pain and aesthetic concern. Conservative treatment of adolescent idiopathic scoliosis (AIS) using physiotherapeutic scoliosis-specific exercises (PSSE), specifically PSSR and rigid bracing was supported by level I evidence. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS. For adult scoliosis, there are only a few studies on the effectiveness of PSSEs and a conclusion cannot as yet be drawn.For hyperkyphosis, there is no high-quality evidence for physiotherapy, bracing or surgery for the treatment of adolescents and adults. However, bracing has been found to reduce thoracic hyperkyphosis, ranging from 55 to 80° in adolescents. In patients over the age of 60, bracing improves the balance score, and reduces spinal deformity and pain. Surgery is indicated in adolescents and adults in the presence of progression of kyphosis, refractory pain and loss of balance. DISCUSSION The available evidence reviewed has suggested that different approaches are needed towards the management of different spinal deformities. Specific exercises should be prescribed in children and adolescents with a Cobb angle in excess of 15°. In progressive curves, they should be used in conjunction with bracing. Clarity regarding differences and similarities is given as to what makes PSSE and PSSR specific exercises. As AIS is relatively benign in nature, conservative treatment should be tried when the curve is at a surgical threshold, before surgery is considered. Similarly, bracing and exercises should be prescribed for patients with hyperkyphosis, particularly when the lumbar spine is afflicted. Surgery should be considered only when the symptoms cannot be managed conservatively. CONCLUSION There is at present high quality evidence in support of the conservative treatment of AIS. The current evidence supports the use of PSSE, especially those using PSSR, together with bracing in the treatment of AIS. In view of the lack of medical consequences in adults with AIS, conservative treatment should be considered for curves exceeding the formerly assumed range of conservative indications.There is, however a lack of evidence in support of any treatment of choice for hyperkyphosis in adolescents and spinal deformities in adults. Yet, conservative treatment should be considered first. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS and hyperkyphosis. Additionally, surgery needs to be considered with caution, as it is associated with a number of long-term complications.
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Affiliation(s)
| | | | | | - Richard Webb
- Peacocks Medical Group, Newcastle-upon-Tyne, Newcastle, UK
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27
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Faraj SSA, Haanstra TM, Martijn H, de Kleuver M, van Royen BJ. Functional outcome of non-surgical and surgical management for de novo degenerative lumbar scoliosis: a mean follow-up of 10 years. Scoliosis Spinal Disord 2017; 12:35. [PMID: 29226253 PMCID: PMC5716239 DOI: 10.1186/s13013-017-0143-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/18/2017] [Indexed: 11/10/2022]
Abstract
Background No studies have evaluated the long-term results of non-surgical and surgical management in de novo degenerative lumbar scoliosis (DNDLS). This study reports on the long-term functional outcome of patients being treated for DNDLS by non-surgical and surgical management. Methods This is a retrospective review of a single center database of DNDLS patients that underwent surgical or usual non-surgical management between 1996 and 2007. In a total of 88 patients, 50 (57%) underwent non-surgical and 38 (43%) surgical management. Baseline demographic, radiological-, clinical-, and surgical-related variables were collected. An Oswestry Disability Index (ODI) 2.0 questionnaire was sent to all patients after written informed consent. Results Twenty-nine of 88 patients participated in the study, 15 (52%) had undergone surgical and 14 (48%) non-surgical management with a mean follow-up of 10.9 years (range 8-15 years). There were no significant differences (p > 0.05) between non-surgical and surgical patients at baseline for age, body mass index, coronal Cobb angle, and clinical data. None of the non-surgical patients had undergone surgery during follow-up. In the surgical group, 40% had revision surgery. There was no significant difference in ODI total scores between groups at final follow-up (p = 0.649). A larger proportion of patients in the non-surgical group reported an ODI total score of ≤ 22, reflecting minimal disability (43 versus 20%; p = 0.245). Conclusions This is the first study that describes the long-term 10-year functional outcome of non-surgical and surgical management in a cohort of patients with DNDLS. No significant difference in functional outcome was found between groups after a mean follow-up of 10 years. Despite the significant potential for selection bias, these results indicate that non-surgical management of patients with DNDLS may lead to adequate functional outcome after long periods of time, with no crossover to surgery. Further study is warranted to define which patients may benefit most from which management regimen.
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Affiliation(s)
- Sayf S A Faraj
- Department of Orthopaedic Surgery, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - Tsjitske M Haanstra
- Department of Orthopaedic Surgery, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - Hugo Martijn
- Department of Orthopaedic Surgery, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - Marinus de Kleuver
- Department of Orthopedics, Radboud University Medical Center, Huispost 611, 6500HB Nijmegen, The Netherlands
| | - Barend J van Royen
- Department of Orthopaedic Surgery, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
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Abstract
The present article is an opinion paper referring to adult scoliosis, sarcopenia and their relation. There is a presentation of adult scoliosis and sarcopenia as a whole including their classifications, aetiopathogenesis, clinical picture and evaluation, therapy options and complications, risk factors and consequences. The most important part is how sarcopenia and adult scoliosis can coexist and how this relation can lead to secondary problems for the patient as falls. Treatment options, for the elimination of all the above pathological conditions, are introduced in order to improve patient’s life and his ADL.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an updated review of adult degenerative scoliosis (ADS). Epidemiology, classification, pathophysiology, and natural history are discussed along with a summary of commonly used outcome measures. Operative vs non-operative outcomes and new surgical techniques are discussed. RECENT FINDINGS The SRS-Schwab classification (2012) combines clinical and radiographic evaluation including overall global alignment. Current evidence regarding risk factors and efficacy of non-surgical modalities are discussed. Recent studies have reported surgical management to provide superior outcomes to non-operative modalities. New surgical techniques provide promising early data in regard to decreasing perioperative morbidity. ADS is a potentially debilitating condition that occurs with asymmetric spinal degeneration. This can produce global sagittal malalignment and central and foraminal stenosis and can lead to significant impairment often necessitating surgery. The surgeon must be aware of the perioperative risks in this population and implement appropriate age-specific alignment goals to achieve the best outcome for patients.
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Affiliation(s)
- Philip J York
- Department of Orthopaedic Surgery, University of Colorado, Aurora, CO, USA
| | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, 10021, USA.
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Sánchez-Mariscal F, Gomez-Rice A, Rodríguez-López T, Zúñiga L, Pizones J, Núñez-García A, Izquierdo E. Preoperative and postoperative sagittal plane analysis in adult idiopathic scoliosis in patients older than 40 years of age. Spine J 2017; 17:56-61. [PMID: 27503264 DOI: 10.1016/j.spinee.2016.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/20/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Most of the papers correlate sagittal radiographic parameters with health-related quality of life (HRQOL) scores for patients with scoliosis. However, we do not know how changes in sagittal profile influence clinical outcomes after surgery in adult population operated for mainly frontal deformity. PURPOSE This study aimed to analyze spinal sagittal profile in a population operated on adult idiopathic scoliosis (AS) and to describe variations in sagittal parameters after surgery and the association between those variations and clinical outcomes. DESIGN/SETTING This is a historical cohort study. PATIENT SAMPLE We included in this study 40 patients operated on AS, older than 40 at the time of surgery (mean age 54.9), and with more than 2-year follow-up (mean 7.4 years). OUTCOME MEASURES Full-length free-standing radiographs, Scoliosis Research Society 22 (SRS22) and Short Form 36 (SF36) instruments, and satisfaction with outcomes were available at final follow-up. METHODS Sagittal preoperative and final follow-up radiographic parameters, radiographic correlation with HRQOL scores at final follow-up, and association between satisfaction and changes in sagittal profile were analyzed. A multivariate analysis was performed. No funds were received for this article. RESULTS Preoperatively, the spinal sagittal plane tended to exhibit kyphosis. Most sagittal parameters did not improve at final follow-up with respect to preoperative values. We saw, after univariate analysis, that worse sagittal profile leads to worse HRQOL, but after multivariate analysis, only spinal tilt (ST) persisted as possible predictor for worse SRS activity scores. Frontal Cobb significantly improved. Most patients (82%) were satisfied with final outcomes. Variations in sagittal profile parameters did not differ between satisfied and dissatisfied patients. CONCLUSIONS Although most sagittal plane parameters did not improve after surgery, surgical treatment in AS achieves a high satisfaction rate. Good clinical results do not correlate with improving sagittal plane parameters. Sagittal profile measurements are not helpful to decide surgical treatment in patients with mainly frontal deformity.
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Affiliation(s)
- Felisa Sánchez-Mariscal
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain.
| | - Alejandro Gomez-Rice
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
| | - Tamara Rodríguez-López
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
| | - Lorenzo Zúñiga
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
| | - Javier Pizones
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
| | - Ana Núñez-García
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
| | - Enrique Izquierdo
- Spinal Unit, Hospital Universitario de Getafe, Carretera de Toledo km 12.5, Getafe, Madrid 28905, Spain
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Fu X, Sun XL, Harris JA, Sheng SR, Xu HZ, Chi YL, Wu AM. Long fusion correction of degenerative adult spinal deformity and the selection of the upper or lower thoracic region as the site of proximal instrumentation: a systematic review and meta-analysis. BMJ Open 2016; 6:e012103. [PMID: 27852709 PMCID: PMC5128941 DOI: 10.1136/bmjopen-2016-012103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare outcomes when the upper and lower thoracic regions were used as the site of proximal instrumentation to treat adult spinal deformity. METHODS MEDLINE, Embase and Cochrane library searches were performed to identify studies that compared outcome measures when the upper and lower thoracic vertebrae (UTV and LTV, respectively) were used as the site of proximal instrumentation. The weighted mean difference (WMD) was calculated for continuous outcomes, and the relative risk (RR) was calculated for dichotomous outcomes. RESULTS Seven articles (n=554 patients) met the final inclusion criteria, and we compared the outcome measures of a long fusion extending to the upper and lower thoracic regions. The pooled analysis revealed that extending fixation into the upper thoracic region decreased the risk of proximal junctional kyphosis (PJK) revision surgery (RR: 0.36, 95% CI 0.14 to 0.90, p<0.05). The operation time (WMD: 0.93, 95% CI 0.48 to 1.39, p<0.05) and estimated blood loss (WMD: 0.59, 95% CI 0.33 to 0.85, p<0.05) were significantly greater in the UTV group than in the LTV group. No significant differences were found in the Scoliosis Research Society pain, self-image, function, mental health, subtotal, satisfaction or total scores; the total number of complications or the total number of revision surgeries. CONCLUSIONS Long posterior fixation extending into the upper thoracic region reduces the incidence of revision surgery related to PJK; however, it increased the operative level resulting in a longer operative time and greater estimated blood loss. This initial analysis indicates that extending fixation to the upper thoracic region is appropriate for patients who are likely to develop PJK following initial scoliosis correction.
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Affiliation(s)
- Xin Fu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Xiao-Lei Sun
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Jonathan A Harris
- Division of Globus Medical, Musculoskeletal Education and Research Centre (MERC), Audubon, Pennsylvania, USA
| | - Sun-Ren Sheng
- Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Centre, Wenzhou, Zhejiang, China
| | - Hua-Zi Xu
- Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Centre, Wenzhou, Zhejiang, China
| | - Yong-Long Chi
- Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Centre, Wenzhou, Zhejiang, China
| | - Ai-Min Wu
- Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Centre, Wenzhou, Zhejiang, China
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Pizones J, Martin-Buitrago MP, Sánchez Perez-Grueso FJ, Pellisé F, Alanay A, Obeid I, Kleinstück F, Acaroglu ER; ESSG European Spine Study Group. Untreated Thoracic Curve in Adult Idiopathic Scoliosis: What Are Patients' Concerns? Spine Deform 2016; 4:439-45. [PMID: 27927574 DOI: 10.1016/j.jspd.2016.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/11/2016] [Accepted: 05/28/2016] [Indexed: 11/21/2022]
Abstract
STUDY DESIGN Retrospective two-cohort comparative analysis of data collected prospectively. OBJECTIVES To analyze a cohort of patients with untreated thoracic curves of an adult multicenter deformity database [European spine study group (ESSG)], describe patient characteristics and concerns, and establish the rate and motivations for surgical intervention. SUMMARY OF BACKGROUND DATA Idiopathic thoracic curves have a significant clinical and socioeconomic impact during adolescence. However, little attention has been given to adult thoracic scoliosis. The complaints of patients that have reached adulthood with an untreated thoracic curve are still not well studied. METHODS The database of 1,142 prospective consecutive adult patients with deformity was searched to identify patients with untreated thoracic idiopathic curves: Schwab Type T curves, and Schwab Type D with thoracolumbar/lumbar (TL/L) curves <40° and a difference between main thoracic (MT) and the TL/L ≥15°. Demographic data, different radiologic preoperative parameters, and health-related quality of life questionnaires were assessed. RESULTS Forty-two patients met inclusion criteria, showing the following characteristics: age, 30.9 ± 12.5 years; thoracic Cobb, 55.6 ± 10.8°; lumbar Cobb, 28.1 ± 7.3°; sagittal vertical axis, 2.9 ± 19.3 cm; Core Outcome Measures Index (COMI), 4 ± 2.5; Oswestry Disability Index (ODI), 20.4 ± 17.4; Scoliosis Research Society-22 questionnaire (SRS-22) subtotal, 3.6 ± 0.7; 36-Item Short Form Health Survey (SF-36) mental health, 46.1 ± 10.1; SF-36 physical health, 47.3 ± 11.1. Only 13 of these patients underwent surgery. Compared with nonoperated patients, they were younger (24.3 ± 7.3 vs. 33.8 ± 13.4 years; p = .009), had larger MT curves (58.7° ± 9.6 vs. 50.6° ± 8.3; p = .012), and had worse SRS-22 self-image scores (2.9 ± 0.8 vs. 3.5 ± 0.8; p = .042). No patients older than 50 years underwent surgery, despite having worse SRS-22 function (3.0 ± 0.9 vs. 4.1 ± 0.9, p = .032) and worse ODI scores (42.4 ± 19.9 vs. 18.7 ± 18.0, p = .026). CONCLUSIONS Very few adult deformity patients sought treatment because of untreated thoracic scoliotic curve. The probability of undergoing surgery was low (13/42), and it was associated with youth, curve magnitude, and poor self-image. The rate of surgical treatment of the thoracic curve appears to diminish with age, despite its being associated with poorer function and greater disability in the older patient.
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Weiss HR, Moramarco K, Moramarco M. Scoliosis bracing and exercise for pain management in adults-a case report. J Phys Ther Sci 2016; 28:2404-7. [PMID: 27630444 PMCID: PMC5011608 DOI: 10.1589/jpts.28.2404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/25/2016] [Indexed: 12/22/2022] Open
Abstract
[Purpose] For adult patients with late-onset idiopathic scoliosis, cosmetic concerns and
pain are the main reasons for seeking treatment at a physician’s office. The purpose of
this paper was to describe the mid-term effect of physical rehabilitation and part-time
bracing on an adult scoliosis patient who had been suffering from chronic low back pain
for fourteen years. [Subject and Methods] Case description: A 37-year-old female patient
with late-onset idiopathic scoliosis presented in the office of the first author in
January 2014. She reported having chronic pain (low back pain) since the age of 23 and
reported daily pain at a level of 5–7 on average on a Visual Analogue Scale of 0 to 10.
She received a short scoliosis-specific Schroth exercise program and was also fitted with
a Gensingen brace for part-time wear. [Results] At a 16 month follow-up, the patient no
longer suffered from daily low back pain (with heavy lifting only) and was fully active.
Additionally, her lumbar Cobb angle and angle of trunk rotation improved. [Conclusion]
Patients with late-onset idiopathic scoliosis and pain may benefit from a pattern-specific
conservative treatment approach. In this population, surgical intervention should be
regarded as the last resort, since there are many long-term unknowns with surgery.
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Ailon T, Scheer JK, Lafage V, Schwab FJ, Klineberg E, Sciubba DM, Protopsaltis TS, Zebala L, Hostin R, Obeid I, Koski T, Kelly MP, Bess S, Shaffrey CI, Smith JS, Ames CP; International Spine Study Group. Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone. Spine Deform 2016; 4:323-9. [PMID: 27927523 DOI: 10.1016/j.jspd.2016.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/01/2016] [Accepted: 02/16/2016] [Indexed: 11/21/2022]
Abstract
OBJECT Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons' ability to accurately predict postoperative alignment. METHODS Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician. Surgeon training, practice characteristics, and use of surgical planning software was assessed. Participants predicted if the surgical plan would lead to adequate deformity correction and attempted to predict postoperative radiographic parameters including sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence to lumbar lordosis mismatch (PI-LL), thoracic kyphosis (TK). RESULTS Seventeen surgeons participated: 71% within 0 to 10 years of practice; 88% devote >25% of their practice to deformity surgery. Surgeons accurately judged adequacy of the surgical plan to achieve correction to specific thresholds of SVA 69% ± 8%, PT 68% ± 9%, and PI-LL 68% ± 11% of the time. However, surgeons correctly predicted the actual postoperative radiographic parameters only 42% ± 6% of the time. They were more successful at predicting PT (61% ± 10%) than SVA (45% ± 8%), PI-LL (26% ± 11%), or TK change (35% ± 21%; p < .05). Improved performance correlated with greater focus on deformity but not number of years in practice or number of three-column osteotomies performed per year. CONCLUSION Surgeons failed to correctly predict the adequacy of the proposed surgical plan in approximately one third of presented cases. They were better at determining whether a surgical plan would achieve adequate correction than predicting specific postoperative alignment parameters. Pelvic tilt and SVA were predicted with the greatest accuracy.
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Glassman SD, Coseo MP, Carreon LY. Sagittal balance is more than just alignment: why PJK remains an unresolved problem. Scoliosis Spinal Disord 2016; 11:1. [PMID: 27252982 PMCID: PMC4888517 DOI: 10.1186/s13013-016-0064-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The durability of adult spinal deformity surgery remains problematic. Revision rates above 20 % have been reported, with a range of causes including wound infection, nonunion and adjacent level pathology. While some of these complications have been amenable to changes in patient selection or surgical technique, Proximal Junctional Kyphosis (PJK) remains an unresolved challenge. This study examines the contributions of non-mechanical factors to the incidence of postoperative sagittal imbalance and PJK after adult deformity surgery. METHODS We reviewed a consecutive series of adult spinal deformity patients who required revision for PJK from 2013 to 2015 and examined in their medical records in detail. RESULTS Neurologic disorders were identified in 22 (76 %) of the 29 PJK cases reviewed in this series. Neurologic disorders included Parkinson's disease (1), prior stroke (5), metabolic encephalopathy (2), seizure disorder (1), cervical myelopathy (7), thoracic myelopathy (1), diabetic neuropathy (5) and other neuropathy (4). Other potential comorbidities affecting standing balance included untreated cataracts (9), glaucoma (1) and polymyositis (1). Eight patients were documented to have frequent falls, with twelve cases having a fall right before symptoms related to the PJK were noted. CONCLUSION PJK is an important contributing factor to the substantial and unsustainable rate of revision surgery following adult deformity correction. Multiple efforts to avoid PJK via alterations in surgical technique have been largely unsuccessful. This study suggests that non-mechanical neuromuscular co-morbidities play an important role in post-operative sagittal imbalance and PJK. Recognizing the multi-factorial etiology of PJK may lead to more successful strategies to avoid PJK and improve surgical outcomes.
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Affiliation(s)
- Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, Kentucky 40202 USA
| | - Mark P Coseo
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, Kentucky 40202 USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, Kentucky 40202 USA
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Faldini C, Di Martino A, Borghi R, Perna F, Toscano A, Traina F. Long vs. short fusions for adult lumbar degenerative scoliosis: does balance matters? Eur Spine J 2015; 24 Suppl 7:887-92. [PMID: 26441257 DOI: 10.1007/s00586-015-4266-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 09/27/2015] [Accepted: 09/27/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Surgery of adult scoliosis was based upon coronal plane radiographical analysis using Cobb angle measurements, but recently it has been demonstrated that sagittal spinopelvic alignment plays a critical role in determining the final outcome. The aim of this paper is to compare the clinical and radiological results of 81 patients affected by adult scoliosis, treated with short or long fusions, and followed for 2-5 year follow-up. MATERIALS AND METHODS 81 patients affected by degenerative lumbar scoliosis managed by posterior-only surgery were retrospectively evaluated. Fifty-seven patients underwent to a short fusion procedure, while 24 had a long fusion. Clinical and radiographic coronal and sagittal spinopelvic parameters were compared between the two groups. RESULTS Coronal Cobb angle was 24° preoperatively and passed to 12° in the short fusion group, while changed from 45° to 10° in the long fusion group. Lumbar lordosis was 45° preoperatively and 60° at final follow-up in the short fusion group passed from 24° to 55° in the long fusion group. Sacral slope passed from 25° to 45° in the short fusion group, while from 10° to 40° in the long fusion group. Pelvic tilt passed from 24° to 13° in the short fusion group, and from 28° to 23° in the long fusion group. CONCLUSION Surgical treatment of degenerative lumbar scoliosis improved balance and alignment of the spine, and also the coronal plane in terms of Cobb angle. These results were associated to a consistent clinical improvement and an acceptable rate of complications.
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Affiliation(s)
- Cesare Faldini
- Department of General Orthopaedics, Department Rizzoli Sicilia, Istituto Ortopedico Rizzoli di Bologna, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | | | - Raffaele Borghi
- Istituto Ortopedico Rizzoli di Bologna, University of Bologna, Bologna, Italy
| | - Fabrizio Perna
- Istituto Ortopedico Rizzoli di Bologna, University of Bologna, Bologna, Italy
| | - Angelo Toscano
- Department of General Orthopaedics, Department Rizzoli Sicilia, Istituto Ortopedico Rizzoli di Bologna, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Francesco Traina
- Department of General Orthopaedics, Department Rizzoli Sicilia, Istituto Ortopedico Rizzoli di Bologna, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Chen JB, Kim AD, Allan-Blitz L, Shamie AN. Prevalence of thoracic scoliosis in adults 25 to 64 years of age detected during routine chest radiographs. Eur Spine J 2016; 25:3082-7. [PMID: 26329652 DOI: 10.1007/s00586-015-4215-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 08/26/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the prevalence of thoracic scoliosis and determine the effect of both age and gender on coronal curve magnitude among asymptomatic adults aged 25-64 years old, using standing posterior-anterior chest radiographs. METHODS This was a retrospective, cross-sectional study evaluating 500 randomly selected digital posterior-anterior chest radiographs taken at a single institution on an outpatient basis between January 2010 and December 2011. Males (n = 184) and females (n = 316) ranged in age from 25 to 64 years. Patients with symptoms of back pain; including a history of back pain, spinal instrumentation, or known pre-existing spinal disease were excluded. Radiographs were evaluated using Centricity PACS Web Diagnostic 2.1 system (General Electric Co. Fairfield, CT). Coronal Cobb angle measurements of the thoracic spine were quantified by the authors, with scoliosis defined as coronal curves greater than 10°. Curvatures were subdivided into groups: a control group with coronal curves less than 10°, curves measuring 10° to 19°, 20° to 29°, and greater than 30°. The effect of age and gender on curve magnitude was examined using Pearson correlation analysis and linear regression analysis. RESULTS There was a 13.4 % (67 patients) prevalence of thoracic scoliosis. The prevalence among asymptomatic males was 10.9 %, while the prevalence among asymptomatic females was 14.9 %. 11.6 % demonstrated a coronal curvature between 10° and 19° (58 patients), 1.6 % between 20° and 29° (8 patients), and 0.2 % greater than 30° (1 patient). Age and gender were not found to be significant independent predictors of curve severity. CONCLUSIONS We found a 13.4 % prevalence of thoracic scoliosis among asymptomatic adults aged 25-64 years on routine outpatient chest radiographs. 11.6 % of patients demonstrated a coronal curvature between 10° and 19°. Unlike prior studies evaluating asymptomatic thoracic curves in elderly patients, age and gender did not significantly affect curve magnitude in our younger cohort. These data may provide a reference point to help clinicians counsel asymptomatic patients diagnosed with thoracic scoliosis on routine chest radiographs.
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Aubin CE, Cammarata M, Wang X, Mac-Thiong JM. Instrumentation Strategies to Reduce the Risks of Proximal Junctional Kyphosis in Adult Scoliosis: A Detailed Biomechanical Analysis. Spine Deform 2015; 3:211-8. [PMID: 27927461 DOI: 10.1016/j.jspd.2014.09.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 08/25/2014] [Accepted: 09/26/2014] [Indexed: 11/20/2022]
Abstract
STUDY DESIGN Biomechanical analysis of proximal junctional kyphosis (PJK) through numerical simulations. OBJECTIVES Assessment of the effect of sagittal alignment, the upper instrumented vertebral level (UIV), and 4 other surgical variables on biomechanical indices related to the PJK risks. SUMMARY OF BACKGROUND DATA Despite retrospective clinical studies, biomechanical analysis of individual parameters associated with PJK is lacking to support instrumentation strategies to reduce the PJK risks. METHODS Instrumentations of 6 adult scoliosis cases with different operative strategies were simulated (1,152 simulations). Proximal junctional (PJ) angle and flexion loads were evaluated against the sagittal alignment and the proximal instrumentation level. RESULTS Instrumenting 1 more proximal vertebra allowed the PJ angle, proximal moment, and force to be reduced by 18%, 25%, and 16%, respectively. Shifting sagittal alignment by 20 mm posteriorly increased the PJ angle and proximal moment by 16% and 22%, and increased the equivalent posterior extensor force by 37%. Bilateral complete facetectomy, posterior ligaments resection, and the combination of the 2 resulted in an increase of the PJ angle (by 10%, 28%, and 53%, respectively), flexion forces (by 4%, 12%, and 22%, respectively), and proximal moments (by 16%, 44%, and 83%, respectively). Transverse process hooks at UIV compared with pedicle screws allowed 26% lower PJ angle and flexion loads. The use of proximal transition rods with proximal diameter reduced from 5.5 to 4 mm slightly reduced PJ angle, flexion force, and moment (less than 8%). The increase in sagittal rod curvature from 10° to 40° increased the PJ angle (from 6% to 19%), flexion force (from 3% to 10%), and moment (from 9% to 27%). CONCLUSIONS Simulated posteriorly shifted sagittal alignment was associated with higher PJK risks, whereas extending instrumentation proximally allowed a lower mechanical risk of PJK. Preserving PJ intervertebral elements and using a more flexible anchorage at UIV help reduce the biomechanical risks of PJK.
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Sánchez-Mariscal F, Gomez-Rice A, Izquierdo E, Pizones J, Zúñiga L, Álvarez-González P. Survivorship analysis after primary fusion for adult scoliosis. Prognostic factors for reoperation. Spine J 2014; 14:1629-34. [PMID: 24345472 DOI: 10.1016/j.spinee.2013.09.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 07/09/2013] [Accepted: 09/27/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adult scoliosis surgery is a challenging procedure with high rate of complications and reoperations. Reoperation rates vary widely. Long-term survival for this surgery still remains unknown, and the prognostic factors for reoperation are not well defined. PURPOSE To assess adult scoliosis surgery survival (without the need of reoperation) after primary fusion in adults with mainly frontal deformity and to define prognostic factors for reoperation. STUDY DESIGN Survival analysis of a cohort of consecutive adult patients, primarily operated on scoliosis using segmental instrumentation (retrospective cohort study). PATIENT SAMPLE Fifty-nine patients older than 21 years at primary surgery (median age, 42 years), who presented idiopathic or degenerative curves with frontal Cobb >40° (median preoperative frontal Cobb 59°), more than four-level fusion, and a 2-year minimum postoperative follow-up (median, 8.5 years; 41% patients had a longer than 10-year follow-up). OUTCOME MEASURES Clinical and preoperative radiographic parameters were analyzed preoperatively and evaluated as prognostic factors for reoperation. METHODS Survival was estimated using Kaplan-Meier method. Prognostic factors (clinical and radiographic) for reoperation were evaluated. Logistic regression using backward elimination was used for multivariate analysis. RESULTS Survival was 89.8% at 1 year, 79.4% at 2 years, 73.4% at 3 years, 64% at 5 years, and 60.9% at 10 years. Overall, 21 patients (35.6%) underwent revision surgery. The most common reasons for reoperation were painful/prominent implants, adjacent-segment degeneration, and infection. American Society of Anesthesiologists Type II patients and double surgical approach were associated with a higher revision rate. Preoperative thoracic kyphosis was significantly higher in reoperated patients. CONCLUSIONS The 10-year survival rate of primary scoliosis surgery in adult patients is 61%. Risk factors identified for reoperation included patients with higher morbidity, double surgical approach, and preoperative thoracic hyperkyphosis.
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Hassanzadeh H, Gupta S, Jain A, El Dafrawy MH, Skolasky RL, Kebaish KM. Type of Anchor at the Proximal Fusion Level Has a Significant Effect on the Incidence of Proximal Junctional Kyphosis and Outcome in Adults After Long Posterior Spinal Fusion. Spine Deform 2013; 1:299-305. [PMID: 27927362 DOI: 10.1016/j.jspd.2013.05.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 03/19/2013] [Accepted: 05/23/2013] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVES To compare the incidence of proximal junctional kyphosis (PJK) and the clinical, radiographic, and functional outcomes in adults undergoing long posterior spinal fusion with transverse process hooks versus pedicle screws at the uppermost instrumented vertebrae. SUMMARY OF BACKGROUND DATA Proximal junctional kyphosis often occurs after instrumented long spinal fusion. Although there have been numerous studies of PJK development in adolescents with idiopathic scoliosis, few studies have focused on adults. METHODS This study reviewed data on 47 consecutive adult patients who underwent long spinal fusion (five or more levels) with hooks or screws at the uppermost instrumented vertebrae, from 2004 through 2009, and had 2-year radiographic and clinical follow-up. The hook group (20 patients) and screw group (27 patients) were similar in terms of age, gender, and levels fused. Proximal junctional kyphosis was defined as a sagittal Cobb angle of at least 10° between the lower end plate of the uppermost instrumented vertebrae and the upper end plate of the 2 immediately superior vertebrae, and at least 10° of progression from the previous measurement. The groups' radiographs, complications, and functional outcomes (Scoliosis Research Society-22 Patient Questionnaire and the Oswestry Disability Index) were compared using Hotelling's t2 test (significance, p < .05). RESULTS Comparing immediate postoperative and final follow-ups, none of the 20 patients in the hook group versus 8 of 27 patients in the screw group (29.6%) developed PJK (p = .01). There were no statistical differences between groups in major or minor complications rates. At final follow-up, patients with hooks had significantly higher functional scores than those with screws (p < .05), and patients with PJK had significantly lower functional scores in all Scoliosis Research Society-22 Patient Questionnaire domains except satisfaction. CONCLUSIONS Transverse process hooks were associated with a lower incidence of PJK and higher functional scores than pedicle screws.
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Affiliation(s)
- Hamid Hassanzadeh
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Sachin Gupta
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Mostafa H El Dafrawy
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA.
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Burneikiene S, Nelson EL, Mason A, Rajpal S, Serxner B, Villavicencio AT. Complications in patients undergoing combined transforaminal lumbar interbody fusion and posterior instrumentation with deformity correction for degenerative scoliosis and spinal stenosis. Surg Neurol Int 2012; 3:25. [PMID: 22439116 PMCID: PMC3307239 DOI: 10.4103/2152-7806.92933] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/13/2012] [Indexed: 11/26/2022] Open
Abstract
Background: Utilization of the transforaminal lumbar interbody fusion (TLIF) approach for scoliosis offers the patients deformity correction and interbody fusion without the additional morbidity associated with more invasive reconstructive techniques. Published reports on complications associated with these surgical procedures are limited. The purpose of this study was to quantify the intra- and postoperative complications associated with the TLIF surgical approach in patients undergoing surgery for spinal stenosis and degenerative scoliosis correction. Methods: This study included patients undergoing TLIF for degenerative scoliosis with neurogenic claudication and painful lumbar degenerative disc disease. The TLIF technique was performed along with posterior pedicle screw instrumentation. The average follow-up time was 30 months (range, 15–47). Results: A total of 29 patients with an average age of 65.9 years (range, 49–83) were evaluated. TLIFs were performed at 2.2 levels on average (range, 1–4) in addition to 6.0 (range, 4–9) levels of posterolateral instrumented fusion. The preoperative mean lumbar lordosis was 37.6° (range, 16°–55°) compared to 40.5° (range, 26°–59.2°) postoperatively. The preoperative mean coronal Cobb angle was 32.3° (range, 15°–55°) compared to 15.4° (range, 1°–49°) postoperatively. The mean operative time was 528 min (range, 276–906), estimated blood loss was 1091.7 mL (range, 150–2500), and hospitalization time was 8.0 days (range, 3–28). A baseline mean Visual Analog Scale (VAS) score of 7.6 (range, 4–10) decreased to 3.6 (range, 0–8) postoperatively. There were a total of 14 (49%) hardware and/or surgical technique related complications, and 8 (28%) patients required additional surgeries. Five (17%) patients developed pseudoarthrosis. The systemic complications (31%) included death (1), cardiopulmonary arrest with resuscitation (1), myocardial infarction (1), pneumonia (5), and pulmonary embolism (1). Conclusion: This study suggests that although the TLIF approach is a feasible and effective method to treat degenerative adult scoliosis, it is associated with a high rate of intra- and postoperative complications and a long recovery process.
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