1
|
Sun W, Wang S, Wang B, Li Y, Chen X, Kong C, Wang P, Lu S. Surgical treatment of Roussouly type 1 with realigning Roussouly spinal shape and improving SRS-Schwab modifier: effect on minimal clinically important difference. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2486-2494. [PMID: 38632137 DOI: 10.1007/s00586-024-08245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/26/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To evaluate outcomes of choosing different Roussouly shapes and improving in Schwab modifiers for surgical Roussouly type 1 patients. METHODS Baseline (BL) and 2-year (2Y) clinical data of adult spinal deformity (ASD) patients presenting with Roussouly type 1 sagittal spinal alignment were isolated in the single-center spine database. Patients were grouped into Roussouly type 1, 2 and 3 with anteverted pelvis (3a) postoperatively. Schwab modifiers at BL and 2Y were categorized as follows: no deformity (0), moderate deformity (+), and severe deformity (++) for pelvic tilt (PT), sagittal vertical axis (SVA), and pelvic incidence and lumbar lordosis mismatch (PI-LL). Improvement in SRS-Schwab was defined as a decrease in the severity of any modifier at 2Y. RESULTS A total of 96 patients (69.9 years, 72.9% female, 25.2 kg/m2) were included. At 2Y, there were 34 type 1 backs, 60 type 2 backs and only 2 type 3a. Type 1 and type 2 did not differ in rates of reaching 2Y minimal clinically important difference (MCID) for health-related quality of life (HRQOL) scores (all P > 0.05). Two patients who presented with type 3a had poor HRQOL scores. Analysis of Schwab modifiers showed that 41.7% of patients improved in SVA, 45.8% in PI-LL, and 36.5% in PT. At 2Y, patients who improved in SRS-Schwab PT and SVA had lower Oswestry disability index (ODI) scores and significantly more of them reached MCID for ODI (all P < 0.001). Patients who improved in SRS-Schwab SVA and PI-LL had more changes of VAS Back and Short Form-36 (SF-36) outcomes questionnaire physical component summary (SF-36 PCS), and significantly more reached MCID (all P < 0.001). By 2Y, type 2 patients who improved in SRS-Schwab grades reached MCID for VAS back and ODI at the highest rate (P = 0.003, P = 0.001, respectively), and type 1 patients who improved in SRS-Schwab grades reached MCID for SF-36 PCS at the highest rate (P < 0.001). CONCLUSION For ASD patients classified as Roussouly type 1, postoperative improvement in SRS-Schwab grades reflected superior patient-reported outcomes while type 1 and type 2 did not differ in clinical outcomes at 2Y. However, development of type 3a should be avoided at the risk of poor functional outcomes. Utilizing both classification systems in surgical decision-making can optimize postoperative outcomes.
Collapse
Affiliation(s)
- Wenzhi Sun
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Shuaikang Wang
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Baobao Wang
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yongjin Li
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiaolong Chen
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Chao Kong
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Peng Wang
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Shibao Lu
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.
| |
Collapse
|
2
|
Balint NT, Antohe BA, Uysal HS, Cristuță AM, Rață M. Relationship between Spinal Range of Motion and Functional Tests in University Students: The Role of Demographic Factors. Healthcare (Basel) 2024; 12:1029. [PMID: 38786439 PMCID: PMC11121651 DOI: 10.3390/healthcare12101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Spinal disorders are some of the most prevalent health concerns, especially among students. Based on student demographics, this cross-sectional study evaluated the correlation between functional tests (FTs) and spinal range of motion (ROM). This study included 206 students (age = 19.85 ± 1.80 years) from the Vasile Alecsandri University of Bacău. Participants' assessments were conducted using the following tests: (i) Ott, (ii) Schober, (iii) Stibor, (iv) finger-to-floor distance, (v) lateral flexion of the cervical and lumbar spine, and (vi) flexion of the cervical spine. Correlation analyses were evaluated using the Spearman correlation coefficient analysis. The results indicated a very strong relationship between lateral flexion of the lumbar spine on the left (LFLSL) and right (LFLSR) for all departments (r = 0.85 to 0.97, p < 0.05). There was a stronger relationship between FT results and spinal ROM for physical-education-department students compared to students from other departments (n = 17, r = -0.38 to 0.93, p < 0.05). There was no statistically significant correlation between FTs and spinal ROM based on age (p > 0.05). The study results provide evidence of the primary risk factors that predispose students to postural deviations. Practitioners and physiotherapists can utilize these values as a reference for potential therapeutic interventions.
Collapse
Affiliation(s)
- Nela Tatiana Balint
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
| | - Bogdan Alexandru Antohe
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
| | - Huseyin Sahin Uysal
- Faculty of Sport Science, Burdur Mehmet Akif Ersoy University, 15500 Burdur, Turkey;
| | - Alina Mihaela Cristuță
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
| | - Marinela Rață
- Faculty of Movement, Sports and Health Science, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania; (N.T.B.); (M.R.)
| |
Collapse
|
3
|
Haas JW, Berry RH, Oakley PA, Harrison DE. A 13-Year Long-Term Follow-Up of a Case Report With Continued Improvement in Severe Chronic Neck and Head Pain Alleviated With Chiropractic BioPhysics® Spinal Rehabilitation Protocols. Cureus 2024; 16:e59024. [PMID: 38680820 PMCID: PMC11052517 DOI: 10.7759/cureus.59024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/01/2024] Open
Abstract
Alleviation of headaches (HAs), neck pain (NP), and disability is a desirable clinical outcome for the billions globally who suffer from these conditions. Chiropractic BioPhysics® (CBP®) methods may provide an option for head and neck-injured patients. A 62-year-old female historically injured multiple times including two motor vehicle collisions (MVC), and a strike to the face with a hockey puck; all resulting in chronic pain and suffering. The subject sought and received successful treatment in 2016 using this conservative protocol at a facility in the USA. The resolution of symptoms following 36 treatments was previously reported. Following 13 years without treatment beyond home exercises, the subject was re-evaluated and found to be stable in the long term for pain, structural and functional assessment. Thirty-six treatments over 12 weeks in 2016 led to an improvement in numerical pain rating scale (NPRS) for NP (5/10 to 1/10), and HA (9+/10 to 0/10), resolution of NP disability (6/100 to 0/100) as well as normalization of ROM without pain and resumption of all activities of daily living including high-level athletics without pain and disability. A 13-year follow-up found continued stability objectively and subjectively. We provide a case of successful conservative treatment using specific traction, exercises, and spine manipulation procedures. CBP® provides an option to treat pain and this case adds to growing evidence.
Collapse
Affiliation(s)
| | | | - Paul A Oakley
- Kinesiology and Health Science, York University, Toronto, CAN
- Chiropractic, CBP Non-Profit, Inc, Newmarket, CAN
| | | |
Collapse
|
4
|
Shen Y, Sardar ZM, Malka M, Katiyar P, Greisberg G, Hassan F, Reyes JL, Le Huec JC, Bourret S, Hasegawa K, Wong HK, Liu G, Dennis Hey HW, Riahi H, Kelly M, Lombardi JM, Lenke LG. Characteristics of Spinal Morphology According to the "Current" and "Theoretical" Roussouly Classification Systems in a Diverse, Asymptomatic Cohort: Multi-Ethnic Alignment Normative Study (MEANS). Global Spine J 2024:21925682241235611. [PMID: 38417069 DOI: 10.1177/21925682241235611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
STUDY DESIGN Cross-sectional cohort study. OBJECTIVE To classify spinal morphology using the "current" and "theoretical" Roussouly systems and assess sagittal alignment in an asymptomatic cohort. METHODS 467 asymptomatic volunteers were recruited from 5 countries. Radiographic parameters were measured via the EOS imaging system. "Current" and "theoretical" Roussouly classification was assigned with sagittal whole spine imaging using sacral slope (SS), pelvic incidence (PI), and the lumbar apex. One-way analysis of variance (ANOVA) was performed to compare subject characteristics across Roussouly types, followed by post hoc Bonferroni correction. RESULTS Volunteers were categorized into 4 groups (Types 1-4) and 1 subgroup (Type 3 AP) using the "current" and "theoretical" Roussouly systems. The mean PI in "current" Roussouly groups was 40.8° (Type 1), 43.6° (Type 2), 52.4° (Type 3), 62.4° (Type 4), and 43.7° (Type 3AP). The mean PI in "theoretical" Roussouly groups was 36.5° (Type 1), 39.1°(Type 2), 52.5° (Type 3), 67.3° (Type 4), and 51.0° (Type 3AP). The difference in PI between "current" and "theoretical" Roussouly types was significant for Type 1 (P = .02), Type 2 (P < .001), Type 4 (P < .001), and Type 3AP (P < .001). 34.7% of subjects had a "current" Roussouly type different from the "theoretical" type. Type 3 theoretical shape had the most frequent mismatch, constituting 61.1% of the mismatched subjects. 51.5% of mismatched Type 3 become "current" Type 4. CONCLUSION The distribution of Roussouly types differs depending on whether the "current" or "theoretical" classification are employed. A sizeable proportion of volunteers exhibited current and theoretical type mismatch, highlighting the need to interpret sagittal alignment cautiously when utilizing the Roussouly system.
Collapse
Affiliation(s)
- Yong Shen
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Matan Malka
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Prerana Katiyar
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Gabriella Greisberg
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Fthimnir Hassan
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Justin L Reyes
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | | | - Stephane Bourret
- Bordeaux University, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | - Hee Kit Wong
- Department of Orthopedic Surgery, National University Hospital, Singapore
| | - Gabriel Liu
- Department of Orthopedic Surgery, National University Hospital, Singapore
| | | | - Hend Riahi
- Institut Kassab d'Orthopédie, La Manouba, Tunisia
| | - Michael Kelly
- Rady Children's Hospital, University of California, San Diego, CA, USA
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
5
|
Park C, Agarwal N, Mummaneni PV, Berven SH. Spinopelvic Alignment: Importance in Spinal Pathologies and Realignment Strategies. Neurosurg Clin N Am 2023; 34:519-526. [PMID: 37718098 DOI: 10.1016/j.nec.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Sagittal spinal malalignment can lead to pain, decreased function, dynamic imbalance, and compromise of patient-reported health status. The goal of reconstructive spine surgery is to restore spinal alignment parameters, and an understanding of appropriate patient-specific alignment is important for surgical planning and approaches. Radiographic spinopelvic parameters are strongly correlated with pain and function. The relationship between spinopelvic parameters and disability in adult spinal deformity patients is well-established, and optimal correction of sagittal alignment results in improved outcomes regarding patient health status and mechanical complications of surgery.
Collapse
Affiliation(s)
- Christine Park
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Sigurd H Berven
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| |
Collapse
|
6
|
Zhong J, Lin S, Xiong J, Zhou Z, Yu H, Ma S, Cao K. The Correlation of Global Spinal Realignment With the Quality of Life After Corrective Surgery for Delayed Thoracolumbar Osteoporotic Fracture-Related Kyphosis. Oper Neurosurg (Hagerstown) 2023; 25:334-342. [PMID: 37499243 DOI: 10.1227/ons.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/05/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Few studies have been conducted to evaluate the precise impact of corrective surgery on sagittal spinal realignment and clinical outcomes in cases of delayed thoracolumbar osteoporotic fracture-related kyphosis. To assess the efficacy of corrective surgery on sagittal spinal alignment and investigate the relationship between spinal alignment and health-related quality of life (HRQoL) in patients with delayed thoracolumbar osteoporotic fracture-related kyphosis. METHODS A total of 78 patients were enrolled. The characteristics and surgical variables were meticulously documented. The sagittal spinal parameters were measured, and the HRQoL was evaluated using Oswestry Disability Index (ODI), SF-12 Physical Component Score (SF-12 PCS), and Scoliosis Research Society-22 Patient Questionnaire (SRS-22) before and after surgery. The changes in spinal parameters and HRQoL were analyzed through the paired t -test. The Pearson correlation analysis was performed to analyze the correlation of parameters with HRQoL. Then, a multiple stepwise regression analysis was performed with HRQoL scores as the dependent variable and spinal parameters as the independent variable. RESULTS The operative time was 185.9 ± 33.2 min, and the estimated blood loss was 782.8 ± 145.2 mL. The results of the paired t -test revealed a significant difference preoperatively and at the final follow-up in the thoracic kyphosis, thoracolumbar kyphosis (TLK), lumbar lordosis, T9 tilt, pelvic tilt, sacral slope, sagittal vertical axis, and spinosacral angle as well as the ODI, SF-12 PCS, and SRS-22 ( P < .05). Multiple stepwise regression analysis revealed that TLK and pelvic tilt, TLK and sagittal vertical axis, and TLK were the primary parameters affecting the ODI, SF-12 PCS, and SRS-22, respectively. CONCLUSION Corrective surgery can effectively realign the global spine and improve HRQoL in patients with delayed thoracolumbar osteoporotic fracture-related kyphosis. The change of TLK is a driving factor to realign the global spine.
Collapse
Affiliation(s)
- Junlong Zhong
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Sijian Lin
- The Rehabilitation Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiachao Xiong
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhenhai Zhou
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Honggui Yu
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shengbiao Ma
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kai Cao
- Institute of Spine and Spinal Cord, Nanchang University, Nanchang, China
- The Orthopaedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
7
|
Lukas KJ, Verhaegen JCF, Livock H, Kowalski E, Phan P, Grammatopoulos G. The effect of ethnicity on the age-related changes of spinopelvic characteristics: a systematic review. Bone Joint Res 2023; 12:231-244. [PMID: 37051815 PMCID: PMC10065848 DOI: 10.1302/2046-3758.124.bjr-2022-0335.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Aims Spinopelvic characteristics influence the hip’s biomechanical behaviour. However, to date there is little knowledge defining what ‘normal’ spinopelvic characteristics are. This study aims to determine how static spinopelvic characteristics change with age and ethnicity among asymptomatic, healthy individuals. Methods This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify English studies, including ≥ 18-year-old participants, without evidence of hip or spine pathology or a history of previous surgery or interventional treatment, documenting lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). From a total of 2,543 articles retrieved after the initial database search, 61 articles were eventually selected for data extraction. Results When all ethnicities were combined the mean values for LL, SS, PT, and PI were: 47.4° (SD 11.0°), 35.8° (SD 7.8°), 14.0° (SD 7.2°), and 48.8° (SD 10°), respectively. LL, SS, and PT had statistically significant (p < 0.001) changes per decade at: −1.5° (SD 0.3°), −1.3° (SD 0.3°), and 1.4° (SD 0.1°). Asian populations had the largest age-dependent change in LL, SS, and PT compared to any other ethnicity per decade at: −1.3° (SD 0.3°) to −0.5° (SD 1.3°), –1.2° (SD 0.2°) to −0.3° (SD 0.3°), and 1.7° (SD 0.2°) versus 1.1° (SD 0.1°), respectively. Conclusion Ageing alters the orientation between the spine and pelvis, causing LL, SS, and PT to modify their orientations in a compensatory mechanism to maintain sagittal alignment for balance when standing. Asian populations have the largest degree of age-dependent change to their spinopelvic parameters compared to any other ethnicity, likely due to their lower PI. Cite this article: Bone Joint Res 2023;12(4):231–244.
Collapse
Affiliation(s)
- Kenneth J. Lukas
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Jeroen C. F. Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopedic Center Antwerp, Antwerp, Belgium
| | - Holly Livock
- Division of Orthopaedic Surgery, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - Philippe Phan
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
- Correspondence should be sent to George Grammatopoulos. E-mail:
| |
Collapse
|
8
|
Lord EL, Ayres E, Woo D, Vasquez-Montes D, Parekh Y, Jain D, Buckland A, Protopsaltis T. The Impact of Global Alignment and Proportion Score and Bracing on Proximal Junctional Kyphosis in Adult Spinal Deformity. Global Spine J 2023; 13:651-658. [PMID: 33977791 DOI: 10.1177/21925682211001812] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVE The goal of this study is to examine the relationship between global alignment and proportion (GAP) score and postoperative orthoses with likelihood of developing proximal junctional kyphosis (PJK). METHODS Patients who underwent thoracic or lumbar fusions of ≥4 levels for adult spinal deformity (ASD) with 1-year post-operative alignment x-rays were included. Chart review was conducted to determine spinopelvic alignment parameters, PJK, and reoperation. RESULTS A total of 81 patients were included; baseline and 1-year postoperative alignment did not differ between patients with and without PJK. There was no PJK in 53.1%, 29.6% had PJK from 10-20°, and 17.3% had severe PJK over 20° (sPJK). At baseline, 80% of patients had severely disproportioned GAP, 13.75% moderate, 6.25% proportioned. GAP improved across the population, but improved GAP was not associated with sPJK. Greater correction of the upper instrumented vertebra to pelvic angle (UIV-PA) was associated with a larger PJK angle (PJKA) change (R = -0.28) as was the 1 year T1-upper instrumented vertebra (T1-UIV) angle (R = 0.30), both P < .05. GAP change was not correlated with PJKA change. Postoperative orthoses were used in 46% of patients and did not impact sPJK. CONCLUSIONS There was no correlation between PJK and GAP or change in GAP. Greater correction of UIV-PA and larger postop T1-UIV was associated with greater PJKA change; suggesting that the greater alignment correction led to greater likelihood of failure. Postoperative orthoses had no impact on PJK.
Collapse
Affiliation(s)
| | - Ethan Ayres
- 12294Columbia University College of Physicians and Surgeons, NY, USA
| | | | | | - Yesha Parekh
- 12287Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Deeptee Jain
- 7548Washington University in Saint Louis, Saint Louis, MO, USA
| | | | | |
Collapse
|
9
|
Ye J, Yin TC, Gupta S, Farooqi AS, Wan W, Yilgor C, Sides BA, Gupta MC. Use of the Global Alignment and Proportion score to predict postoperative health-related quality of life in adult spinal deformity surgery. J Neurosurg Spine 2023; 38:340-347. [PMID: 36683189 DOI: 10.3171/2022.9.spine22809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/30/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The purpose of this study was to validate the Global Alignment and Proportion (GAP) score as a predictor of health-related quality of life (HRQOL) outcomes for patients undergoing adult spinal deformity (ASD) surgery. METHODS This was a retrospective cohort study of patients with ASD undergoing long-segment spine fusions (≥ 5 vertebrae fused) at a single institution over a 2-year period (n = 85). Radiographic parameters were measured at preoperative, 6-week postoperative, 1-year postoperative, and 2-year postoperative visits. GAP scores were calculated using 4 sagittal parameters: relative pelvic version, relative lumbar lordosis, lordosis distribution index, and relative spinopelvic alignment. Patients were stratified into 3 GAP categories at each time point: proportioned (score 0-2), moderately disproportioned (score 3-6), and severely disproportioned (score ≥ 7). HRQOL outcomes were collected at preoperative, 1-year postoperative, and 2-year postoperative visits; these measures included patient self-reported outcome measures (i.e., PROMIS), Scoliosis Research Society-22 spinal deformity questionnaire (SRS-22), and Oswestry Disability Index (ODI) scores. RESULTS Overall, 42% of cases were revision surgeries and 96.5% of patients underwent fusion to the sacrum. The mean preoperative GAP score significantly improved from preoperative (7.84) to immediate postoperative (3.31) assessment (p < 0.001). Similarly, the percentage of patients categorized as proportioned improved from 9.4% at preoperative to 45.9% at immediate postoperative evaluation. The preoperative GAP score or category was not significantly associated with any preoperative HRQOL outcome metrics. The immediate postoperative GAP score was not correlated with any 1-year HRQOL outcomes. However, the immediate postoperative GAP score was significantly associated with 2-year SRS-22 outcomes, including SRS-22 function (r = -0.35, p < 0.01), self-image (r = -0.27, p = 0.044), and subtotal (r = -0.35, p < 0.01) scores. As compared to severely disproportioned patients, proportioned patients had better SRS-22 pain (4.08 vs 3.17, p = 0.04), satisfaction (4.40 vs 3.50, p = 0.02), and subtotal (4.01 vs 3.27, p = 0.036) scores. The immediate postoperative GAP score was also significantly associated with 2-year PROMIS outcomes, including PROMIS pain (r = 0.31, p = 0.023) and physical function (r = -0.35, p < 0.01) scores. As compared to severely disproportioned patients, proportioned patients had better PROMIS pain (53.18 vs 63.60, p = 0.025) and physical function (41.66 vs 34.18, p = 0.017) scores. Postoperative GAP score or category did not predict any ODI outcomes. CONCLUSIONS The postoperative GAP score is a predictor of long-term HRQOL outcomes following ASD surgery, and proportioned patients are more likely to have less pain and be satisfied with their surgery. However, the postoperative GAP score does not predict outcomes as measured by ODI.
Collapse
Affiliation(s)
- Jichao Ye
- 1Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tsung-Cheng Yin
- 2Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sachin Gupta
- 3Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ali S Farooqi
- 3Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wenbing Wan
- 4The Second Affiliated Hospital of Nanchang University, Nanchang, Jangxi, China
| | - Caglar Yilgor
- 5Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey; and
| | - Brenda A Sides
- 6Department of Orthopaedic Surgery, Barnes-Jewish Hospital, Washington University in St. Louis, Missouri
| | - Munish C Gupta
- 6Department of Orthopaedic Surgery, Barnes-Jewish Hospital, Washington University in St. Louis, Missouri
| |
Collapse
|
10
|
Crossing the Bridge From Degeneration to Deformity: When Does Sagittal Correction Impact Outcomes in Adult Spinal Deformity Surgery? Spine (Phila Pa 1976) 2023; 48:E25-E32. [PMID: 36007130 DOI: 10.1097/brs.0000000000004461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with less severe adult spinal deformity (ASD) undergo surgical correction and often achieve good clinical outcomes. However, it is not well understood how much clinical improvement is due to sagittal correction rather than treatment of the spondylotic process. PURPOSE Determine baseline thresholds in radiographic parameters that, when exceeded, may result in substantive clinical improvement from surgical correction. STUDY DESIGN Retrospective. MATERIALS AND METHODS ASD patients with BL and two-year data were included. Parameters assessed: sagittal vertical axis, pelvic incidence-lumbar lordosis mismatch, pelvic tilt, T1 pelvic angle, L1 pelvic angle, L4-S1 lordosis, C2-C7 sagittal vertical axis, C2-T3, C2 slope. Outcomes: Good Outcome (GO) at two years: [meeting either: (1) Substantial Clinical Benefit for Oswestry Disability Index (change >18.8), or (2) Oswestry Disability Index <15 and Scoliosis Research Society Total>4.5]. Binary logistic regression assessed each parameter to determine if correction was more likely needed to achieve GO. Conditional inference tree run machine learning analysis generated baseline thresholds for each parameter, above which, correction was necessary to achieve GO. RESULTS We included 431 ASD patients. There were 223 (50%) that achieved a GO by two years. Binary logistic regression analysis demonstrated, with increasing baseline severity in deformity, sagittal correction was more often seen in those achieving GO for each parameter(all P <0.001). Of patients with baseline T1 pelvic angle above the threshold, 95% required correction to meet GO (95% vs. 54%, P <0.001). A baseline pelvic incidence-lumbar lordosis >10° (74% of patients meeting GO) needed correction to achieve GO (odds ratio: 2.6, 95% confidence interval: 1.4-4.8). A baseline C2 slope >15° also necessitated correction to obtain clinical success (odds ratio: 7.7, 95% confidence interval: 3.7-15.7). CONCLUSIONS Our study highlighted point may be present at which sagittal correction has an outsized influence on clinical improvement, reflecting the line where deformity becomes a significant contributor to disability. These new thresholds give us insight into which patients may be more suitable for sagittal correction, as opposed to intervention for the spondylotic process only, leading to a more efficient utility of surgical intervention for ASD.
Collapse
|
11
|
Balaban B, Yilgor C, Yucekul A, Zulemyan T, Obeid I, Pizones J, Kleinstueck F, Perez-Grueso FJS, Pellise F, Alanay A, Sezerman OU. Building clinically actionable models for predicting mechanical complications in postoperatively well-aligned adult spinal deformity patients using XGBoost algorithm. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
12
|
Ignasiak D, Behm P, Mannion AF, Galbusera F, Kleinstück F, Fekete TF, Haschtmann D, Jeszenszky D, Zimmermann L, Richner-Wunderlin S, Vila-Casademunt A, Pellisé F, Obeid I, Pizones J, Sánchez Pérez-Grueso FJ, Karaman MI, Alanay A, Yilgor Ç, Ferguson SJ, Loibl M. Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:571-583. [PMID: 36526952 DOI: 10.1007/s00586-022-07477-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sagittal malalignment is a risk factor for mechanical complications after surgery for adult spinal deformity (ASD). Spinal loads, modulated by sagittal alignment, may explain this relationship. The aims of this study were to investigate the relationships between: (1) postoperative changes in loads at the proximal segment and realignment, and (2) absolute postoperative loads and postoperative alignment measures. METHODS A previously validated musculoskeletal model of the whole spine was applied to study a clinical sample of 205 patients with ASD. Based on clinical and radiographic data, pre-and postoperative patient-specific alignments were simulated to predict loads at the proximal segment adjacent to the spinal fusion. RESULTS Weak-to-moderate associations were found between pre-to-postop changes in lumbar lordosis, LL (r = - 0.23, r = - 0.43; p < 0.001), global tilt, GT (r = 0.26, r = 0.38; p < 0.001) and the Global Alignment and Proportion score, GAP (r = 0.26, r = 0.37; p < 0.001), and changes in compressive and shear forces at the proximal segment. GAP score parameters, thoracic kyphosis measurements and the slope of upper instrumented vertebra were associated with changes in shear. In patients with T10-pelvis fusion, moderate-to-strong associations were found between postoperative sagittal alignment measures and compressive and shear loads, with GT showing the strongest correlations (r = 0.75, r = 0.73, p < 0.001). CONCLUSIONS Spinal loads were estimated for patient-specific full spinal alignment profiles in a large cohort of patients with ASD pre-and postoperatively. Loads on the proximal segments were greater in association with sagittal malalignment and malorientation of proximal vertebra. Future work should explore whether they provide a causative mechanism explaining the associated risk of proximal junction complications.
Collapse
Affiliation(s)
- Dominika Ignasiak
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland.
| | - Pascal Behm
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Anne F Mannion
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Fabio Galbusera
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Frank Kleinstück
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Tamás F Fekete
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Dezsö Jeszenszky
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Laura Zimmermann
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Çaglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Stephen J Ferguson
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| |
Collapse
|
13
|
Fan X, Xue D, Pan Z, Wang Y. Comparison of sagittal spinal alignment on standing plain x-rays and supine MRI in degenerative lumbar disease. Front Surg 2023; 10:1103952. [PMID: 36911604 PMCID: PMC9993244 DOI: 10.3389/fsurg.2023.1103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/06/2023] [Indexed: 02/24/2023] Open
Abstract
Background The purpose of the present study is to examine the possible correlation between standing plain x-rays and supine magnetic resonance imaging (MRI) for evaluating spinal sagittal alignment in degenerative lumbar disease (DLD). Methods The characteristics and images of 64 patients with DLD were reviewed retrospectively. The thoracolumbar junction kyphosis (TJK), lumbar lordosis (LL) and sacral slope (SS) were measured on lateral plain x-rays and by MRI. Inter- and intra-observer reliability was tested using intra-class correlation coefficients. Results The results suggested that TJK measurements obtained from MRI tended to underestimate the radiographic measures by 2°, whereas SS measurements obtained from MRI tended to overestimate the radiographic measures by 2°. The LL measurements obtained from MRI were approximately equal to the radiographic measures, and the x-ray and MRI measurements were linearly related. Conclusions In conclusion, supine MRI can be directly translated into sagittal alignment angle measurements obtained from standing x-rays with an acceptable degree of accuracy. This can avoid the impaired view caused by the overlapping ilium, while reducing the patient's exposure to radiation.
Collapse
Affiliation(s)
- Xiaolong Fan
- Department of Orthopedics, 1st Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Deting Xue
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhijun Pan
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yulu Wang
- Department of Orthopedics, 1st Affiliated Hospital of Baotou Medical College, Baotou, China
| |
Collapse
|
14
|
Qiu H, Chu TW, Niu XJ, Zhang Y, Yang SZ, Chen WG. Multisegment transforaminal lumbar interbody fusion (TLIF) combined with Ponte osteotomy in degenerative lumbar scoliosis (DLS) surgery: a minimum of five years' follow-up. INTERNATIONAL ORTHOPAEDICS 2022; 46:2897-2906. [PMID: 36153365 PMCID: PMC9674761 DOI: 10.1007/s00264-022-05572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/31/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the long-term clinical outcomes of degenerative lumbar scoliosis (DLS) with the administration of multisegment transforaminal lumbar interbody fusion (TLIF) combined with Ponte osteotomy long-level fixation fusion, as well as to identify the factors affecting health-related quality of life (HRQOL). METHODS This was a retrospective single-centre study involving comprehensive clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) outcomes, and Scoliosis Research Society (SRS-22) questionnaire were recorded to assess HRQOL. A correlation analysis was performed to determine the association between HRQOL and radiographic parameters. RESULTS A total of 41 consecutive patients (15 males and 26 females) met the inclusion criteria with a follow-up of 8.62 ± 1.20 years. Factors associated with HRQOL were significantly improved post-operation. Global sagittal parameters, including the sagittal vertebral axis (SVA) and T1 pelvic angle (TPA), and local parameters, including apical vertebral translation (AVT) and apical vertebral rotation (AVR), were significantly improved at the last follow-up. Significantly strong correlations between each clinical and radiographic parameter were demonstrated. Moreover, a multiple linear regression analysis demonstrated that the differences in AVT and AVR were significantly correlated with the difference in lumbar lordosis (LL), which was significantly correlated with the differences in SVA and TPA. CONCLUSION The surgical treatment of DLS with multisegment TLIF accompanied by Ponte osteotomy and long-level fixations improved the quality of life of patients with a long-term effect. AVR correction is an important factor for LL restoration that significantly correlates with improvements in the sagittal balance parameters SVA and TPA, which are key factors for guaranteeing good HRQOL.
Collapse
Affiliation(s)
- Hao Qiu
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Tong-wei Chu
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Xiao-Jian Niu
- Department of Orthopedics, 907 Hospital of The Joint Logistics Team, Nanping, Fujian Province People’s Republic of China 353000
| | - Ying Zhang
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Si-Zhen Yang
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Wu-Gui Chen
- Department of Spinal Surgery, Mindong Hospital, Ningde, Fujian Province People’s Republic of China 355000
| |
Collapse
|
15
|
Li J, Zhang Y, Zhang Y, Li X, Yang Z, Hu P, Li W, Zeng Y, Wang Y, Sun Z, Zhou S, Yu M. Clinical Application of the Roussouly Classification in the Sagittal Balance Reconstruction of 101 Adolescent Idiopathic Scoliosis Patients. Orthop Surg 2022; 15:141-151. [PMID: 36398431 PMCID: PMC9837253 DOI: 10.1111/os.13503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Although Roussouly classification has been widely used in spinal surgery, it was mainly applied to degenerative scoliosis patients and correlational studies concerning adolescent idiopathic scoliosis (AIS) are still insufficient. This retrospective study explored the clinical application of Roussouly classification in surgeries and prognosis prediction for AIS. METHODS This clinical research selected 101 AIS patients who received surgeries between August 2005 and November 2019. Whole spine standing radiographs were obtained for each patient preoperatively, postoperatively, and at the last follow-up (>24 months). All patients were classified into "theoretical types" and "current types." Patients were further divided into mismatch or match groups based on the consistency of their current type and theoretical type. The main parameters include: proximal junctional angle (PJA), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), fixed thoracic kyphosis (TK), global TK, fixed lumbar lordosis (LL), global LL, thoracic tilt, proximal thoracic alignment (PTA), lumbar tilt, spino-sacral angle (SSA), and spinal tilt (ST). RESULTS A total of 47.5% of AIS patients were subject to a preoperative mismatch of Roussouly classification. There was a significant difference in PI-LL between the preoperative mismatch and match groups (p = 0.008). There was a significant difference in the rate of PI-LL deformity between the match and mismatch groups with a preoperative mismatch (p = 0.037). A significant difference in thoracic tilt was observed between the postoperative mismatch and match groups (p = 0.019). The preoperative mismatch group has a higher risk of postoperative PI-LL malformation than match group (OR = 2.303, 95% CI: 1.026, 5.165). When mismatch occurred postoperatively, there were significant differences between groups in the rate of pelvic deformity (p = 0.002) and PI-LL deformity (p = 0.025) at the last follow-up. Compared with the postoperative match group, mismatch group had an increased risk of pelvic deformity (OR = 5.029, 95% CI: 1.618, 15.629) and PJK deformity (OR = 3.017, 95% CI: 1.709, 11.375) at the last follow-up. Short Form-36 and Scoliosis Research Society 22 score of the match group was significantly higher than that of the mismatch group at the last follow-up. CONCLUSION The Roussouly classification mismatch before or after operation leads to increased risks of PI-LL deformity and pelvis deformity postoperatively or at the follow-up, which seriously worsens the clinical symptoms and prognosis of patients. Therefore, recovering to the theoretical type in Roussouly classification may effectively improve patients' prognosis.
Collapse
Affiliation(s)
- Junyu Li
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | | | - Yiqiao Zhang
- Peking University Health Science CenterBeijingChina
| | - Xinyi Li
- Peking University Health Science CenterBeijingChina
| | - Zexi Yang
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Panpan Hu
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yan Zeng
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yongqiang Wang
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Zhuoran Sun
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Siyu Zhou
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Miao Yu
- Orthopaedic DepartmentPeking University Third HospitalBeijingChina,Engineering Research Center of Bone and Joint Precision MedicineBeijingChina,Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| |
Collapse
|
16
|
Sun W, Li Y, Chen X, Wang B, Kong C, Wang P, Lu S. Roussouly type 2 could evolve into type 1 shape as sagittal spinal alignment deterioration progresses with age. Front Surg 2022; 9:1049020. [PMID: 36439527 PMCID: PMC9681925 DOI: 10.3389/fsurg.2022.1049020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 09/04/2023] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To identify whether Roussouly type 2 could evolve into type 1 as the deterioration progresses. METHODS The study group comprised subjects with a low pelvic incidence (PI). All subjects underwent a standing whole spinal radiograph and sagittal parameters were measured: T1 pelvic angle (TPA), lumbar lordosis (LL), PI, pelvic tilt (PT), L4-S1 angle, thoracolumbar kyphosis (TLK), thoracic kyphosis (TK), lumbar sagittal apex (LSA), lordosis distribution index (LDI) and number of vertebrae included in the lordosis (NVL). All subjects were distributed into two groups; with primary (de novo) degenerative scoliosis (PDS) and without PDS. Subjects without PDS were divided into young adult, adult, middle-aged and elderly groups. The differences in sagittal parameters of each subgroup were compared. RESULTS In total, 270 subjects were included with a mean age of 58.6 years (range 20-87 years). There was a stepwise increase in the proportion of type 1 with age, whereas type 2 decreased. The TPA, PT, PI-LL, TK, TLK and LDI increased with age in subjects without PDS. The TPA, LDI, TLK and TK increased with age in subjects who displayed type 1, whereas the PT, LL, L4-S1 and PI-LL were unchanged. The TPA, PT, PI-LL and TLK increased with age in subjects who displayed type 2, whereas LL and L4-S1 were decreased, while the LDI and TK remained unchanged. The LSA of subjects without PDS became lower and the NVL decreased with age, with similar phenomena found in the subjects with type 2. There was no statistical difference among the groups for the LSA or NVL distribution of subjects with type 1. The TPA, PT and PI-LL of subjects with PDS were greater than those in Group IV, while the SS, LL and TK were less. The Roussouly-type, NVL and LSA distribution were identical between these two groups. CONCLUSION Roussouly type 1 shape may not be an actual individual specific spine type. Rather, type 2 could evolve into the "type 1" shape as deterioration of the sagittal spinal alignment progresses with age. Primary (de novo) degenerative scoliosis had little effect on whether type 2 became type 1. This should be taken into consideration during the assessment and restoration of sagittal balance.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Shibao Lu
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, Beijing, China
| |
Collapse
|
17
|
Quantitative evaluation of correlation between lumbosacral lordosis and pelvic incidence in standing position among asymptomatic Asian adults: a prospective study. Sci Rep 2022; 12:18965. [PMID: 36347920 PMCID: PMC9643535 DOI: 10.1038/s41598-022-21840-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
The determination of lumbopelvic alignment is essential for planning adult spinal deformity surgery and for ensuring favorable surgical outcomes. This prospective study investigated the correlation between the lumbar section of lumbar spine lordosis and increasing pelvic incidence in 324 Asian adults with a mean age of 55 ± 13 years (range: 20-80 years), comprising 115 male and 209 female volunteers. Participants were divided into three groups based on pelvic incidence (G1, G2, and G3 had pelvic incidence of < 45°, 45-55°, and ≥ 55°, respectively). We determined that distal and proximal lumbar lordosis contributed differentially to the increase in pelvic incidence, whereas the lordosis ratio of the L3-L4 and L4-L5 segments mostly remained constant. The mean contribution ratio of the segmental lordosis from L1 to S1 was as follows: L1-L2, 2.3%; L2-L3, 11.7%; L3-L4, 18.1%; L4-L5, 25.2%; and L5-S1, 42.7%. Pelvic incidence had a stronger correlation with proximal lumbar lordosis than did distal lumbar lordosis. The ratios of proximal lumbar lordosis to distal lumbar lordosis were 37.8% in G1, 45.8% in G2, and 55.9% in G3. These findings serve as a reference for future lumbar spine correction or fusion surgery for Asian adults.
Collapse
|
18
|
Bouknaitir JB, Carreon LY, Brorson S, Andersen MØ. Change in sagittal alignment after decompression alone in patients with lumbar spinal stenosis without significant deformity: a prospective cohort study. J Neurosurg Spine 2022; 37:57-63. [PMID: 34996042 DOI: 10.3171/2021.10.spine21445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' objective was to investigate whether sagittal balance improves in patients with spinal stenosis after decompression alone. METHODS This prospective longitudinal cohort study compared preoperative and 6-month postoperative 36-inch full-length radiographs in patients aged older than 60 years. Patients underwent decompression alone for central lumbar spinal stenosis with either a minimally invasive bilateral laminotomy for central decompression, unilateral laminectomy as an over-the-top procedure for bilateral decompression, or traditional wide laminectomy with removal of the spinous processes on both sides. The following radiographic parameters were measured: sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), PI-LL mismatch, coronal Cobb angle, and sacral slope (SS). Patient-reported outcome measures (PROMs) were collected, including scores on the Oswestry Disability Index (ODI), visual analog scale (VAS) for leg and back pain, and EQ-5D. RESULTS Forty-five patients (24 males) with a mean ± SD age of 71.8 ± 5.6 years were included. Sagittal balance showed statistically significant improvement, with the mean SVA decreasing from 52.3 mm preoperatively to 33.9 mm postoperatively (p = 0.0001). The authors found an increase in LL, from mean -41.5° preoperatively to -43.9° postoperatively, but this was not statistically significant (p = 0.055). A statistically significant decrease in PI-LL mismatch from mean 8.4° preoperatively to 5.8° postoperatively was found (p = 0.002). All PROM scores showed significant improvement after spinal decompression surgery. The correlations between SVA and all PROMs were statistically significant at both preoperative and postoperative time points, although most correlations were weak except for those between preoperative SVA and ODI (r = 0.55) and between SVA and VAS for leg pain (r = 0.58). CONCLUSIONS Sagittal balance and PROMs show improvement at short-term follow-up evaluations in patients who have undergone decompression alone for lumbar spinal stenosis.
Collapse
Affiliation(s)
- Jamal Bech Bouknaitir
- 1Spine Unit, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark; and
- 2Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Leah Y Carreon
- 2Spine Surgery and Research, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Stig Brorson
- 1Spine Unit, Department of Orthopedic Surgery, Zealand University Hospital, Køge, Denmark; and
| | | |
Collapse
|
19
|
Teles AR, Aldebeyan S, Aoude A, Swamy G, Nicholls FH, Thomas KC, Jacobs WB. Mechanical Complications in Adult Spinal Deformity Surgery: Can Spinal Alignment Explain Everything? Spine (Phila Pa 1976) 2022; 47:E1-E9. [PMID: 34468439 DOI: 10.1097/brs.0000000000004217] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cohort study. OBJECTIVE Our goal was to verify the validity of the global alignment and proportion (GAP) score, SRS-Schwab, and Roussouly theoretical apex of lordosis in predicting mechanical complications in adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA Achieving adequate sagittal alignment is critical to obtain favorable outcomes in ASD surgery. It has been proposed that mechanical complications are largely secondary to postoperative spinal alignment. METHODS Retrospective review of consecutive primary ASD cases that underwent deformity correction in the same institution over a 5-year period. Association between the 6-week postoperative spinal alignment classification and occurrence of mechanical complications on the last follow-up was assessed using logistic regressions. The discriminant capacity was assessed using the receiver operating characteristic (ROC) curve analysis. RESULTS 58.3% (N = 49/84) of patients presented with mechanical complications and 32.1% (N = 27/84) underwent revision surgery. GAP score did not show discriminant ability to predict complications (AUC = 0.53, 95% confidence interval [CI] = 0.40-0.66, P = 0.58). Conversely, the SRS-Schwab sagittal modifier score demonstrated a statistically significant (although modest) predictive value for mechanical complications (AUC = 0.67, 95% CI = 0.54-0.79, P = 0.008). There was a significant association between pelvic tilt (PT) (P = 0.03) and sagittal vertical axis (SVA) (P = 0.01) at 6 weeks postoperatively and the occurrence of later mechanical complications. There was no significant association between matched Roussouly theoretical apex of lordosis and final outcome (P = 0.47). CONCLUSION The results point to the complexity of mechanical failure and the high likelihood that causative factors are multifactorial and not limited to alignment measures. GAP score should be used with caution as it may not explain or predict mechanical failure based on alignment in all populations as originally expected. Future studies should focus on etiology, surgical technique, and patient factors in order to generate a more universal score that can be applied to all populations.Level of Evidence: 4.
Collapse
Affiliation(s)
- Alisson R Teles
- Neurosurgery and Spine Program, Hospital Beneficente São Carlos, Farroupilha - RS, Brazil
| | - Sultan Aldebeyan
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Aoude
- Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Ganesh Swamy
- Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Fred H Nicholls
- Spine Program, University of Calgary, Calgary, Alberta, Canada
| | | | | |
Collapse
|
20
|
Cirillo Totera JI, Fleiderman Valenzuela JG, Garrido Arancibia JA, Pantoja Contreras ST, Beaulieu Lalanne L, Alvarez-Lemos FL. Sagittal balance: from theory to clinical practice. EFORT Open Rev 2021; 6:1193-1202. [PMID: 35839102 PMCID: PMC8693232 DOI: 10.1302/2058-5241.6.210062] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Adequate sagittal balance (SB) is essential to maintain an upright, efficient, and painless posture. It has been shown that sagittal profile alterations affect quality of life of patients with a similar or even greater impact than chronic disease. Evaluation of the SB has gained much relevance in recent years, with recognition of its importance in the evaluation of spinal pathology. This review summarizes the basic principles of SB, aiming to obtain a practical, simple and understandable evaluation of the sagittal profile of a patient. SB is a dynamic process that involves a varying degree of energy expenditure. Distinguishing between a balanced, compensated imbalance or decompensated imbalanced patient, is relevant to diagnosis and therapeutic decision-making.
Cite this article: EFORT Open Rev 2021;6:1193-1202. DOI: 10.1302/2058-5241.6.210062
Collapse
Affiliation(s)
- Juan I. Cirillo Totera
- Clínica Universidad de los Andes, Santiago, Chile
- Hospital del Trabajador, Santiago, Chile
| | | | | | | | | | | |
Collapse
|
21
|
Teraguchi M, Kawakami M, Ishimoto Y, Nagata K, Nakagawa M, Minetama M, Matsuo S, Nakagawa Y. Sagittal imbalance of the spine-pelvis-lower extremity axis associated with back-related disability. J Orthop Sci 2021; 26:986-991. [PMID: 33293187 DOI: 10.1016/j.jos.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/27/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The impact of sagittal imbalance in patients has been reported in LBP and LBP-related disabilities due to spinopelvic imbalance. However, no reports investigating the spine-pelvis-lower extremity axis using lateral images have been reported thus far. This study introduced a novel parameter of the spine-pelvis-lower extremity axis and evaluated whether this parameter was related to symptoms. METHODS A total of 343 subjects were included in this cross-sectional study. Standing spine-pelvis and pelvis-lower extremity radiographs were obtained to assess the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis, and thoracic kyphosis. The sacral-knee distance (SKD) (i.e., distance from the anterior femoral condyle to the vertical axis at the upper posterior edge of S1 body) was measured. Furthermore, the SVA/SKD ratio was calculated for global balance. Subjects were divided into leg compensated (LC; SVA/SKD ratio <0.8) and decompensated (LD; SVA/SKD ratio ≥0.8) groups. The SVA was divided into balanced spine (BS; SVA ≤40 mm) and imbalanced spine (IS; SVA >40 mm) groups. All individuals were classified into LC + BS, LC + IS, LD + BS, and LD + IS groups. The relationships among the four groups and low back pain (LBP), Oswestry Disability Index (ODI), and knee pain were examined. RESULTS SKD was significantly correlated with SVA, SS, PI, PT, and knee-femoral angle. ODI was significantly higher in the LC + IS group than in the LD + BS group (p < 0.05). Knee pain prevalence was significantly higher in the LC + IS and LC + BS groups than in the LD + IS group (p < 0.05). CONCLUSION SVA/SKD ratio is useful for evaluating global alignment. Our findings are significant because they highlight the importance of SKD with respect to knee pain, LBP, and LBP- related disabilities.
Collapse
Affiliation(s)
- Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan.
| | - Mamoru Kawakami
- Department of Orthopaedic Surgery, Saiseika Hospital, Wakayama, Japan
| | - Yuyu Ishimoto
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Sachika Matsuo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan
| |
Collapse
|
22
|
Kim KR, Le Huec JC, Jang HJ, Noh SH, Park JY, Ha Y, Kuh SU, Chin DK, Kim KS, Jin BH, Cho YE, Kim KH. Which Is More Predictive Value for Mechanical Complications: Fixed Thoracolumbar Alignment (T1 Pelvic Angle) Versus Dynamic Global Balance Parameter (Odontoid-Hip Axis Angle). Neurospine 2021; 18:597-607. [PMID: 34610691 PMCID: PMC8497258 DOI: 10.14245/ns.2142452.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Objective In this study, we investigate about relationship between postoperative global sagittal imbalance and occurrence of mechanical complications after adult spinal deformity (ASD) surgery. In global sagittal balance parameters, odontoid-hip axis (OD-HA) angle and T1 pelvic angle (TPA) were analyzed.
Methods Between January 2009 and December 2016, 199 consecutive patients (26 males and 173 females) with ASD underwent corrective fusion of more than 4 levels and were followed up for more than 2 years. Immediate postoperative and postoperative 2 years whole spine x-rays were checked for evaluating immediate postoperative OD-HA, TPA, and other parameters. In clinical outcomes, back and leg pain visual analogue scale, Scoliosis Research Society-22 spinal deformity questionnaire (SRS-22), Oswestry Disability Index (ODI), 36-item Short Form Health Survey (SF-36) were evaluated.
Results Based on the occurrence of mechanical complications, a comparative analysis was performed for each parameter. In univariable analysis, mechanical complications were significantly much more occurred in OD-HA abnormal group (odds ratio [OR], 3.296; p<0.001; area under the curve [AUC]=0.645). In multivariable analysis, the result was much more related (OR, 2.924; p=0.001; AUC=0.727). In contrast, there was no significant difference between normal and the occurrence of mechanical complications in TPA. In clinical outcomes (normal vs. abnormal), the differences of SRS-22 (0.88±0.73 vs. 0.68±0.64, p=0.042), ODI (-24.72±20.16 vs. -19.01±19.95, p=0.046), SF-36 physical composite score (19.33±18.55 vs. 12.90±16.73, p=0.011) were significantly improved in OD-HA normal group.
Conclusion The goal of ASD surgery is to improve patient life quality through correction. In our study, TPA was associated with spinopelvic parameter and OD-HA angle was associated with health-related quality of life and complications. OD-HA angle is predictable factor for mechanical complications after ASD surgery.
Collapse
Affiliation(s)
- Kwang-Ryeol Kim
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Hyun-Jun Jang
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Hyun Noh
- Department of Neurosurgery, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Uk Kuh
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun-Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Ho Jin
- Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Yong-Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
23
|
Noh SH, Ha Y, Park JY, Kuh SU, Chin DK, Kim KS, Cho YE, Lee HS, Kim KH. Modified Global Alignment and Proportion Scoring With Body Mass Index and Bone Mineral Density Analysis in Global Alignment and Proportion Score of Each 3 Categories for Predicting Mechanical Complications After Adult Spinal Deformity Surgery. Neurospine 2021; 18:484-491. [PMID: 34610679 PMCID: PMC8497256 DOI: 10.14245/ns.2142470.235] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aimed to analyze the prediction rate of the modified Global Alignment and Proportion (GAP) scoring system with body mass index and bone mineral density (GAPB) in each GAP of the 3 categories. METHODS Between January 2009 and December 2016, 203 consecutive patients with adult spinal deformity (ASD) underwent corrective fusion of more than 4 levels and were followedup for more than 2 years. As a validation of the GAPB, the GAPB was divided into tertiles (Q1, Q2, Q3) for each section of the GAP score. Each patient's GAP score and GAPB system complication rate were examined. RESULTS Of the 203 patients, 89 patients (44%) developed mechanical complications after ASD surgery. A GAP score analysis of the patients found that 42 patients were proportioned, 85 patients were moderately disproportioned, and 76 patients were severely disproportioned. Mechanical complications occurred with increasing GAPB in the proportioned group, but were not statistically significant (p = 0.0534). However, mechanical complications occurred in a statistically significant manner in the moderately disproportioned and severely disproportioned groups as GAPB increased (p < 0.001). CONCLUSION The GAPB system showed improved predictability for mechanical complications after surgery for ASD in each category of the GAP score.
Collapse
Affiliation(s)
- Sung Hyun Noh
- Department of Neurosurgery, Ajou University College of Medicine, Suwon, Korea.,Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Uk Kuh
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
24
|
Song J, Pan F, Zhu W, Kong C, Lu S. Characteristics of the sagittal spinal balance in the asymptomatic elderly Chinese population. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:233-240. [PMID: 34463863 DOI: 10.1007/s00586-021-06979-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the normal values of the sagittal spinal parameters and analyze the distribution of the global spinal profiles in a Chinese population with age over 75. METHODS Two hundred and twelve sets of the whole spine lateral radiographs were obtained from a database of an asymptomatic elderly population. Global and regional spinal parameters were measured. Sagittal profiles were determined according to the Roussouly classification compared with previous studies involving different populations. RESULTS A total of 102 elderly subjects (≥ 75 years) were enrolled with an average age of 79.24 ± 3.53 years. The mean values of the spinopelvic parameters were 42.89 ± 11.64° for TK, 13.84 ± 10.78° for TLK, 44.48 ± 12.88° for LL, 44.76 ± 9.84° for PI, 17.19 ± 8.08° for PT, 28.35 ± 7.94° for SS, 3.47 ± 3.56 cm for SVA, 14.75 ± 7.85° for TPA, -0.27 ± 11.95° for PI-LL, respectively. Subjects ≥ 75 years were found to have significantly smaller LL and SS, but greater TLK, PT, SVA, TPA, and PI-LL than those 60-74 years (p < 0.05). Significant age- and sex-dependent differences were found in the Roussouly classification's distribution between the two subgroups. CONCLUSIONS The normal values of the sagittal parameters were presented in the elderly Chinese asymptomatic population (≥ 75 years). Ethnic, age, and sex displayed significant effects on the behaviors of the sagittal spinal balance and profiles. These results could be served as physiological references for the planning of surgical strategies in elderly Chinese patients over 75 years.
Collapse
Affiliation(s)
- Jipeng Song
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fumin Pan
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weiguo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
25
|
Xue R, Liu D, Shen Y. Comparison of Posterior Unilateral Vertebral Column Resection Versus Posterior Vertebral Column Resection for Severe Thoracolumbar Angular Kyphosis as a Revision Surgical Modality: A Retrospective Cohort Study. Clin Spine Surg 2021; 34:E303-E307. [PMID: 33323700 PMCID: PMC8168930 DOI: 10.1097/bsd.0000000000001123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the safety and efficacy of posterior unilateral vertebral column resection (PUVCR) as revision surgery for severe thoracolumbar angular kyphosis. PATIENTS AND METHODS This is a retrospective cohort study. Adult patients undergoing revision surgery for severe thoracolumbar angular kyphosis in 2010-2016 with ≥2-year follow-up at our institution were assessed. Perioperative complications and clinical outcomes, including blood loss, operation time, Visual Analog Scale score, Oswestry Disability Index, and preoperative and postoperative kyphotic angles, were analyzed. RESULTS This study included 58 patients who were divided into the PUVCR group and the posterior vertebral column resection (PVCR) group. Age ( P =0.810), sex distribution ( P =0.500), and vertebrae that underwent surgery ( P =0.638) were similar in the 2 groups. Shorter mean operation time was observed in the PUVCR group as compared with the PVCR group ( P <0.001). In addition, less blood loss was recorded in the PUVCR group as compared with the PVCR group ( P =0.001). There were no significant differences between the 2 groups in a change of Visual Analog Scale scores postoperation versus preoperation ( P =0.961), and at postoperative 3 months ( P =0.906), 12 months ( P =0.752), and 24 months ( P =0.811) versus postoperation, respectively. There were no significant differences between the 2 groups in Oswestry Disability Index changes postoperation versus preoperation ( P =0.157), and at postoperative 3 months ( P =0.899), 12 months ( P =0.947), and 24 months ( P =0.811) versus postoperation, respectively. PUVCR and PVCR were comparable in deformity correction ( P =0.434) and final angle correction ( P =0.790). Complication rates in the PUVCR and PVCR groups were 7.1% and 36.7%, respectively. CONCLUSION PUVCR has comparable safety and efficacy to PVCR in treating severe thoracolumbar angular kyphosis, with the advantages of the shorter operation time, less blood loss, and fewer complications.
Collapse
Affiliation(s)
| | - Dai Liu
- Rehabilitation Office, The Third Hospital of HeBei Medical University, Shi Jiazhuang, China
| | | |
Collapse
|
26
|
The use of electronic PROMs provides same outcomes as paper version in a spine surgery registry. Results from a prospective cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2645-2653. [PMID: 33970326 DOI: 10.1007/s00586-021-06834-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Patient-Reported Measured Outcomes (PROMs) are essential to gain a full understanding of a patient's condition, and in spine surgery, these questionnaires are of help when tailoring a surgical strategy. Electronic registries allow for a systematic collection and storage of PROMs, making them readily available for clinical and research purposes. This study aimed to investigate the reliability between the electronic and paper form of ODI (Oswestry Disability Index), SF-36 (Short Form Health Survey 36) and COMI-back (Core Outcome Measures Index for the back) questionnaires. METHODS A prospective analysis was performed of ODI, SF-36 and COMI-back questionnaires collected in paper and electronic format in two patients' groups: Pre-Operatively (PO) or at follow-up (FU). All patients, in both groups, completed the three questionnaires in paper and electronic form. The correlation between both methods was assessed with the Intraclass Correlation Coefficients (ICC). RESULTS The data from 100 non-consecutive, volunteer patients with a mean age of 55.6 ± 15.0 years were analysed. For all of the three PROMs, the reliability between paper and electronic questionnaires results was excellent (ICC: ODI = 0.96; COMI = 0.98; SF36-MCS = 0.98; SF36-PCS = 0.98. For all p < 0.001). CONCLUSIONS This study proved an excellent reliability between the electronic and paper versions of ODI, SF-36 and COMI-back questionnaires collected using a spine registry. This validation paves the way for stronger widespread use of electronic PROMs. They offer numerous advantages in terms of accessibility, storage, and data analysis compared to paper questionnaires.
Collapse
|
27
|
Yao YC, Kim HJ, Bannwarth M, Smith J, Bess S, Klineberg E, Ames CP, Shaffrey CI, Burton D, Gupta M, Mundis GM, Hostin R, Schwab F, Lafage V. Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity: Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up. Global Spine J 2021; 13:932-939. [PMID: 33906457 DOI: 10.1177/21925682211009178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare the outcomes of patients with adult spinal deformity (ASD) following spinal fusion with the lowest instrumented vertebra (LIV) at L4/L5 versus S1/ilium. METHODS A multicenter ASD database was evaluated. Patients were categorized into 2 groups based on LIV levels-groups L (fusion to L4/L5) and S (fusion to S1/ilium). Both groups were propensity matched by age and preoperative radiographic alignments. Patient demographics, operative details, radiographic parameters, revision rates, and health-related quality of life (HRQOL) scores were compared. RESULTS Overall, 349 patients had complete data, with a mean follow-up of 46 months. Patients in group S (n = 311) were older and had larger sagittal and coronal plane deformities than those in group L (n = 38). After matching, 28 patients were allocated to each group with similar demographic, radiographic, and clinical parameters. Sagittal alignment restoration at postoperative week 6 was significantly better in group S than in group L, but it was similar in both groups at the 2-year follow-up. Fusion to S1/ilium involved a longer operating time, higher PJK rates, and greater PJK angles than that to L4/L5. There were no significant differences in the complication and revision rates between the groups. Both groups showed significant improvements in HRQOL scores. CONCLUSIONS Fusion to S1/ilium had better sagittal alignment restoration at postoperative week 6 and involved higher PJK rates and greater PJK angles than that to L4/L5. The clinical outcomes and rates of revision surgery and complications were similar between the groups.
Collapse
Affiliation(s)
- Yu-Cheng Yao
- Department of Orthopedics and Traumatology, 46615Taipei Veterans General Hospital, Taipei, Taiwan.,Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Han Jo Kim
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | | | - Justin Smith
- Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Douglas Burton
- Department of Orthopedic Surgery, 21638University of Kansas Medical Center, Kansas City, KS, USA
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA
| | | | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA
| | - Frank Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
28
|
Iwai C, Pizones J, Boissière L, Jakinapally S, Yilgor Ç, Larrieu D, Pellise F, Vital JM, Bourghli A, Obeid I. Static and dynamic sagittal lumbar apex: a new concept for the assessment of lumbar lordosis distribution in spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1155-1163. [PMID: 33606102 DOI: 10.1007/s00586-021-06767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/20/2020] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Sagittal lumbar apex has been demonstrated to be a key parameter in sagittal plane morphology. Our aim was to understand its behavior with postural changes, analyzing two different concepts of lumbar apex. MATERIALS AND METHODS Prospective observational study with a cohort of patients presenting sagittal malalignment identified from a monocenter database of adult spinal deformities (ASD). Inclusion criteria were age > 30 years, SVA > 40 mm, and/or PT > 20. All patients had full-spine EOS radiographs in 2 different positions: (P1: natural position) and position 2 (P2: compensated position). Sagittal alignment, spinopelvic values, and two different methods of assessing lordosis apex location were analyzed in both P1 and P2 positions. Changes between P1 and P2 were compared using a paired t test with a significance level at p < 0.05. RESULTS Twenty-five patients were recruited (21 women and 4 men). The mean age was 64.8 years (range 21-79). The patient's main compensation was based on an increase in the femoral shaft angle, and pelvic retroversion, with a subsequent decrease in sacral slope, and therefore of the lower lumbar arc. When the lumbar apex was calculated as the most anterior point touching the vertical line in a lateral radiograph, postural compensation changes modified its location usually shifting it to a more caudal position. When the lumbar apex was assessed as the most distant point of the global lumbar lordosis, its position remained stable regardless of compensation. CONCLUSIONS Postural changes can modify the location of the lumbar apex when understanding its location as the cornerstone of sagittal plane harmonic distribution. This concept can be useful as an additional sign to assess compensation. However, if the lumbar apex was calculated as the angular point of the global lordosis, its position remained stable regardless of postural changes. This concept can help to mold lumbar lordosis in ASD surgery. LEVEL OF EVIDENCE IV Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
Collapse
Affiliation(s)
- Chizuo Iwai
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France.,Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Louis Boissière
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Sreenath Jakinapally
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Çaglar Yilgor
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Daniel Larrieu
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Ferran Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | - Jean-Marc Vital
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France.
| |
Collapse
|
29
|
Proximal Junctional Kyphosis According to the Type of Lumbar Degenerative Kyphosis Following Lumbosacral Long Fusion. Spine (Phila Pa 1976) 2021; 46:232-240. [PMID: 33475278 DOI: 10.1097/brs.0000000000003764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of this study was to investigate proximal junctional kyphosis (PJK) after lumbosacral long fusion according to preoperative Roussouly and lumbar degenerative kyphosis (LDK) types. SUMMARY OF BACKGROUND DATA Although previous studies have suggested some risk factors for PJK, the effects of preoperative grade of sagittal imbalance and paraspinal muscles degeneration on PJK remain unclear. METHODS Eighty-seven patients who had undergone lumbosacral fusion more than five levels with available clinical and radiological data were enrolled. The presence of PJK defined as sagittal Cobb angle ≥20° between the uppermost instrumented vertebra (UIV) and two supra-adjacent vertebrae at postoperative 2-year radiographs was recorded. Its occurrence was compared according to preoperative Roussouly and LDK types (Takemistu type) and the degree of paraspinal muscle degeneration at the upper level of UIV. Other sagittal radiographic parameters were also measured. RESULTS In this series, 28 patients (group I, 32.2%) showed radiological PJK, whereas 59 patients did not show radiological PJK (non-PJK patients, group II, 67.8%) at postoperative 2 years. PJK presented more prevalence in type III and type IV of LDK types (26/27, 96.3%). However, Roussouly types did not show any significant difference in PJK prevalence. In radiological parameters, a larger preoperative SVA (P = 0.018) and PI-LL (P = 0.015) were associated with PJK. Also, smaller quantity and lower quality of paraspinal muscles at T12-L1 level showed significant (P < 0.001) relationship with PJK. On multivariate logistic regression, higher LDK type (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.24-3.56), smaller quantity (OR: 1.03, 95% CI: 1.00-1.07), and higher degree of paraspinal muscle degeneration (OR: 1.46, 95% CI: 0.92-2.31) were independent predictors of postoperative PJK. CONCLUSION Although various factors are related to PJK following long segment fusion, preoperative conditions such as LDK types and degree of paraspinal muscle degeneration might be related to the development of PJK.Level of Evidence: 3.
Collapse
|
30
|
Postural Sway in Older Patients with Sagittal Imbalance and Young Adults during Local Vibratory Proprioceptive Stimulation. Healthcare (Basel) 2021; 9:healthcare9020210. [PMID: 33672014 PMCID: PMC7919372 DOI: 10.3390/healthcare9020210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/22/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to assess differences in somatosensory control strategies between older patients with sagittal imbalance and young adults during postural tasks. The center of pressure displacement in 27 older patients with sagittal imbalance and 27 young adults was determined upon standing blindfolded on a balance board. Vibratory stimulation at 56 to 100 Hz was applied bilaterally to the gastrocnemius and soleus muscles (GS) and lumbar multifidus to evaluate the contributions of proprioceptive signals to postural control. Data of older patients and young adults were compared using the Mann–Whitney U-test or independent sample t-tests. Compared with the young adults, the older patients were significantly more reliant on the GS (p < 0.005) for their postural control and showed a higher relative proprioceptive weighting ratio (RPW) (p = 0.038). The postural strategy adopted by the older patients depended on the level of proprioceptive stimulation applied to the GS, and the postural control strategy of the ankle correlated with RPW. Overall, this study identifies RPW as a novel measure of postural strategy in older patients with sagittal imbalance and provides an understanding of strategies used to maintain balance, which may assist in developing preventative measures to reduce the risk of falls.
Collapse
|
31
|
Ham DW, Kim HJ, Choi JH, Park J, Lee J, Yeom JS. Validity of the global alignment proportion (GAP) score in predicting mechanical complications after adult spinal deformity surgery in elderly patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1190-1198. [PMID: 33528658 DOI: 10.1007/s00586-021-06734-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/30/2020] [Accepted: 01/11/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE This study aimed to validate the usefulness of the global alignment proportion (GAP) score to predict postoperative mechanical failure in the elderly (mean age, 70.5 years) individuals with severe sagittal imbalance. METHODS A total of 84 patients were enrolled: mechanical complications (MC), minor mechanical complications (mMC), proximal junctional failure (PJF), and revision surgery occurred in 61% (51/84), 58% (49/84), 44% (37/84), and 13% (11/84) of the patients, respectively. The GAP score was calculated using the X-ray obtained in the early postoperative period. The validity of the GAP score's predictive ability was evaluated by calculating the area under the curve (AUC) of the receiver operating characteristics curve. Univariate logistic regression analysis and Cochran-Armitage test of trend were performed to determine the association between mechanical complications and GAP score. RESULTS The discriminatory power of GAP score to predict MC, mMC, and PJF was "moderately accurate," with an AUC of 0.839 (confidence interval [CI] 0.755-0.824, p < 0.001), 0.836 (CI 0.749-0.923, p < 0.001), and 0.702 (CI 0.588-0.851, p < 0.001), respectively. The GAP score showed a statistically significant association with MC, mMC, and PJF in univariate logistic regression analysis and Cochran-Armitage test for trend. However, it was not significantly associated with revision surgery. CONCLUSION This study showed promising results regarding the GAP score's predictive power for MC, mMC, and PJF in the elderly population with degenerative kyphoscoliosis. Using the GAP score, we can determine the patient's specific correction goal preoperatively to prevent mechanical failure based on individual patient's characteristics such as pelvic incidence.
Collapse
Affiliation(s)
- Dae-Woong Ham
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Seoul National University Bundang Hospital, 166 Gumiro Bundang-gu, Seongnam, 463-707, Republic of Korea.
| | - Jae Heouk Choi
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiwon Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junpyo Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
32
|
Mar DE, Clary SJ, Ansley B, Bunch JT, Burton DC, McIff TE. Biomechanics of prophylactic tethering for proximal junctional kyphosis: effects of cyclic loading on tether strength and failure properties. Spine Deform 2020; 8:863-870. [PMID: 32249406 DOI: 10.1007/s43390-020-00111-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Biomechanical evaluation of woven polyester tethers. OBJECTIVES To quantify changes in tether elongation, stiffness, and failure characteristics after cyclic loading. Ligamentous augmentation is gaining interest as a technique to prevent proximal junctional kyphosis (PJK) in adult spinal fusions. There are a lack of data regarding the effects of cyclic loading on polyester tether mechanical properties. Tether stretch may lead to loss of stabilization and increased risk of tether failure. Biomechanical data are needed to determine the effects of cyclic loading on tether integrity. METHODS Testing was done in two materials: (1) a synthetic cortical bone composite to determine baseline mechanical properties, and (2) nine cadaveric L1 spinous processes. 5 mm woven polyester tethers were looped through 2.5 mm holes drilled in each material. First, five tethers were tested directly to failure in the synthetic bone to establish baseline failure properties. Next, tethers were tested at one of the three cyclic load ranges [5%, 25%, and 50% (n = 5 each) of baseline failure] for 1000 cycles and then loaded to failure. Cadaveric tests were done at the 25% range and compared to synthetic bone tests at the same range. Cadaveric failure tests were classified as either tether failure or spinous process bone failure. RESULTS Greater cyclic loading range had a significant effect on tether loop elongation, increased stiffness, and decreased ultimate tensile force. Among the cadaveric failure tests, 56% resulted in tether failure and the remaining 44% resulted in bone failure. CONCLUSIONS Polyester tethers stretch significantly when loaded to physiological ranges. Anticipation of tether stretch may be an important consideration for a tethering strategy to prevent PJK. Improved understanding of tether material properties can provide guidance for the evaluation of clinical outcomes associated with techniques to reduce the risk of PJK caused by ligamentous laxity. LEVEL OF EVIDENCE Biomechanical study.
Collapse
Affiliation(s)
| | - Steven J Clary
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3031, Kansas City, KS, 66160, USA
| | - Brant Ansley
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3031, Kansas City, KS, 66160, USA
| | - Joshua T Bunch
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3031, Kansas City, KS, 66160, USA
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3031, Kansas City, KS, 66160, USA.
| | - Terence E McIff
- Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3031, Kansas City, KS, 66160, USA
| |
Collapse
|
33
|
Mok JK, Vaishnav AS, Chaudhary C, Alluri RK, Lee R, Urakawa H, Sato K, Chen DA, Gang CH, Huang R, Albert TJ, Qureshi SA. Impact of Nonlordotic Sagittal Alignment on Short-term Outcomes of Cervical Disc Replacement. Neurospine 2020; 17:588-602. [PMID: 33022164 PMCID: PMC7538348 DOI: 10.14245/ns.2040398.199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate outcomes of cervical disc replacement (CDR) in patients with nonlordotic alignment.
Methods Patients who underwent CDR were retrospectively reviewed and divided into 3 cohorts: (1) neutral/lordotic segmental and C2–7 Cobb angle (L), (2) nonlordotic segmental Cobb angle, lordotic C2–7 Cobb angle (NL-S), and (3) nonlordotic segmental and C2–7 Cobb angle (NL-SC). Radiographic and patient-reported outcomes (PROMs) were compared.
Results One-hundred five patients were included (L: 37, NL-S: 30, NL-SC: 38). A significant gain in segmental lordosis was seen in all cohorts at < 6 months (L: -1.90° [p = 0.007]; NL-S: -5.16° [p < 0.0001]; NL-SC: -6.00° [p < 0.0001]) and ≥ 6 months (L: -2.07° [p = 0.031; NL-S: -6.04° [p < 0.0001]; NL-SC: -6.74° [p < 0.0001]), with greater lordosis generated in preoperatively nonlordotic cohorts (p < 0.0001). C2–7 lordosis improved in the preoperatively nonlordotic cohort (NL-SC: 8.04°) at follow-up of < 6 months (-4.15°, p=0.003) and ≥ 6 months (-6.40°, p=0.003), but not enough to create lordotic alignment (< 6 months: 3.89°; ≥ 6 months: 4.06°). All cohorts showed improvement in Neck Disability Index, visual analogue scale (VAS) neck, and VAS arm, without significant difference among groups in the amount of improvement (≥ 6-month PROMs follow-up=69%).
Conclusion In patients without major kyphotic deformity, CDR has the potential to generate and maintain lordosis and improve PROMs in the short-term, and can be an effective treatment option for patients with nonlordotic alignment.
Collapse
Affiliation(s)
- Jung Kee Mok
- Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Ryan Lee
- Hospital for Special Surgery, New York, NY, USA
| | | | - Kosuke Sato
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Russel Huang
- Weill Cornell Medical College, New York, NY, USA.,Hospital for Special Surgery, New York, NY, USA
| | - Todd J Albert
- Weill Cornell Medical College, New York, NY, USA.,Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A Qureshi
- Weill Cornell Medical College, New York, NY, USA.,Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
34
|
Gera C, Malik M, kaur J, Saini M. A systematic review and meta-analysis on effect of spinal mobilization and manipulation on cardiovascular responses. Hong Kong Physiother J 2020; 40:75-87. [PMID: 33005072 PMCID: PMC7526060 DOI: 10.1142/s1013702520500122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/26/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Spinal pain or misalignment is a very common disorder affecting a significant number of populations resulting in substantial disability and economic burden. Various manual therapeutic techniques such as spinal manipulations and mobilizations can be used to treat and manage pain and movement dysfunctions such as spinal mal-alignments and associated complications. These manual therapeutic techniques can affect the cardiovascular parameters.Objective: The objective of this systematic review and meta-analysis is to assess the effect of spinal manipulation and mobilization on cardiovascular parameters.Methods: We conducted a systematic review and meta-analysis to assess the effects of spinal mobilization and manipulation on cardiovascular responses. Mean changes in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR) were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Quality of the included studies was assessed by PEDro Rating scale. Risk of bias was assessed by Cochrane collaboration tool of risk of bias.Results: Results of meta-analysis showed that there was statistically significant decrease in SBP ([Formula: see text], 95% [Formula: see text], 0.08; [Formula: see text]) with moderate heterogeneity ([Formula: see text], [Formula: see text]) in experimental group as compared to control group. There was statistically non-significant decrease in DBP ([Formula: see text], 95% [Formula: see text], 0.69; [Formula: see text]) with high heterogeneity ([Formula: see text], [Formula: see text]), Change HR was statistically non-significant ([Formula: see text], 95% [Formula: see text], 3.11; [Formula: see text]) with moderate heterogeneity ([Formula: see text], [Formula: see text]). Exclusion of short duration studies in sensitivity analysis revealed a statistically significant change in DBP ([Formula: see text], 95% [Formula: see text], [Formula: see text]; [Formula: see text]). However, the result was statistically non-significant for HR after sensitivity analysis.Conclusion: Spinal manipulations and mobilizations may result in significant decrease of systolic as well as diastolic Blood Pressure.
Collapse
Affiliation(s)
- Charu Gera
- Department of Physiotherapy, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - Manoj Malik
- Department of Physiotherapy, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - Jaspreet kaur
- Department of Physiotherapy, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - Minaxi Saini
- Mother Teresa Saket College of Physiotherapy, Saket, Panchkula, Haryana, India
| |
Collapse
|
35
|
Haddas R, Kisinde S, Mar D, Lieberman I. Does improved radiographic alignment truly enhance dynamic functional balance? Spine Deform 2020; 8:685-694. [PMID: 32065379 DOI: 10.1007/s43390-020-00089-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Prospective concurrent cohort study. OBJECTIVE To establish the relationship between radiographic alignment parameters and functional CoE measurements at 1 week before and at 3 months after realignment surgery in ADS patients. Adult degenerative scoliosis (ADS) represents a significant healthcare burden with exceedingly high and increasing prevalence, particularly among the elderly. Radiographic alignment measures and patient-reported outcomes currently serve as the standard means to assess spinal alignment, deformity, and stability. Neurological examinations have served as qualitative measures for indicating muscle strength, motor deficits, and gait abnormalities. Three-dimensional motion analysis is increasingly being used to identify and measure gait and balance instability. Recently, techniques have been established to quantify balance characteristics described by Dubousset as the "cone of economy" (CoE). The relationship between radiographic alignment parameters and CoE balance measures of ADS patients before and after realignment surgery is currently unknown. PATIENT SAMPLE 29 ADS patients treated with realignment surgery. METHODS Patients were evaluated at 1 week before realignment surgery and at their 3-month follow-up examination. During each evaluation, patients completed self-reported outcomes (visual analog scales for pain, Oswestry Disability Index, SRS22r) and a functional balance test. Mean changes in dependent measures from before to after surgery were compared using paired t tests. Pearson correlations were used to test for significant correlations between changes in radiographic and CoE measures. RESULTS Significant improvements were found for all patient-reported outcomes, in several radiographic measures, and in CoE measures. Improvements of scoliosis Cobb angle, coronal pelvic tilt, lumbar lordosis, and thoracic kyphosis showed significant correlations with CoE sway and total distance measures at both the center of mass and center of the head. CONCLUSION Improved radiographic alignment measures significantly correlated with improved CoE balance measures among ADS patients treated with realignment surgery at their three-month follow-up. These findings indicate that functional balance evaluations when used in conjunction with radiographic measurements, may provide a more robust and improved patient-specific sensitivity for postoperative assessments. CoE balance may represent a new measure of added value for surgical intervention of ADS.
Collapse
Affiliation(s)
- Ram Haddas
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA.
| | - Stanley Kisinde
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
| | - Damon Mar
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
| | - Isador Lieberman
- Texas Back Institute, 6020 West Parker Road, Plano, TX, 75093, USA
| |
Collapse
|
36
|
Yeganeh A, Moghtadaei M, Ameri Mahabadi E, Mahdavi SM, Pirani A, Safdari F. Sagittal Spinopelvic Alignment in Asymptomatic Iranian Adults Aged 18 to 40 Years. ARCHIVES OF IRANIAN MEDICINE 2020; 23:391-396. [PMID: 32536176 DOI: 10.34172/aim.2020.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/12/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent studies have revealed the increasing importance of sagittal spinopelvic alignment. Knowing the values of sagittal spinopelvic parameters, which are affected by ethnicity, is essential in the normal asymptomatic population. In the current study, these parameters were measured in a sample of asymptomatic Iranian population. METHODS Seventy asymptomatic participants without complaint of musculoskeletal problems were enrolled. They had no complaint about musculoskeletal problems. Lateral full-length spinal and pelvic x-rays were taken. The following parameters were measured on x-rays and presented as mean ± standard deviation: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), lumbar tilt (LT) and thoracic tilt (TT). RESULTS The population consisted of 37 males and 33 females aged 26.6 ± 4.27 years. The mean values of PI, SS, PT, LL, TK, LT, and TT were 44.5 ± 10.1, 35.4 ± 6.7, 9.1 ± 7.9, 41.9 ± 14.7, 28.8 ± 8.3, 11.9 ± 7.4 and -7.5 ± 5.7 (median: -10; 5th percentile: -14; 95th percentile: 4.4) degrees, respectively. The variables were similar between males and females except for LL which was significantly higher in females (37.8 ± 16.5 versus 46.5 ± 11; P = 0.013). In addition, the linear regression model revealed age to be independently related with PI (beta = 0.344; P = 0.004) and PT (beta = 0.366; P = 0.002). PI (r = 0.344, P = 0.004) and PT (r = 0.359, P = 0.002) were positively correlated with age. Additionally, PI was positively correlated to SS, PT and LL and negatively to TT. CONCLUSION These findings may be used as referential values for sagittal spinopelvic parameters in the Iranian population. The positive correlation of PI with age questions the constancy of PI throughout life. However, larger studies are required.
Collapse
Affiliation(s)
- Ali Yeganeh
- Department of orthopedics, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moghtadaei
- Department of orthopedics, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Ameri Mahabadi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mani Mahdavi
- Orthopedic Spine Surgery Department, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pirani
- Department of orthopedics, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Safdari
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation, Tehran, Iran
| |
Collapse
|
37
|
Effect of lumbar pedicle subtraction osteotomy level on lordosis distribution and shape. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1388-1396. [PMID: 32328789 DOI: 10.1007/s00586-020-06421-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Little is known about the qualitative results (postoperative upper/lower lumbar arches distribution and lumbar apex or inflection point positioning) of lumbar pedicle subtraction osteotomies (L-PSO) depending on the level of L-PSO. METHODS We conducted a retrospective analysis of prospectively collected data of adult deformity patients undergoing single-level L-PSO. We analyzed several variables in preoperative and postoperative sagittal radiographs: L-PSO level, Roussouly classification (R-type), inflection point (InfP), lumbar apex (LApex), spinopelvic parameters, lordosis distribution index (LDI = L4-S1/L1-S1), and number of levels in the lordosis (NVL). Comparisons between PSO levels were performed to determine lordosis distribution and sagittal shape using ANOVA test and Chi-squared statistics. RESULTS A total of 126 patients were included in this study. L5-PSO mainly increased the lower lumbar arch, thereby increasing LDI. L4 increased upper/lower arches similarly. PSOs at and above L3 increased the upper lumbar arch, thereby decreasing LDI (P < 0.001). L4-PSO added 1 vertebra into the lordosis (NVL = + 1.2 ± 2.2). PSOs above L3 added 2 vertebrae into the lordosis (NVL = + 2.3 ± 1.4). Overall P = 0.007. PSOs above L4 shifted the LApex cranially in 70% of the cases (mean 1.12 levels) and the InfP in 85% of the cases (mean 2.4 levels). L5-PSO shifted the LApex caudally in 70% of the cases (mean - 1.1 levels) and the InfP in 50% of the cases (mean - 1.6 levels). Overall P < 0.006. The L-PSO level was not associated with a specific Roussouly-type P > 0.05. CONCLUSIONS The level of L-PSO influenced upper/lower lumbar arches distribution, and lumbar apex and inflection point positioning. The correct level should be chosen based on the individual assessment of each patient.
Collapse
|
38
|
McAviney J, Mee J, Fazalbhoy A, Du Plessis J, Brown BT. A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data. BMC Musculoskelet Disord 2020; 21:87. [PMID: 32035480 PMCID: PMC7007692 DOI: 10.1186/s12891-020-3095-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/27/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is a paucity of literature regarding the conservative management of adult scoliosis. The authors review and summarize the literature from 1967 to 2018 on the clinical outcomes of spinal brace/orthosis use in this subgroup of the population. METHODS CINAHL, Embase, CENTRAL, PubMed and PEDro were searched from database inception to the 30th of October, 2018. A combination of medical subject heading terms and keywords pertaining to three core concepts (adult, scoliosis, and braces/orthoses) were used in the search. Studies were included if A) clinical outcomes were collected from B) participants ≥18 years C) receiving spinal brace/orthosis treatment for D) primary degenerative (de novo) scoliosis or progressive idiopathic scoliosis. A step-wise screening process was employed which involved a title and abstract screen for relevancy followed by a full text eligibility appraisal by two authors. Data were extracted, and a risk of bias assessment was performed on the included cohort studies using the Newcastle-Ottawa Scale. Given the overall level and quality of the available evidence, conclusions were drawn based on a qualitative summary of the evidence. RESULTS Ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Commonly reported outcomes were pain (7 studies), function (3 studies) and Cobb angles (3 studies), with follow-up times ranging from 2 days to 17 years. Brace wear prescriptions ranged from 2 to 23 h per day, and there was mixed brace-compliance reported. Most studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing. Participants from one study noted discomfort associated with bracing. Each of the six cohort studies demonstrated a high risk of bias. CONCLUSION There is evidence to suggest that spinal brace/orthosis treatment may have a positive short - medium term influence on pain and function in adults with either progressive primary (de novo) degenerative scoliosis or progressive idiopathic scoliosis. At this point in time the evidence is of low quality and has been focused primarily on female patients with thoracolumbar and lumbar curves. More granular statements regarding the efficacy of different brace types or manufacturers, or the effect of this therapy on different curve types cannot be determined based on the current literature. Properly constructed prospective trials are required to better understand the efficacy of bracing in adult scoliosis.
Collapse
Affiliation(s)
- Jeb McAviney
- Sydney Scoliosis Clinic, Kirk Place, Level 5, Suite 5.08, 15 Kensington St, Kogarah, NSW, 2217, Australia
| | - Johanna Mee
- Melbourne Scoliosis Clinic, Ground Floor, Suite 3, 492 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Azharuddin Fazalbhoy
- Melbourne Scoliosis Clinic, Ground Floor, Suite 3, 492 St Kilda Road, Melbourne, VIC, 3004, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, 3083, Australia
| | - Juan Du Plessis
- Sydney Scoliosis Clinic, Kirk Place, Level 5, Suite 5.08, 15 Kensington St, Kogarah, NSW, 2217, Australia
| | - Benjamin T Brown
- Sydney Scoliosis Clinic, Kirk Place, Level 5, Suite 5.08, 15 Kensington St, Kogarah, NSW, 2217, Australia.
- Department of Chiropractic, Macquarie University, North Ryde, NSW, 2109, Australia.
| |
Collapse
|
39
|
Bassani T, Galbusera F, Luca A, Lovi A, Gallazzi E, Brayda-Bruno M. Physiological variations in the sagittal spine alignment in an asymptomatic elderly population. Spine J 2019; 19:1840-1849. [PMID: 31377476 DOI: 10.1016/j.spinee.2019.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Sagittal plane alignment is of crucial importance for the treatment of spinal deformities. When planning corrective strategies, spine surgeons need to refer to normative parameters' ranges which characterize the alignment in the asymptomatic population. Changes are known to occur with age. For the Caucasian population, the reference ranges are extensively documented for the young and middle-aged adults. In contrast, only a few studies have evaluated individuals in advanced age (>60 years) and in groups of limited numbers of subjects (less than 50). PURPOSE To describe the normative parameter ranges of sagittal spine alignment in a large population of asymptomatic elderly subjects. STUDY DESIGN/SETTING Monocentric, prospective, cross-sectional study. PATIENT SAMPLE One hundred sixty asymptomatic elderly volunteers (age>60 years, Caucasian heritage), consecutively enrolled. OUTCOME MEASURES Sagittal parameters of spine and pelvis: thoracic kyphosis (TK); lumbar lordosis (LL); sacral slope (SS); pelvic incidence (PI); pelvic tilt (PT); sagittal vertical axis (SVA); T1 pelvic angle (TPA); mismatch between PI and LL (PI-LL); Roussouly classification of the lumbopelvic profile. METHODS Each subject underwent one radiographic scan, performed in standing position with EOS low-dose system (EOS Imaging, Paris, France). The radiographic images were processed with sterEOS software allowing identification of the anatomical parameters and the presence of scoliosis. SVA, TPA, and the lumbopelvic profile were manually measured in the lateral images. The results were compared to previous studies describing younger adult populations. The study was supported by the Italian Ministry of Health in the amount of $15,000. The authors declare that there are no conflicts of interests. RESULTS Overall, the average values of the spinopelvic parameters were the followings: TK, 55±14°; LL, 57±12°; PI, 55±11°; SS, 38±10°; PT, 16±7°. The average PI-LL, SVA, and TPA was -3±11°, 25±32 mm, and 14.6±7.4°, respectively. TK, TPA, and SVA were found increasing with age. As for classification of the lumbopelvic profile, 16% of subjects were excluded because they were considered not to belong to any of the Roussouly types. In the classified subjects, the distribution was similar to that of younger adults. Asymptomatic scoliosis (average Cobb angle, 22±7°) was identified in 27% of individuals. CONCLUSIONS The ranges of values pointed out differences compared to younger adults and represent an important resource for spine surgeons in planning the surgical correction of spinal deformities. The characteristic changes occurring with age, as well as the observed presence of mild or moderate asymptomatic scoliosis, should be carefully taken into account. The classification of the lumbopelvic profile based on the Roussouly scheme revealed some limitations, although similar frequencies were identified compared to younger adults.
Collapse
Affiliation(s)
- Tito Bassani
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. LABS - Laboratory of Biological Structures Mechanics.
| | - Fabio Galbusera
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. LABS - Laboratory of Biological Structures Mechanics
| | - Andrea Luca
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. III Spine Surgery - Scoliosis Department
| | - Alessio Lovi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. III Spine Surgery - Scoliosis Department
| | - Enrico Gallazzi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. III Spine Surgery - Scoliosis Department
| | - Marco Brayda-Bruno
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. III Spine Surgery - Scoliosis Department
| |
Collapse
|
40
|
Zhou S, Xu F, Wang W, Zou D, Sun Z, Li W. Age-based normal sagittal alignment in Chinese asymptomatic adults: establishment of the relationships between pelvic incidence and other parameters. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:396-404. [DOI: 10.1007/s00586-019-06178-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/11/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
|
41
|
Sagittal Reconstruction and Clinical Outcome Using Traditional ACDF, Versus Stand-alone ACDF Versus TDR: A Systematic Review and Quantitative Analysis. Spine (Phila Pa 1976) 2019; 44:E1151-E1158. [PMID: 31261280 DOI: 10.1097/brs.0000000000003077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To determine the difference in postoperative sagittal alignment when single level cervical radiculopathy or myelopathy is treated with an anterior cervical discectomy and fusion (ACDF) using a structural graft and plate, a stand-alone ACDF, or a total disc arthroplasty (TDR). We also wanted to determine if postoperative sagittal alignment impacted clinical outcomes in this patient population. SUMMARY OF BACKGROUND DATA Although there are several accepted techniques for interbody reconstruction during single level anterior cervical surgery, little is known on the impact of any of them on segmental and regional sagittal alignment. METHODS A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines of the PubMed, Embase, and Cochrane databases. Only studies which contained pre and postoperative C2-7 Cobb angles as well as Neck Disability Index (NDI) scores following single level traditional ACDF with plate and cage, stand-alone ACDF, or TDR with at least 1 year follow up were included. RESULTS There were 12 publications that fulfilled the inclusion criteria with a total of 658 patients. Cluster regression analysis showed no difference between treatment arms at each respective time-point or in the overall change in NDI from preoperative to postoperative (P = 0.88). Cluster regression analysis showed no difference between treatment arms at each respective time point or in the overall change in lordosis from pre-op to post-op (P = 0.93). CONCLUSION This review provides evidence that while NDI scores improved across all devices, there was no significant difference in NDI improvement or C2-7 Cobb angle change between single level traditional ACDF, stand-alone ACDF, or TDR. Although TDR has not been considered a lordosis producing operation, our investigation shows it does not differ significantly in sagittal profile from other cervical fusion techniques. Moreover, we show that the NDI score improved, regardless of device implanted. LEVEL OF EVIDENCE 1.
Collapse
|
42
|
Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A. Sagittal balance of the spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1889-1905. [DOI: 10.1007/s00586-019-06083-1] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022]
|
43
|
Diebo BG, Shah NV, Boachie-Adjei O, Zhu F, Rothenfluh DA, Paulino CB, Schwab FJ, Lafage V. Adult spinal deformity. Lancet 2019; 394:160-172. [PMID: 31305254 DOI: 10.1016/s0140-6736(19)31125-0] [Citation(s) in RCA: 236] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022]
Abstract
Adult spinal deformity affects the thoracic or thoracolumbar spine throughout the ageing process. Although adolescent spinal deformities taken into adulthood are not uncommon, the most usual causes of spinal deformity in adults are iatrogenic flatback and degenerative scoliosis. Given its prevalence in the expanding portion of the global population aged older than 65 years, the disorder is of growing interest in health care. Physical examination, with a focus on gait and posture, along with radiographical assessment are primarily used and integrated with risk stratification indices to establish optimal treatment planning. Although non-operative treatment is regarded as the first-line response, surgical outcomes are considerably favourable. Global disparities exist in both the assessment and treatment of adults with spinal deformity across countries of varying incomes, which represents an area requiring further investigation. This Seminar presents evidence and knowledge that represent the evolution of data related to spinal deformity in adults over the past several decades.
Collapse
Affiliation(s)
- Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA.
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | | | - Feng Zhu
- Department of Orthopaedic and Traumatology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dominique A Rothenfluh
- Division of Spinal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, New York, NY, USA
| | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
44
|
Segreto FA, Passias PG, Lafage R, Lafage V, Smith JS, Line BG, Mundis GM, Bortz CA, Stekas ND, Horn SR, Diebo BG, Brown AE, Ihejirika Y, Nunley PD, Daniels AH, Gupta MC, Gum JL, Hamilton DK, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. Incidence of Acute, Progressive, and Delayed Proximal Junctional Kyphosis Over an 8-Year Period in Adult Spinal Deformity Patients. Oper Neurosurg (Hagerstown) 2019; 18:75-82. [DOI: 10.1093/ons/opz128] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Proximal junctional kyphosis (PJK) is a common radiographic complication of adult spinal deformity (ASD) corrective surgery. Although previous literature has reported a 5 to 61% incidence of PJK, these studies are limited by small sample sizes and short-term follow-up.
OBJECTIVE
To assess the incidence of PJK utilizing a high-powered ASD database.
METHODS
Retrospective review of a prospective multicenter ASD database. Operative ASD patients > 18 yr old from 2009 to 2017 were included. PJK was defined as ≥ 10° for the sagittal Cobb angle between the inferior upper instrumented vertebra (UIV) endplate and the superior endplate of the UIV + 2. Chi-square analysis and post hoc testing assessed annual and overall incidence of acute (6-wk follow-up [f/u]), progressive (increase in degree of PJK from 6 wk to 1 yr), and delayed (1-yr, 2-yr, and 3-yr f/u) PJK development.
RESULTS
A total of 1005 patients were included (age: 59.3; 73.5% F; body mass index: 27.99). Overall PJK incidence was 69.4%. Overall incidence of acute PJK was 48.0%. Annual incidence of acute PJK has decreased from 53.7% in 2012 to 31.6% in 2017 (P = .038). Overall incidence of progressive PJK was 35.0%, with stable rates observed from 2009 to 2016 (P = .297). Overall incidence of 1-yr-delayed PJK was 9.3%. Annual incidence of 1-yr-delayed PJK has decreased from 9.2% in 2009 to 3.2% in 2016 (P < .001). Overall incidence of 2-yr-delayed PJK development was 4.3%. Annual incidence of 2-yr-delayed PJK has decreased from 7.3% in 2009 to 0.9% in 2015 (P < .05). Overall incidence of 3-yr-delayed PJK was 1.8%, with stable rates observed from 2009 to 2014 (P = .594).
CONCLUSION
Although progressive PJK has remained a challenge for physicians over time, significantly lower incidences of acute and delayed PJK in recent years may indicate improving operative decision-making and management strategies.
Collapse
Affiliation(s)
- Frank A Segreto
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Peter G Passias
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Renaud Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Breton G Line
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Gregory M Mundis
- Department of Orthopedics, San Diego Center for Spinal Disorders, La Jolla, California
| | - Cole A Bortz
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Nicholas D Stekas
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Samantha R Horn
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Bassel G Diebo
- Department of Orthopedic Surgery, State University of New York Downstate Medical Center, Brooklyn, New York, New York
| | - Avery E Brown
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Yael Ihejirika
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | | | - Alan H Daniels
- Department of Orthopedics, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Munish C Gupta
- Department of Orthopedic Surgery, University of California, Davis, Davis, California
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, Kentucky
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburg School of Medicine, Pittsburgh, Pennsylvania
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California, Davis, Davis, California
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert A Hart
- Department of Orthopedics, Swedish Neuroscience Institute, Seattle, Washington
| | - Frank J Schwab
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| |
Collapse
|
45
|
Jacobs E, van Royen BJ, van Kuijk SMJ, Merk JMR, Stadhouder A, van Rhijn LW, Willems PC. Prediction of mechanical complications in adult spinal deformity surgery-the GAP score versus the Schwab classification. Spine J 2019; 19:781-788. [PMID: 30503298 DOI: 10.1016/j.spinee.2018.11.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgery for adult spinal deformity is a challenging and complex procedure with high reported complication (8.4%-42%) and revision rates (9%-17.6%). Failure to achieve or maintain adequate postoperative sagittal alignment has been reported to be the main cause of mechanical complications. In order to define appropriate surgical targets, the Scoliosis Research Society-Schwab classification and the Global Alignment and Proportion (GAP) score were established. In the literature, no study has yet compared these classification systems with respect to the risk of developing mechanical complications. PURPOSE To assess and compare the ability of the Schwab classification and the GAP score to predict mechanical complications following adult spinal deformity surgery. STUDY DESIGN Two-center, retrospective cohort study. PATIENT SAMPLE Thirty-nine patients suffering adult spinal deformity who underwent long segment spinal fusion (≥4 levels), minimum follow-up of 2years. OUTCOME MEASURES The ability of the Schwab classification and GAP score to predict mechanical failure was determined by computing the Area Under the receiver operating characteristic curve. METHODS Full-spine pre- and postoperative radiographs of all patients were analyzed for mechanical complications. Subsequently, the pre- and postoperative Schwab and GAP score were determined. Logistic regression analysis was used to assess the ability of both systems to determine which was the most appropriate for the prediction of mechanical failure. Correlations between the various factors constituting the GAP score and Schwab classification were estimated using the Spearman rank order correlation coefficient. RESULTS The results demonstrated that both classification systems are capable of predicting radiographic evidence of mechanical failure; however, the GAP score proved to be significantly better (p=.003). The relative pelvic version of the GAP score serves a similar role as the pelvic tilt modifier from the Schwab classification (ρ=-0.84, p<.01). The relative lumbar lordosis from the GAP score functions much like the PI-LL modifier from the Schwab classification (ρ=-0.94, p<.01). The GAP score is most significantly dependent on relative spinopelvic alignment, relative lumbar lordosis, and relative pelvic version (ρ=0.85, ρ=0.84, and ρ=0.84, respectively, p<.01). Correlation with the lordosis distribution index was also significant but was not as strong (ρ=0.65, p<.01). Age, on the contrary, showed poor correlation with the GAP score (ρ=0.17, p=.300). CONCLUSIONS Both the Schwab classification and the GAP score are capable of predicting mechanical complications. The GAP score proved to be significantly more appropriate. This difference is probably attributed to the fact that in the GAP score all parameters are related to the patient's individual pelvic incidence.
Collapse
Affiliation(s)
- Eva Jacobs
- Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Barend J van Royen
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johannes M R Merk
- Department of Finance, Maastricht University, Maastricht, the Netherlands
| | - Agnita Stadhouder
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Lodewijk W van Rhijn
- Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul C Willems
- Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
| |
Collapse
|
46
|
Zhu WY, Zang L, Li J, Guan L, Hai Y. A biomechanical study on proximal junctional kyphosis following long-segment posterior spinal fusion. Braz J Med Biol Res 2019; 52:e7748. [PMID: 31038576 PMCID: PMC6487758 DOI: 10.1590/1414-431x20197748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 02/11/2019] [Indexed: 11/29/2022] Open
Abstract
Posterior long-segment spinal fusion may lead to proximal junctional kyphosis (PJK). The present study sought to identify the appropriate fusion levels required in order to prevent PJK using finite element analysis. A finite element model was constructed based on the whole-spine computed tomography findings of a healthy adult. Nine commonly used posterior spinal fusion methods were selected. Stress on the annulus fibrosis fibers, the posterior ligamentous complex, and the vertebrae after various spinal fusions in the upright position were compared. This study was divided into two groups: non-fusion and fusion. In the former, the stress between the T10 and the upper thoracic vertebrae was higher. Comparing thoracic and lumbar segments in the fusion group, the peak stress values of the upper instrumented vertebrae (UIV) were mainly observed in T2 and L2 whilst those of the UIV+1 were observed in T10 and L2. After normalization, the peak stress values of the UIV and UIV+1 were located in T2 and L2. Similarly, the peak stress values of the annulus fibrosus at the upper adjacent level were on T10 and L2 after normalization. However, the peak stress values of the interspinal/supraspinal complex forces were concentrated on T11, T12, and L1 after normalization whilst the peak stress value of the pedicle screw was on T2. Controversy remains over the fusion of T10, and this study simulated testing conditions with gravitational loading only. However, further assessment is needed prior to reaching definitive conclusions.
Collapse
Affiliation(s)
- Wen-Yi Zhu
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jian Li
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li Guan
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
47
|
Passias PG, Jalai CM, Diebo BG, Cruz DL, Poorman GW, Buckland AJ, Day LM, Horn SR, Liabaud B, Lafage R, Soroceanu A, Baker JF, McClelland S, Oren JH, Errico TJ, Schwab FJ, Lafage V. Full-Body Radiographic Analysis of Postoperative Deviations From Age-Adjusted Alignment Goals in Adult Spinal Deformity Correction and Related Compensatory Recruitment. Int J Spine Surg 2019; 13:205-214. [PMID: 31131222 PMCID: PMC6512393 DOI: 10.14444/6028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Full-body stereographs for adult spinal deformity (ASD) have enhanced global deformity and lower-limb compensation associations. The advent of age-adjusted goals for classic ASD parameters (sagittal vertical axis, pelvic tilt, spino-pelvic mismatch [PI-LL]) has enabled individualized evaluation of successful versus failed realignment, though these remain to be radiographically assessed postoperatively. This study analyzes pre- and postoperative sagittal alignment to quantify patient-specific correction against age-adjusted goals, and presents differences in compensation in patients whose postoperative profile deviates from targets. METHODS Single-center retrospective review of ASD patients ≥ 18 years with biplanar full-body stereographic x-rays. Inclusion: ≥ 4 levels fused, complete baseline and early (≤ 6-month) follow-up imaging. Correction groups generated at postoperative visit for actual alignment compared to age-adjusted ideal values for pelvic tilt, PI-LL, and sagittal vertical axis derived from clinically relevant formulas. Patients that matched exact ± 10-year threshold for age-adjusted targets were compared to unmatched cases (undercorrected or overcorrected). Comparison of spinal alignment and compensatory mechanisms (thoracic kyphosis, hip extension, knee flexion, ankle flexion, pelvic shift) across correction groups were performed with ANOVA and paired t tests. RESULTS The sagittal vertical axis, pelvic tilt, and PI-LL of 122 patients improved at early postoperative visits (P < .001). Of lower-extremity parameters, knee flexion and pelvic shift improved (P < .001), but hip extension and ankle flexion were similar (P > .170); global sagittal angle decreased overall, reflecting global postoperative correction (8.3° versus 4.4°, P < .001). Rates of undercorrection to age-adjusted targets for each spino-pelvic parameter were 30.3% (sagittal vertical axis), 41.0% (pelvic tilt), and 43.6% (PI-LL). Compared to matched/overcorrections, undercorrections recruited increased posterior pelvic shift to compensate (P < .001); knee flexion was recruited in undercorrections for sagittal vertical axis and pelvic tilt; thoracic hypokyphosis was observed in PI-LL undercorrections. All undercorrected groups displayed consequentially larger global sagittal angle (P < .001). CONCLUSIONS Global alignment cohort improvements were observed, and when comparing actual to age-adjusted alignment, undercorrections recruited pelvic and lower-limb flexion to compensate. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Cyrus M Jalai
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Dana L Cruz
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Gregory W Poorman
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Aaron J Buckland
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Louis M Day
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Samantha R Horn
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Barthélemy Liabaud
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Alexandra Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Joseph F Baker
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Shearwood McClelland
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Jonathan H Oren
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Thomas J Errico
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| |
Collapse
|
48
|
Praeger AJ, Wang YYI, Goldschlager T. Intraoperatively predicting postoperative sagittal balance using intraoperative X-rays. J Clin Neurosci 2019; 63:48-54. [PMID: 30827877 DOI: 10.1016/j.jocn.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/15/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
This study aimed to assess the correlation of sagittal balance parameters measured intraoperatively, against the gold standard post-operative standing full spine X-ray. A secondary aim was to create a predictive algorithm, that could be used intraoperatively to predict the post-operative balance. 49 patients, who underwent thoracolumbar spinal fusion over a 12-month period were included in this study. Standing full-spine X-rays were obtained both pre and post-surgical fixation. Parallel intraoperative X-rays were taken with the c-arm centred on femoral heads, operative level, S1 and L1. The sagittal parameters pelvic incidence (PI), lumbar lordosis (LL), spino-pelvic mismatch (PI-LL), and sagittal vertical axis were then measured and the correlations statistically analysed. For prone positioned patients the mean LL was 59.9° ± 10.6° intraoperatively (post-fixation) and post-operatively 55.4° ± 10.9° with a mean difference of -4.5° ± 6.1° (p-value < 0.001). For laterally positioned patients the mean LL was 50.9° ± 8.6° intraoperatively and 53.1° ± 10.1° postoperatively for a mean difference of -2.3° ± 6.5° (p-value = 0.117). The linear regression analysis resulted in a predictive algorithm that can be utilised intraoperatively to predict the post-operative standing pelvic mismatch for prone positioned patients. In conclusion, measuring spino-pelvic parameters of sagittal balance intraoperatively can be used to estimate postoperative standing full spine x-ray result. Specifically, in the prone position, the surgeon should aim for intraoperative lordosis that is 4.5° more than the desired post-operative lordosis. The predictive formula provides a direct method to quickly calculate the post-operative pelvic mismatch intraoperatively.
Collapse
Affiliation(s)
- Adrian J Praeger
- Department of Neurosurgery, Monash Health, Melbourne, Australia.
| | - Yi Yuen Ian Wang
- Department of Neurosurgery, St Vincent's Hospital, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| |
Collapse
|
49
|
Abstract
STUDY DESIGN A retrospective analysis of data collected prospectively in an adult spine deformity multicenter database. OBJECTIVE The aim of this study was to determine the impact of adult scoliosis (AS) on the type of Roussouly sagittal shape in terms of classification applicability, scoliosis modification of a patient theoretical sagittal shape, and coronal-sagittal deformity associations. SUMMARY OF BACKGROUND DATA Roussouly described a four-type sagittal shape classification in healthy individuals, which has been also applied to patients with degenerative spinal disease. However, it remains uncertain if its principles can be applied to AS patients. METHODS AS patients recorded in a prospective multicenter database of adult spinal deformity were included. Preoperative sagittal radiographs were analyzed using the KEOPS software to measure pelvic parameters, global sagittal alignment, and the various criteria used for the Roussouly classification. The different sagittal shape types were compared using the Chi-square and McNemars tests, and analysis of variance with Bonferroni correction. RESULTS The classification was applicable to all of the 190 analyzed AS patients. In addition to Roussouly criteria, two parameters helped differentiate the different shapes: T10-L2 angle (24° ± 19 type-1; 14° ± 15 type-2; 3° ± 15 type-3; 0.4° ± 14 type-4; P < 0.001), and lordosis distribution index (90% ± 17 type-1; 83% ± 16 type-2; 73% ± 21 type-3; 63% ± 16 type-4; P < 0.001). AS changed the theoretical shape in 34% of the patients (P < 0.001). Curve etiology and curve pattern were not associated with any particular type of sagittal shape (P > 0.05). Type-1 was associated with older patients (P = 0.02), degenerative curves (P = 0.02), and greater PI-LL mismatch (P = 0.012). Types 3 to 4 were associated with younger age and idiopathic etiology (P < 0.001). CONCLUSION Roussouly four-type sagittal shape classification could be applied to AS patients. AS modified the theoretical type in one of every three patients. No particular association was found between the sagittal types and specific coronal deformities. Sagittal shape recognition in patients with AS will help restore the appropriate theoretical shape through surgery, which can eventually lead to better surgical outcomesLevel of Evidence: 2.
Collapse
|
50
|
Jack-knife Posture After Correction Surgery for Degenerative Sagittal Imbalance-Does Spinopelvic Parameter Always Matter in Preventing Stooping Posture? Spine Deform 2019; 6:771-780. [PMID: 30348357 DOI: 10.1016/j.jspd.2018.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/31/2018] [Accepted: 03/06/2018] [Indexed: 11/22/2022]
Abstract
STUDY DESIGN A retrospective comparative cohort study. OBJECTIVE To investigate the causes of jack-knife posture (JKP) without proximal junctional kyphosis (PJK) and to compare the causes of PJK and JKP without PJK. SUMMARY OF BACKGROUND DATA PJK causing stooping posture could be inevitable after long instrumented lumbar fusion for degenerative sagittal imbalance. However, few studies have addressed JKP without PJK, which is a different type of sagittal malalignment. METHODS Ninety-four adult patients who underwent long instrumented lumbar fusion for degenerative sagittal imbalance were divided into three groups depending on the presence of a postoperative sagittal deformity: JKP, PJK, or none. JKP was defined as a sagittal vertical axis of at least 8 cm anterior to the posterosuperior corner of S1 upper endplate without PJK. PJK was defined as a proximal kyphotic angle ≥10° and at least 10° greater than the preoperative measurement. RESULTS Seventeen patients (18.1%) showed JKP, and 39 patients (41.5%) showed PJK. The mean age at the surgery of JKP and PJK patients was 70.0 and 65.5 years, respectively (p = .05). JKP developed more frequently if the preoperative pelvic tilt was <25° or the sagittal vertical axis was >8 cm (p = .048, 0.004, respectively). PJK developed more frequently if the preoperative pelvic tilt was >25°, surgically corrected lumbar lordosis was >30°, or the lumbar lordosis to thoracic kyphosis angle was <0° (p = .002, .010, .031, respectively). JKP was more likely to develop in patients without sacropelvic fixation (p = .042), although they had a more degenerative L5-S1 segment (p = .010). CONCLUSIONS Postoperative sagittal deformity can be classified into two types: JKP and PJK. JKP is caused mainly by hip and back extensor muscle weakness even though the cause of postoperative sagittal decompensation could be multifactorial. However, PJK developed mainly due to spinopelvic malalignment. Therefore, hip and back extensor weakness, which is age-dependent, may explain why older patients experienced more postoperative sagittal deformity. LEVEL OF EVIDENCE Level IV.
Collapse
|