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Passias PG, Ahmad W, Tretiakov PS, Lafage R, Lafage V, Schoenfeld AJ, Line B, Daniels A, Mir JM, Gupta M, Mundis G, Eastlack R, Nunley P, Hamilton DK, Hostin R, Hart R, Burton DC, Shaffrey C, Schwab F, Ames C, Smith JS, Bess S, Klineberg EO. Critical Analysis of Radiographic and Patient-Reported Outcomes Following Anterior/Posterior Staged Versus Same-Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity. Spine (Phila Pa 1976) 2024; 49:893-901. [PMID: 37450674 DOI: 10.1097/brs.0000000000004774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
STUDY DESIGN A retrospective cohort study of a prospectively collected multicenter adult spinal deformity (ASD) database. OBJECTIVE The aim of this study was to compare staged procedures to same-day interventions and identify the optimal time interval between staged surgeries for the treatment of ASD. BACKGROUND Surgical intervention for ASD is an invasive and complex procedure that surgeons often elect to perform on different days (staging). Yet, there remains a paucity of literature on the timing and effects of the interval between stages. MATERIALS AND METHODS ASD patients with 2-year data undergoing an anterior/posterior (A/P) fusion to the ilium were included. Propensity score matching was performed for the number of levels fused, number of interbody devices, surgical approaches, number of osteotomies/three-column osteotomy, frailty, Oswestry Disability Index, Charlson Comorbidity Index, revisions, sagittal vertical axis, pelvic incidence-lumbar lordosis, and upper instrumented vertebrae to create balanced cohorts of same-day and staged surgical patients. Staged patients were stratified by intervening time-period between surgeries, using quartiles. RESULTS A total of 176 propensity score-matched patients were included. The median interval between A/P staged procedures was 3 days. Staged patients had greater operative time and lower intensive care unit stays postoperatively ( P <0.05). At 2 years, staged compared with same-day showed a greater improvement in T1 slope-cervical lordosis, C2 sacral slope, and SRS-Schwab sagittal vertical axis ( P <0.05). Staged patients had higher rates of minimal clinically important difference for 1-year SRS-Appearance and 2-year Physical Component Summary scores. Assessing different intervals of staging, patients at the 75th percentile interval showed greater improvement in 1-year SRS-Pain and SRS-Total postoperative as well as SRS-Activity, Pain, Satisfaction, and Total scores ( P <0.05) compared with patients in lower quartiles. Compared with the 25th percentile, patients reaching the 50th percentile interval were associated with increased odds of improvement in Global Alignment and Proportion score proportionality [9.3 (1.6-53.2), P =0.01]. CONCLUSIONS This investigation is among the first to compare multicenter staged and same-day surgery A/P ASD patients fused to ilium using propensity matching. Staged procedures resulted in significant improvement radiographically, reduced intensive care unit admissions, and superior patient-reported outcomes compared with same-day procedures. An interval of at least 3 days between staged procedures is associated with superior outcomes in terms of Global Alignment and Proportion score proportionality.
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Affiliation(s)
- Peter G Passias
- Department of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY
| | - Waleed Ahmad
- Department of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY
| | - Peter S Tretiakov
- Department of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY
| | - Renaud Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Andrew J Schoenfeld
- Department of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, Boston, MA
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | - Alan Daniels
- Department of Orthopedics, Brown University, Warren Alpert Medical School, Providence, RI
| | - Jamshaid M Mir
- Department of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO
| | - Gregory Mundis
- Department of Orthopedic Surgery, San Diego Center for Spinal Disorders, La Jolla, CA
| | - Robert Eastlack
- Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA
| | - Pierce Nunley
- Department of Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, LA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX
| | - Robert Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | | | - Frank Schwab
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, CA
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Moses J, Hach S, Mason J, Treacher A. Defining and measuring objective and subjective spinal stiffness: a scoping review. Disabil Rehabil 2023; 45:4489-4502. [PMID: 36516462 DOI: 10.1080/09638288.2022.2152878] [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: 09/25/2020] [Accepted: 11/24/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Examine and identify the breadth of definitions and measures of objective and subjective spinal stiffness in the literature, with a focus on clinical implications. METHODS A scoping review was conducted to determine what is known about definitions and measures of the specific term of spinal stiffness. Following the framework by Arksey and O'Malley, eligible peer-reviewed studies identified using PubMed, Ebsco health, and Scopus were included if they reported definitions or measures of spinal stiffness. Using a data abstraction form, the studies were classified into four themes: biomechanical, surgical, pathophysiological, and segmental spinal assessment. To identify similarities and differences between studies, sixteen categories were generated. RESULTS In total, 2426 records were identified, and 410 met the eligibility criteria. There were 350 measures (132 subjective; 218 objective measures) and 93 indicators of spinal stiffness. The majority of studies (n = 69%) did not define stiffness. CONCLUSION This review highlights the breadth of objective and subjective measures that are both clinically and methodologically diverse. There is no consensus regarding a standardised definition of stiffness in the reviewed literature.
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Affiliation(s)
- Joel Moses
- Private Practice, Cambridge, New Zealand
| | - Sylvia Hach
- School of Community Studies, Unitec Institute of Technology, Auckland, New Zealand
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Haddad S, Yasuda T, Vila-Casademunt A, Yilgor Ç, Nuñez-Pereira S, Ramirez M, Pizones J, Alanay A, Kleinstuck F, Obeid I, Pérez-Grueso FJS, Matsuyama Y, Pellisé F. Revision surgery following long lumbopelvic constructs for adult spinal deformity: prospective experience from two dedicated databases. 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; 32:1787-1799. [PMID: 36939889 DOI: 10.1007/s00586-023-07627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE Pan Lumbar Arthodesis (PLA) are often required for Adult Spinal Deformity (ASD) correction, reducing significantly the compensatory capacity in case of postoperative sagittal malalignment. Few papers have investigated outcomes and complications in this vulnerable subset of patients. The objective of this study was to assess revision surgery rate for PLA in ASD, its risk factors and impact on clinical outcomes. METHODS Retrospective multicenter review of prospective ASD data from 7 hospitals covering Europe and Asia. ASD patients included in two prospective databases having a posterior instrumentation spanning the whole lumbar region with more than 2-years of follow-up were reviewed. Demographic, surgical, radiographic parameters and Health-Related Quality of Life (HRQoL) scores were analyzed. Univariate and multivariate regression models analyzed risk factors for revision surgery as well as surgical outcomes. Patients with Early versus Late and PJK versus Non-PJK mechanical complications were also compared. RESULTS Out of 1359 ASD patients included in the database 589 (43%) had a PLA and 357 reached 2-years mark. They were analyzed and compared to non-PLA patients. Average age was 67 and 82% were females. 100 Patients (28.1%) needed 114 revision surgeries (75.4% for mechanical failures). Revised patients were more likely to have a nerve system disorder, higher BMI and worst immediate postoperative alignment (as measured by GAP Parameters). These risk factors were also associated with earlier mechanical complications and PJK. Deformity and HRQoL parameters were comparable at baseline. Non-revised patients had significantly better clinical outcomes at 2-years (SRS 22 scores, ODI, Back pain). Multivariate analysis could identify nerve system disorder (OR 4.8; CI 1.8-12.6; p = 0.001), postoperative sagittal alignment (GAP Score) and high BMI (OR 1.07; CI 1.01-1.13; p = 0.004) as independent risk factors for revisions. CONCLUSIONS Revision surgery due to mechanical failures is relatively common after PLA leading to worse clinical outcomes. Prevention strategies should focus on individualized restoration of sagittal alignment and better weight control to decrease stress on these rigid constructs in non-compliant spines. Nerve system disorders independently increase revision risk in PLA. LEVEL OF EVIDENCE II Prognosis.
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Affiliation(s)
- Sleiman Haddad
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain.
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
| | - Tatsuya Yasuda
- Department of Orthopedic Surgery, Iwata City Hospital, Iwata-City, Shizuoka, Japan
| | | | - Çaglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey
| | - Susana Nuñez-Pereira
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - Manuel Ramirez
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - Javier Pizones
- Spine Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey
| | | | - Ibrahim Obeid
- Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | | | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-City, Shizuoka, Japan
| | - Ferran Pellisé
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
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Ushio S, Yoshii T, Otani K, Shindo S, Mizuno K, Kusano K, Yamada T, Inose H, Hirai T, Yuasa M, Kawabata A, Nakai O, Okawa A. Pelvic incidence is a risk factor for lower instrumented vertebra failure in adult spinal deformity patients who underwent corrective fusion terminating at the L5 vertebra. J Orthop Sci 2023; 28:302-307. [PMID: 34924249 DOI: 10.1016/j.jos.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/12/2021] [Accepted: 11/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Factors related to postoperative mechanical failure after long fusion with lower instrumented vertebra (LIV) at L5 have not been well investigated. Elucidating such factors may allow us to perform alternatives to spinopelvic fusion for adult spinal deformity (ASD) cases. We investigated the incidence and risk factors of LIV failure in patients with ASD who underwent surgical treatment of long corrective fusion until the L5 vertebrae. METHODS Between 2009 and 2018, 52 patients who underwent corrective fusions to L5 were followed-up for at least one-year. We evaluated the associated patient factors for LIV failure which include loosening of the pedicle screw of LIV, fracture of LIV, distal junctional kyphosis (DJK). RESULTS The mean age of the participants was 71.2 ± 7.59 (range, 44-84). LIV failure occurred in 20 patients (38.5%), and 6 patients (11.5%) underwent secondary surgery for caudal segments. The mean pelvic incidence (PI) was 52.5 ± 9.8 in the failure group versus 45.3 ± 11.4 in non-failure group (P = 0.02) and pelvic tilt (PT) was 39.1 ± 9.0 versus 32.4 ± 13.0. There were no significant differences in sex, age, body mass index, number of levels fused, and other radiographic data. Logistic regression analysis that included T1 pelvic angle, PT, PI - postoperative LL and PI also identified PI as the only significant determinant of LIV failure (OR = 1.07, P = 0.034). Receiver operating characteristic analysis demonstrated that a PI over 50.0° was associated with LIV failure (sensitivity 63%, specificity 70%, AUC 0.694). CONCLUSION LIV failure was frequently observed after long corrective fusion for patients with ASD. High PI was found to be a significant risk factor for the LIV failure.
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Affiliation(s)
- Shuta Ushio
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
| | - Kazuyuki Otani
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Shigeo Shindo
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Kouichi Mizuno
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Kazuo Kusano
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Tsuyoshi Yamada
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Hiroyuki Inose
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Takashi Hirai
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Masato Yuasa
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Atsuyuki Kawabata
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Osamu Nakai
- Department of Orthopaedic Surgery, Kudanzaka Hospital, Chiyoda-ku, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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5
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Cervical Spine Research Society-Cervical Stiffness Disability Index (CSRS-CSDI): Validation of a Novel Scoring System Quantifying the Effect of Postarthrodesis Cervical Stiffness on Patient Quality of Life. Spine (Phila Pa 1976) 2022; 47:1263-1269. [PMID: 35797641 DOI: 10.1097/brs.0000000000004402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE The aim was to create and validate a novel patient-reported outcome measure (PROM) focusing on stiffness-related patient functional limitations after cervical spine fusion. SUMMARY OF BACKGROUND DATA Cervical arthrodesis is a common treatment for myelopathy/radiculopathy, however, results in increased neck stiffness as a collateral outcome. No current PROM exists quantifying the impact of postoperative stiffness on patient function. METHODS The Cervical Spine Research Society-Cervical Stiffness Disability Index (CSRS-CSDI) was created through a modified Delphi process. The resultant 10-item questionnaire yields a score out of 100 with higher scores indicating increased functional difficulty related to neck stiffness. Cross-sectional study of control and postoperative patients was completed for CSRS-CSDI validation. Retest reliability (intraclass correlation coefficient), internal consistency (Cronbach alpha), responsiveness (levels fused vs. CSRS-CSDI scores), and discriminatory validation (CSRS-CSDI vs. neck disability index) scores) were completed. RESULTS Fifty-seven surgical and 24 control patients completed the questionnaire. Surgical patients underwent a variety of procedures: 11 (19%) motion preserving operations, nine (16%) subaxial 1-2 level fusions, seven (12%) subaxial 3-5 level fusions, five (9%) C1-subaxial cervical spine fusions, 20 (35%) C2-upper thoracic spine fusions, five (9%) occiput-subaxial or thoracic spine fusions. The questionnaire demonstrated high internal consistency (Cronbach alpha=0.92) and retest reliability (intraclass correlation coefficient=0.95, P <0.001). Good responsiveness validity with a significant difference between fusion cohorts was found ( P <0.001, rs =0.63). Patient CSRS-CSDI scores also correlated with neck disability index scores recorded ( P <0.001, r =0.70). CONCLUSION This is the first study to create a PROM addressing the functional impact of cervical stiffness following surgical arthrodesis. The CSRS-CSDI was a reliable and valid measure of postoperative stiffness impact on patient function. This may prove useful in counseling patients regarding their expected outcomes with further investigation demonstrating its value in a prospective fashion.
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Takami M, Kawakami M, Hashizume H, Tsutsui S, Oka H, Shinozaki T, Iwasaki H, Yamada H. Psychometric Evaluation and External Validity of the Japanese Version of Lumbar Stiffness Disability Index. Spine Surg Relat Res 2022; 6:696-703. [PMID: 36561157 PMCID: PMC9747221 DOI: 10.22603/ssrr.2022-0066] [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: 03/12/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction Long fusion surgery for adult spinal deformity may restrict activities of daily living due to lumbar stiffness. While the Lumbar Stiffness Disability Index (LSDI) can help assess lumbar stiffness, in Asia the external validity of this questionnaire has not been sufficiently examined. We performed the psychometric evaluation and external validation of the Japanese version of the LSDI (LSDI-J). Methods Fifty consecutive patients (14 males and 36 females; mean age 70.6 years) who underwent lumbar fusion surgery at our institution a minimum of one year after surgery and who visited the outpatient clinic between April and May 2019, were surveyed using the LSDI-J. The mean number of fusion levels was 4.4. Cronbach's alpha coefficients were calculated for internal consistency, and the intraclass correlation coefficient (ICC) was calculated to evaluate reliability. External validity was assessed by comparisons with the Oswestry Disability Index (ODI), the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and the lumbar range of motion (LROM) with LSDI-J scores. Results Cronbach's alpha coefficient was 0.652 overall, and 0.849 after excluding Question 10 due to a low response rate. The ICC was 0.824 overall and 0.851 after excluding Question 10. The correlation with the ODI was 0.684, and the correlation coefficients with each domain of the JOABPEQ ranged from -0.590 to -0.413, indicating moderate correlation. However, LROM and the LSDI-J were not correlated (r=-0.055, P=0.734). Conclusions The LSDI-J may not be suitable in Japan because there was no correlation with LROM, the most important factor for external validity. It may be necessary to investigate why the LSDI-J did not apply to the Japanese population in terms of lower limb function. Alternatively, a unique method may be needed to assess lumbar stiffness disability that is more suitable for actual clinical practice in Japan.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Mamoru Kawakami
- Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, The University of Tokyo, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Wu N, Shao J, Zhang Z, Wang S, Li Z, Zhao S, Yang Y, Liu L, Yu C, Liu S, Zhao Z, Du Y, Zhang Y, Wang L, Zhao Y, Yu K, Zhao H, Shen J, Qiu G, Wu Z, Zhang TJ. Factors and predictive model associated with perioperative complications after long fusion in the treatment of adult non-degenerative scoliosis. BMC Musculoskelet Disord 2021; 22:483. [PMID: 34034738 PMCID: PMC8152117 DOI: 10.1186/s12891-021-04361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/10/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Adult non-degenerative scoliosis accounts for 90% of spinal deformities in young adults. However, perioperative complications and related risk factors of long posterior instrumentation and fusion for the treatment of adult non-degenerative scoliosis have not been adequately studied. Methods We evaluated clinical and radiographical results from 146 patients with adult non-degenerative scoliosis who underwent long posterior instrumentation and fusion. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for perioperative complications. Potential and independent risk factors for perioperative complications were evaluated by univariate analysis and logistic regression analysis. Results One hundred forty-six adult non-degenerative scoliosis patients were included in our study. There were 23 perioperative complications for 21 (14.4%) patients, eight of which were cardiopulmonary complications, two of which were infection, six of which were neurological complications, three of which were gastrointestinal complications, and four of which were incision-related complication. The independent risk factors for development of total perioperative complications included change in Cobb angle (odds ratio [OR] = 1.085, 95% CI = 1.035 ~ 1.137, P = 0.001) and spinal osteotomy (OR = 3.565, 95% CI = 1.039 ~ 12.236, P = 0.043). The independent risk factor for minor perioperative complications is change in Cobb angle (OR = 1.092, 95% CI = 1.023 ~ 1.165, P = 0.008). The independent risk factors for major perioperative complications are spinal osteotomy (OR = 4.475, 95% CI = 1.960 ~ 20.861, P = 0.036) and change in Cobb angle (OR = 1.106, 95% CI = 1.035 ~ 1.182, P = 0.003). Conclusions Our study indicate that change in Cobb angle and spinal osteotomy are independent risk factors for total perioperative complications after long-segment posterior instrumentation and fusion in adult non-degenerative scoliosis patients. Change in Cobb angle is an independent risk factor for minor perioperative complications. Change in Cobb angle and spinal osteotomy are independent risk factors for major perioperative complications.
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Affiliation(s)
- Nan Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China.
| | - Jiashen Shao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - Zhen Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ziquan Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Sen Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China
| | - Yang Yang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lian Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - Chenxi Yu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - Sen Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhengye Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - You Du
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China
| | - Yuanqiang Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China.,Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Lianlei Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Beijing, 100005, China.,Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yu Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Keyi Yu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hong Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jianxiong Shen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Guixing Qiu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China
| | | | - Zhihong Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China.,Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Terry Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China.
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Deckey DG, Gulbrandsen MT, Hinckley NB, Lara N, Mayfield CK, Makovicka JL, Adeniyi B, Chang MS. Does Laterality Matter? The Effect of Unilateral v. Bilateral Sacroiliac Screw Fixation on Personal Hygiene. Global Spine J 2021; 13:1036-1041. [PMID: 34000853 DOI: 10.1177/21925682211015675] [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 comparative analysis of prospective cohort. OBJECTIVE To determine whether sacroiliac (SI) screw fixation ipsilateral to hand dominance compared to bilateral fixation impacts personal hygiene (wiping) after toileting. METHODS Inclusion criteria were adult spinal deformity (ASD) patients with long arthrodesis (≥T12-pelvis) who had undergone primary unilateral or bilateral SI fixation with a minimum of 2-years-follow-up. RESULTS 117 consecutive patients were included and separated into 2 groups: bilateral SI fixation (BL, n = 61) and unilateral SI fixation (UNI, n = 56), with no difference in age. Of UNI patients, 10.7% (6) performed personal hygiene with a different hand after surgery, compared to 6.6% (4) of patients who received BL fixation (P = 0.422). All UNI patients who switched hands were right-hand dominant, and 5/6 received right-sided fixation. There was no statistical difference found between number of levels fused (<8, 9-11, or >11 levels) and changes in personal hygiene habits. Over a third of patients from both groups had difficulty performing personal hygiene after fusion (UNI = 39.3% BL = 36.1%, P = 0.719). CONCLUSION SI screws increase the difficulty of performing personal hygiene; yet, the side of unilateral screws does not significantly change personal hygiene habits when compared to bilateral screw placement. Moreover, the length of the construct does not have a significant impact on ability to perform personal hygiene, cause changes in habits, or require the assistance of another individual. However, among our sample of individuals, bilateral fixation did result in a higher rate of revision instrumentation.
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Affiliation(s)
- David G Deckey
- 23387Mayo Clinic Arizona, Department of Orthopaedic Surgery; Phoenix, AZ, USA
| | | | | | - Nina Lara
- 23387Mayo Clinic Arizona, Department of Orthopaedic Surgery; Phoenix, AZ, USA
| | - Cory K Mayfield
- Keck School of Medicine, 5116University of Southern California; Los Angeles, CA, USA
| | - Justin L Makovicka
- 23387Mayo Clinic Arizona, Department of Orthopaedic Surgery; Phoenix, AZ, USA
| | | | - Michael S Chang
- 23387Mayo Clinic Arizona, Department of Orthopaedic Surgery; Phoenix, AZ, USA.,Sonoran Spine Center; Tempe, AZ, USA
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Construct Validity and Reliability of the Japanese Version of the Lumbar Stiffness Disability Index. Spine (Phila Pa 1976) 2021; 46:E333-E337. [PMID: 33156281 DOI: 10.1097/brs.0000000000003772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Outcome study to determine the construct validity and reliability of the Japanese version of the Lumbar Stiffness Disability Index. OBJECTIVE The aim of this study was to evaluate the psychometric measurement properties of the Japanese version of the Lumbar Stiffness Disability Index (J-LSDI) following lumbar spinal surgery in order to assess its construct validity and reliability. SUMMARY OF BACKGROUND DATA The LSDI was designed and validated as a tool to assess functional impacts of lumbar spine stiffness and diminished spinal flexibility. A Japanese version has been developed, but its construct validity and reliability have not been evaluated. METHODS A Pearson correlation coefficient was calculated using flexion and extension range of motion, Oswestry Disability Index (ODI) and Tampa Scale for Kinesiophobia (TSK) as external standards to evaluate construct validity. An intraclass correlation coefficient (ICC) and a Bland-Altman analysis were used to evaluate test-retest reliability. RESULTS A total of 244 patients following lumbar spinal surgery participated in the study. Fifty one of the 244 patients participated in the reliability study. The ICC of the J-LSDI for test-retest reliability was 0.89 (95% confidence interval, 0.79-0.93). There was no systematic error found in the results of the Bland-Altman analysis. One hundred ninety-three of the 244 patients participated in the validity study. There were significant correlations between the J-LSDI and trunk flexion range of motion (r = -0.66), extension (r = -0.51), ODI (r = 0.62), and TSK (r = 0.38). CONCLUSION The construct validity and reliability of the Japanese version of the LSDI were confirmed. The J-LSDI can be used to evaluate lumbar stiffness and associated disability in Japanese patients following lumbar spinal surgery.Level of Evidence: 2.
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Koller H, Koller J, Stengel F, Meyer B. [Surgical challenges with spinal balance in adult spinal deformities-the forgotten coronal plane]. DER ORTHOPADE 2020; 49:883-892. [PMID: 32880703 DOI: 10.1007/s00132-020-03993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article gives a brief overview of the importance, planning and correction of coronal spinal imbalance in patients with adult and pediatric spinal deformity.
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Affiliation(s)
- Heiko Koller
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland. .,Universitätsklinik für Orthopädie und Traumatologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
| | | | - Felix Stengel
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Bernhard Meyer
- Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Can we stop the long fusion at L5 for selected adult spinal deformity patients with less severe disability and less complex deformity? Clin Neurol Neurosurg 2020; 194:105917. [PMID: 32454414 DOI: 10.1016/j.clineuro.2020.105917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES It is controversial whether to stop the fusion at L5 or S1 in adult spinal deformity (ASD) surgery. Our hypothesis is that we can stop long fusion at L5 for selected patients with less severe disability and less complex deformity. Aim was to compare minimum 5-year outcomes between ASD patients with fusion to L5 versus S1. PATIENTS AND METHODS Consecutive 40 patients (≥50 years of age) with ASD underwent spinal fusion from lower thoracic spine to L5 or S1 between 2008 and 2011. 33 patients (82.5 %) had a minimum 5-year follow-up. Lower instrumented vertebra (LIV) was L5 in 12 patients (L5 group) and S1 in 21 (S1 group). Clinical and radiographical parameters were compared between L5 and S1 group. RESULTS There were statistically significant differences between two groups (L5 vs S1) in %male (50 % vs 14 %), %type-N of SRS-Schwab classification (83 % vs 38 %), preop ODI (40.5 vs 56), correction loss of LL (11˚ vs 3˚), final TK (32˚ vs 50˚), correction loss of TK (-1˚ vs 17˚), final improvement of PT (3˚ vs 10˚), final improvement of PI-LL (26˚ vs 39˚), PJK (8% vs 48 %), and revision surgery rate (50 % vs 14 %). Causes of revision surgery in L5 group were distal junctional failure in 5 patients and foraminal stenosis at L5-S1 in 1. All of them underwent additional spinal fusion to the sacrum. Whereas, causes of revision surgery in S1 group were rod fracture in 2 patients and proximal junctional failure in 1. CONCLUSION Although fusion to L5 was conducted for selected ASD patients with less severe disability (better ODI) and less complex deformity (type N), 50 % of the patients required additional fusion to the pelvis. Decision making to stop the long fusion at L5 for ASD patients ≥50 years of age should be made with careful considerations.
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Jia F, Wang G, Liu X, Li T, Sun J. Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis. 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; 29:24-35. [DOI: 10.1007/s00586-019-06187-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 08/31/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose
Choosing an optimal distal fusion level for adult spinal deformity (ASD) is still controversial. To compare the radiographic and clinical outcomes of distal fusion to L5 versus the sacrum in ASD, we conducted a meta-analysis.
Methods
Relevant studies on long fusion terminating at L5 or the sacrum in ASD were retrieved from the PubMed, Embase, Cochrane, and Google Scholar databases. Then, studies were manually selected for inclusion based on predefined criteria. The meta-analysis was performed by RevMan 5.3.
Results
Eleven retrospective studies with 1211 patients were included in meta-analysis. No significant difference was found in overall complication rate (95% CI 0.60 to 1.30) and revision rate (95% CI 0.59 to 1.99) between fusion to L5 group (L group) and fusion to the sacrum group (S group). Significant lower rate of pseudarthrosis and implant-related complications (95% CI 0.29 to 0.64) as well as proximal adjacent segment disease (95% CI 0.35 to 0.92) was found in L group. Patients in S group obtained a better correction of lumbar lordosis (95% CI − 7.85 to − 0.38) and less loss of sagittal balance (95% CI − 1.80 to − 0.50).
Conclusion
Our meta-analysis suggested that long fusion terminating at L5 or the sacrum was similar in scoliosis correction, overall complication rate, revision rate, and improvement in pain and disability. However, fusion to L5 had advantages in lower rate of pseudarthrosis, implant-related complications, and proximal adjacent segment disease, while fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance, and absence of distal adjacent segment disease.
Graphic abstract
These slides can be retrieved under Electronic Supplementary Material.
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Younger Patients Are Differentially Affected by Stiffness-Related Disability Following Adult Spinal Deformity Surgery. World Neurosurg 2019; 132:e297-e304. [PMID: 31479783 DOI: 10.1016/j.wneu.2019.08.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/17/2019] [Accepted: 08/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The Lumbar Stiffness Disability Index (LSDI) assesses impact of lumbar stiffness on activities of daily living. We hypothesized that patients <60 years old would perceive greater lumbar stiffness-related functional limitation following fusion for adult spinal deformity. METHODS Patients completed the LSDI and Scoliosis Research Society 22 Questionnaire, Revised (SRS-22r) preoperatively and at 2 years postoperatively. The primary independent variable was patient age <60 versus ≥60. Multivariable regression analyses were used. RESULTS Analysis included 267 patients. Patients <60 years old (51.3%) and ≥60 years old (48.7%) were evenly represented. In bivariable analysis, patients age <60 exhibited lower LSDI at baseline versus patients age ≥60 (25.7 vs. 35.5, β -9.8, P < 0.0001), but a directionally smaller difference at 2 years (26.4 vs. 32.3, β -5.8, P = 0.0147). LSDI was associated with lower SRS-22r total score among both age groups at baseline and 2 years (all P < 0.0001); the association was stronger among patients age <60 versus ≥60 at 2 years. LSDI was associated with SRS-22r satisfaction scores at 2 years among patients age <60 (P < 0.0001), but not patients age ≥60 (P = 0.2250). The difference in SRS-22r satisfaction per unit LSDI between patients <60 years old and ≥60 years old was significant (P = 0.0021). CONCLUSIONS Among patients with adult spinal deformity managed operatively, higher LSDI was associated with inferior SRS-22r total score and satisfaction at 2 years postoperatively. The association between increased LSDI and worse patient-reported outcome measures was greater among patients age <60 versus ≥60. Preoperative counseling is needed for patients age <60 undergoing adult spinal deformity surgery regarding effects that lumbar stiffness may have on postoperative function and satisfaction.
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Silva FTMD, Marchi L, Pokorny G, Amaral R, Jensen R, Pimenta L. L5-S1 SURVIVAL AFTER INTERBODY FUSION BY LATERAL APPROACH UNTIL L5 IN DEGENERATIVE DISEASE. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191802196689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives: Whether or not to include L5-S1 in multiple level lumbar fusions is not yet a consensus in the literature. The option to preserve L5-S1 maintains the mobile segment and the possibility of a natural fit to the sagittal alignment of the lumbar spine. However, a long fusion above L5-S1 may accelerate the degenerative process and an extension to the sacrum may be necessary in the future. In this study, we evaluated the survival of the L5-S1 level after lateral lumbar interbody fusion (LLIF) of 3-4 levels up to L5 and attempted to identify risk factors that could guide the selection of cases. Methods: Retrospective study in a single center. Inclusion: Patients that submitted to interbody fusion (LLIF) from 3-4 levels to L5 due to degenerative spine disease with at least 5 years of follow-up. Exclusion: L5 sacralization or L5-S1 disc ankylosis. We evaluated the reoperation rate including L5-S1 disc. We reviewed the preoperative images regarding coronal Cobb angle, lumbar lordosis, pelvic incidence; distal fractional curve; radiographic classification of DDD (modified by Weiner and Pfirrmann), as well as demographics parameters. These parameters were compared between the case group (reoperated) and the control group. Results: Forty-seven patients were included achieving a success rate of inclusion of 81%; the mean age was 69.1 years, 83% were women, and the mean of operated levels was 3.2. The survival rate of L5-S1 level was 89.6% at 5-year follow-up. No differences were found between the groups regarding the parameter evaluated. Conclusions: The L5-S1 survival rate was 896% after LLIF of 3-4 levels up to L5 at 5-year follow-up. Statistically no risk factors were found to warrant preoperative inclusion of L5-S1. Level of Evidence III; Retrospective Study.
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Abstract
STUDY DESIGN Retrospective comparative analysis of data collected prospectively in an adult spine deformity (ASD) multicenter database. OBJECTIVE To evaluate the impact of the iliac screws on the quality of life of ASD patients compared with those instrumented above the pelvis (L5/S1/S2). SUMMARY OF BACKGROUND DATA The impact on patient's daily activities and functions, of immobilizing the sacroiliac joint with iliac screws for the treatment of ASD is still underexplored. METHODS Inclusion criteria were ASD patients with a long arthrodesis of at least eight levels and whose lowest instrumented vertebrae (LIV) were L5 or below. We analyzed the following preoperative and 2 years' follow-up variables: age, Cobb angle, coronal and sagittal alignment, number of instrumented levels, Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), Scoliosis Research Society-22 (SRS-22), and Short Form 36 (SF-36) questionnaires. Statistical analysis was performed with Mann-Whitney U test, and Wilcoxon test. RESULTS A total of 129 patients were included, and separated into two groups: "Iliac Yes," with the LIV at the Ilium (N = 104), and "iliac No," with the LIV at L5/S1/S2 (N = 25). Patients instrumented with Iliac screws were older (x = 66 vs. 56 yr, P = 0.008), and had lower Cobb magnitude (x = 31° vs. 45°, P = 0.019). No statistically significant differences were found in the health related quality of life (HRQOL) questionnaires prior to surgery or at 2-years' follow up. The "Iliac Yes" group significantly improved all radiographic and HRQOL scores parameters 2 years after surgery (P < 0.005). While the "Iliac No" group failed to significantly improve (coronal balance, sagittal vertical axis, SF-36 Physical functioning, SF-36 General health, and COMI) (P > 0.05) CONCLUSION.: ASD patients instrumented with iliac screws significantly improved all their HRQOL questionnaires 2 years after surgery. The 2 years' postoperative HRQOL scores were similar in both groups, regardless of the sacroiliac joint immobilization. Therefore, with the currently available tools, we cannot state that iliac instrumentation has a negative influence on patient's quality of life. LEVEL OF EVIDENCE 4.
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Tateen A, Bogert J, Koller H, Hempfing A. Komplikationen des lumbosakralen Übergangs bei Korrektur von Erwachsenendeformitäten. DER ORTHOPADE 2018; 47:320-329. [DOI: 10.1007/s00132-018-3534-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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