1
|
Yang H, Li Z, Hai Y, Pan A, Guan L, Liu Y. Comparison of complications, revisions, spinopelvic parameters, and health-related quality of life after posterior spinal fusion using multiple-rod constructs or two-rod constructs for adult spinal deformity: a systematic review and 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 2023; 32:3634-3650. [PMID: 37555956 DOI: 10.1007/s00586-023-07876-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND The incidence of mechanical complications is high in patients undergoing posterior spinal fusion (PSF) for adult spinal deformity (ASD), especially for cases with severe sagittal malalignment or a prior spinal fusion requiring three-column osteotomy (3-CO) or spinopelvic fixation (SPF). The purpose of this systematic review and meta-analysis was to compare the complications, revisions, radiographic spinopelvic parameters, health-related quality of life (HRQoL), and surgical data of PSF using multiple-rod constructs to those of two-rod constructs for the treatment of ASD. METHODS A comprehensive literature search was performed for relevant studies in PubMed, EMBASE, Web of Science, and the Cochrane Library. Complications, revisions, spinopelvic parameters, HRQoL, and surgical date were compared between patients with ASD who underwent PSF using multiple-rod constructs (multi-rod group) and two-rod constructs (two-rod group). RESULTS Ten studies, comprising 797 patients with ASD (399 in the multi-rod group and 398 in the two-rod group), were included. All these studies were retrospective cohort studies. There were no significant differences in the surgical, wound-related, and systemic complications between the groups. In the multi-rod group, we noted a significantly lower incidence of rod fracture (RR, 0.43; 95% CI 0.33 to 0.57, P < 0.01), pseudoarthrosis (RR, 0.38; 95% CI 0.28 to 0.53, P < 0.01), and revisions (RR, 0.44; 95% CI 0.33 to 0.58, P < 0.01); a superior restoration of PI-LL (WMD, 3.96; 95% CI 1.03 to 6.88, P < 0.01) and SVA (WMD, 31.53; 95% CI 21.16 to 41.90, P < 0.01); a better improvement of ODI score (WMD, 6.82; 95% CI 2.33 to 11.31, P < 0.01), SRS-22 total score (WMD, 0.44; 95% CI 0.06 to 0.83, P = 0.02), and VAS-BP score (WMD, 1.02; 95% CI 0.31 to 1.73, P < 0.01). CONCLUSION Compared with the two-rod constructs, PSF using multiple-rod constructs was associated with a lower incidence of mechanical complications, a lower revision rate, a superior restoration of sagittal alignment, and a better improvement of HRQoL, without increasing surgical invasiveness. Multiple-rod constructs should be routinely considered to for ASD patients, especially for cases with severe sagittal malalignment or a prior spinal fusion requiring 3-CO or SPF.
Collapse
Affiliation(s)
- Honghao Yang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China
| | - Zhangfu Li
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China.
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China
| | - Li Guan
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China
| |
Collapse
|
2
|
Suri A, Tang S, Kargilis D, Taratuta E, Kneeland BJ, Choi G, Agarwal A, Anabaraonye N, Xu W, Parente JB, Terry A, Kalluri A, Song K, Rajapakse CS. Conquering the Cobb Angle: A Deep Learning Algorithm for Automated, Hardware-Invariant Measurement of Cobb Angle on Radiographs in Patients with Scoliosis. Radiol Artif Intell 2023; 5:e220158. [PMID: 37529207 PMCID: PMC10388214 DOI: 10.1148/ryai.220158] [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: 08/01/2022] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 08/03/2023]
Abstract
Scoliosis is a disease estimated to affect more than 8% of adults in the United States. It is diagnosed with use of radiography by means of manual measurement of the angle between maximally tilted vertebrae on a radiograph (ie, the Cobb angle). However, these measurements are time-consuming, limiting their use in scoliosis surgical planning and postoperative monitoring. In this retrospective study, a pipeline (using the SpineTK architecture) was developed that was trained, validated, and tested on 1310 anterior-posterior images obtained with a low-dose stereoradiographic scanning system and radiographs obtained in patients with suspected scoliosis to automatically measure Cobb angles. The images were obtained at six centers (2005-2020). The algorithm measured Cobb angles on hold-out internal (n = 460) and external (n = 161) test sets with less than 2° error (intraclass correlation coefficient, 0.96) compared with ground truth measurements by two experienced radiologists. Measurements, produced in less than 0.5 second, did not differ significantly (P = .05 cutoff) from ground truth measurements, regardless of the presence or absence of surgical hardware (P = .80), age (P = .58), sex (P = .83), body mass index (P = .63), scoliosis severity (P = .44), or image type (low-dose stereoradiographic image vs radiograph; P = .51) in the patient. These findings suggest that the algorithm is highly robust across different clinical characteristics. Given its automated, rapid, and accurate measurements, this network may be used for monitoring scoliosis progression in patients. Keywords: Cobb Angle, Convolutional Neural Network, Deep Learning Algorithms, Pediatrics, Machine Learning Algorithms, Scoliosis, Spine Supplemental material is available for this article. © RSNA, 2023.
Collapse
|
3
|
Assi A, Rebeyrat G, El Rachkidi R, Semaan K, Saad E, Mekhael E, Nassim N, Massaad A, Lafage V, Ghanem I, Pillet H, Skalli W. ASD with high pelvic retroversion develop changes in their acetabular orientation during walking. BRAIN & SPINE 2023; 3:101752. [PMID: 37383434 PMCID: PMC10293306 DOI: 10.1016/j.bas.2023.101752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/10/2023] [Accepted: 05/02/2023] [Indexed: 06/30/2023]
Abstract
Introduction It was hypothesized that pelvic retroversion in Adult Spinal Deformity (ASD) can be related to an increased hip loading explaining the occurrence of hip-spine syndrome. Research question How pelvic retroversion can modify acetabular orientation in ASD during walking? Methods 89 primary ASD and 37 controls underwent 3D gait analysis and full-body biplanar X-rays. Classic spinopelvic parameters were calculated from 3D skeletal reconstructions in addition to acetabular anteversion, abduction, tilt, and coverage. Then, 3D bones were registered on each gait frame to compute the dynamic value of the radiographic parameters during walking. ASD patients having a high PT were grouped as ASD-highPT, otherwise as ASD-normPT. Control group was divided in: C-aged and C-young, age matched to ASD-hightPT and ASD-normPT respectively. Results 25/89 patients were classified as ASD-highPT having a radiographic PT of 31° (vs 12° in other groups, p < 0.001). On static radiograph, ASD-highPT showed more severe postural malalignment than the other groups: ODHA = 5°, L1L5 = 17°, SVA = 57.4 mm (vs 2°, 48° and 5 mm resp. in other groups,all p < 0.001). During gait, ASD-highPT presented a higher dynamic pelvic retroversion of 30° (vs 15° in C-aged), along with a higher acetabular anteversion of 24° (vs 20°), external coverage of 38° (vs 29°) and a lower anterior coverage of 52° (vs 58°,all p < 0.05). Conclusion ASD patients with severe pelvic retroversion showed an increased acetabular anteversion, external coverage and lower anterior coverage during gait. These changes in acetabular orientation, computed during walking, were shown to be related to hip osteoarthritis.
Collapse
Affiliation(s)
- Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
| | - Guillaume Rebeyrat
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
| | - Rami El Rachkidi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Karl Semaan
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Eddy Saad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Elio Mekhael
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Nabil Nassim
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | | | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers, Paris, France
| |
Collapse
|
4
|
Adhikari P, Çetin E, Çetinkaya M, Nabi V, Yüksel S, Vila Casademunt A, Obeid I, Sanchez Perez-Grueso F, Acaroğlu E. Ability of Visual Analogue Scale to predict Oswestry Disability Index improvement and surgical treatment decision in patients with adult spinal deformity. BRAIN & SPINE 2022; 2:100934. [PMID: 36605390 PMCID: PMC9808375 DOI: 10.1016/j.bas.2022.100934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/26/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
Introduction The effect of pain on HRQoL scores in ASD patients is not well studied. Disability is a major factor on decision and outcomes. On the other hand, little is known about the effect of perceived and reported pain on these parameters, especially in the elderly population. We hypothesized that baseline back and leg pain would not affect the treatment decision whereas may have a negative effect on outcomes. Research question To determine the correlation between preoperative ODI and VAS scores; and to identify the effect of baseline VAS score on treatment decision and ODI improvement following treatment. Material and methods In this retrospective study, patients with a follow-up duration of minimum 2 years were enrolled from a prospective multicentric ASD database. Pearson and Spearman correlation tests were used to evaluate the correlation between ODI and VAS scores; univariate binary logistic regression method was used to analyze the effect of VAS on treatment decision as well as the outcomes. Results 1050 patients (mean age 48.2) were analyzed. Baseline ODI and back, leg pain VAS scores were significantly correlated (P < 0.001). One unit increase in baseline back and leg pain VAS scores, increased the probability of improvement in ODI by 1.219 (P = 0.016) and 1.182 times (P = 0.029), respectively in surgically treated patients; and reduced it by 0.894 times (P = 0.012) for conservatively treated patients. For patients >70 years old, one-unit increase in baseline leg pain VAS score increased the probability of deciding on surgical treatment by 1.121 times (p = 0.016). Discussion and conclusions Preoperative back and leg pain VAS scores were found to be significantly correlated with the preoperative ODI scores. Additionally, preoperative baseline back and leg pain VAS scores were useful in predicting the improvement in disability as assessed by ODI. Another important finding was that, higher baseline leg pain (but not back pain) VAS scores increased the rate of elderly patients preferring surgical treatment.
Collapse
Affiliation(s)
- Prashant Adhikari
- Hospital for Advance Medicine and Surgery (HAMS), Dhumbarai, Mandhikatar Road, Kathmandu, Nepal,Corresponding author. Hospital for Advance Medicine and Surgery (HAMS), Dhumbarai, Mandhikatar Road, Kathmandu, Nepal.
| | - Engin Çetin
- Gaziosmanpasa Training and Research Hospital, Karayolları Mahallesi, Osmanbey Caddesi, 621, Sokak, 34255, Gaziosmanpaşa, Istanbul, Turkey
| | - Mehmet Çetinkaya
- Başakşehir Çam ve Sakura City Hospital, Başakşehir Olimpiyat Bulvarı Yolu, 34480, Başakşehir, Istanbul, Turkey
| | - Vugar Nabi
- Antalya Training and Research Hospital, Varlık Mh, Kazım Karabekir Cd, 07100, Antalya, Turkey
| | - Selcen Yüksel
- Yıldırım Beyazıt University, Department of Biostatistics, Yıldırım Beyazıt Üniversitesi Biyoistatistik Departmenı, Ankara, Turkey
| | | | - Ibrahim Obeid
- Bordeaux University Department of Orthopaedics, Bordeaux University Hospital, Department of Orthopaedics, Bordeaux, France
| | | | - Emre Acaroğlu
- Ankara Spine Center, Iran Caddesi 45/2, Kavaklidere, 06700, Ankara, Turkey
| | | |
Collapse
|
5
|
Kieser DC, Yuksel S, Boissiere L, Yilgor C, Cawley DT, Hayashi K, Alanay A, Kleinstueck FS, Pellise F, Perez-Grueso FJS, Jean-Marc V, Bourghli A, Acaroglu ER, Obeid I. Impact of radiologic variables on item responses of ODI, SRS22 and SF-36. in adult spinal deformity patients: differential item functioning (DIF) analysis results from a multi-center database. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1166-1173. [PMID: 35059861 DOI: 10.1007/s00586-021-07088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/24/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine if responses given to each question of the Scoliosis Research Society-22 (SRS22), Oswestry disability index (ODI) and Short Form-36 (SF-36) questionnaires are influenced by the radiological parameters. METHODS Patients enrolled in a multi-centre prospectively collected adult spinal deformity database who had complete SRS22, ODI and SF-36 data at baseline and at one-year follow-up were analysed. The presence of a differential item function of each question within each score in relation to radiological parameters was analysed using a mixed Rasch model with the radiological threshold value(s) determined. RESULTS Of those patients analysed (n = 1745; 1406 female, average age 51.0 ± 19.8 years), 944 were surgically and 801 were non-surgically treated. For the SRS22, questions (Q) 3, 5 and 18 were sensitive to almost all radiological parameters and the overall score was found sensitive to the Cobb angle. For the ODI, Q3, 6, 9 and 10 were not sensitive to any radiologic parameters whereas Q4 and 5 were sensitive to most. In contrast, only 3 of the SF-36 items were sensitive to radiological parameters. CONCLUSIONS 78% of the SRS-22, 60% of the ODI and 8% of the questions in the SF-36 are sensitive to radiological parameters. Sagittal imbalance is independently associated with a poor overall outcome, but affects mental status and function more than pain and self-image. The assembly of questions responsive to radiological parameters may be useful in establishing a connection between changes in radiologic parameters and HRQL.
Collapse
Affiliation(s)
- D C Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, 2 Riccarton Avenue, 8011, Christchurch, New Zealand.
| | - S Yuksel
- School of Medicine Ankara, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - L Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - C Yilgor
- Mater Private Hospital, Dublin, Ireland
| | - D T Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France.,Mater Private Hospital, Dublin, Ireland
| | - K Hayashi
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - A Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | - F Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Vital Jean-Marc
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - A Bourghli
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | | | - I Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | | |
Collapse
|
6
|
Ahmad HS, Yang AI, Basil GW, Wang MY, Yoon JW. Objective Outcomes in Lateral Osteotomy Through Anterior-to-Psoas for Severe Adult Degenerative Spine Deformity Correction. Cureus 2021; 13:e18277. [PMID: 34722055 PMCID: PMC8545550 DOI: 10.7759/cureus.18277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 01/23/2023] Open
Abstract
Multilevel lateral interbody fusion is an acceptable surgical technique in patients with severe degenerative adult spinal deformity (ASD). The current standard-of-care in spine surgery includes the use of patient reported outcome measures (PROMs) to assess post-operative improvement. Objective activity data during the peri-operative period may provide supplementary information for patients recovering from ASD surgery. In this report, we use smartphone-based activity data as an objective outcome measure for a patient who underwent a two-stage operation for ASD corrective surgery: lateral osteotomy and lumbar interbody fusion with posterior column release. An 82-year-old male presented with intractable back pain secondary to severe thoracolumbar scoliotic deformity (Lenke 5BN). Pre-operative images demonstrated the presence of bridging osteophytes over the left lateral aspect of L2-5 disc spaces and over the apex of the lumbar curvature, with significant neuroforaminal stenosis. Surgical correction was completed in two stages: (1) left-sided lateral osteotomy using anterior-to-psoas approach (ATP) in a right lateral decubitus position, and (2) multilevel Ponte osteotomies and instrumented fusion from T10-pelvis. Post-operative radiography showed correction to scoliotic deformity and sagittal misalignment. The patient had developed seroma and wound dehiscence, which was evacuated on post-operative day 11. At 14-month follow-up, the patient reported significant improvement in pain symptoms, corroborated by patient reported outcome measures. To further quantify and assess patient recovery, smartphone-based patient activity data was collected and analyzed to serve as a proxy for the patient's functional improvement. The patient's walking steps-per-day was compared pre- and post-operatively. The patient's pre-operative baseline was 223 steps/day; the patient's activity during immediate post-operative recovery dropped to 179 steps/day; the patient returned to baseline activity levels approximately 3 months after surgery, reaching an average of 216 steps/day. In conclusion, we found that lateral osteotomy through an ATP approach is a powerful tool to restore normal spine alignment and can be successfully performed using anatomic landmarks. Additionally, smartphone-based mobility data can assess pre-operative activity level and allow for remote patient monitoring beyond routine follow-up schedule.
Collapse
Affiliation(s)
- Hasan S Ahmad
- Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Andrew I Yang
- Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Gregory W Basil
- Neurosurgery, University of Miami Miller School of Medicine, Miami, USA
| | - Michael Y Wang
- Neurosurgery, University of Miami Miller School of Medicine, Miami, USA
| | - Jang W Yoon
- Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
7
|
Kieser DC, Boissiere L, Bourghli A, Hayashi K, Cawley D, Yilgor C, Alanay A, Acaroglu E, Kleinstueck F, Pizones J, Pellise F, Perez-Grueso FJS, Obeid I. Obeid-Coronal Malalignment Classification Is Age Related and Independently Associated to Personal Reported Outcome Measurement Scores in the Nonfused Spine. Neurospine 2021; 18:475-480. [PMID: 34610677 PMCID: PMC8497236 DOI: 10.14245/ns.2142458.229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To evaluate Obeid-coronal malalignment (O-CM) modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs), in the mobile spine.
Methods Retrospective review of a prospective multicenter adult spinal deformity (ASD) database with 1,243 (402 nonoperative, 841 operative) patients with no prior fusion surgery. Patients were included if they were aged over 18 years and were affected by spinal deformity defined by one of: Cobb angle ≥ 20°, pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°. Patients were classified according to the O-CM classification and compared to coronally aligned patients. Multivariate analysis was performed on the relationship between PROMs and age, global tilt (GT) and coronal malalignment (CM).
Results Four hundred forty-three patients had CM of more than 2 cm compared to 800 who did not. The distribution of these modifiers was correlated to age. After multivariate analysis, using age and GT as confounding factors, we found that before the age of 50 years, 2A1 patients had worse sex life and greater satisfaction than patients without CM. After 50 years of age, patients with CM (1A1, 1A2) had worse self-image and those with 2A2, 2B had worse self-image, satisfaction, and 36-item Short Form Health Survey physical function. Self-image was the consistent determinant of patients opting for surgery for all ages.
Conclusion CM distribution according to O-CM modifiers is age dependent. A clear correlation between the coronal malalignment and PROMs exists when using the O-CM classification and in the mobile spine, this typically affects self-image and satisfaction. Thus, CM classified according to O-CM modifiers is correlated to PROMs and should be considered in ASD.
Collapse
Affiliation(s)
- David Christopher Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Louis Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Kazunori Hayashi
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Derek Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Caglar Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Emre Acaroglu
- Spine Surgery Unit, Ankara Acibadem ARTES Spine Center, Ankara, Turkey
| | | | | | - Ferran Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | | |
Collapse
|
8
|
Cawley DT, Boissiere L, Yilgor C, Larrieu D, Fujishiro T, Kieser D, Alanay A, Kleinstück F, Pérez-Grueso FS, Pellisé F, Obeid I. Relative pelvic version displays persistent compensatory measures with normalised sagittal vertical axis after deformity correction. Spine Deform 2021; 9:1449-1456. [PMID: 33914299 DOI: 10.1007/s43390-021-00345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE A normal sagittal vertical axis (SVA) after spinal deformity correction can yield mechanical complications of up to 30%. Post-operative compensatory pelvic orientation can produce a normal SVA. We assess relative pelvic version (RPV), an individualised measure, for persistent post-operative compensatory measures. METHODS Adult spinal deformity (ASD) patients who were treated operatively, with a normal SVA (< ± 50 mm) at 6-week follow-up were included, who were then followed-up after 2 years. These only included patients with fusion of > 4 vertebrae extending to L5 or below. Six-week subgroups were made regarding pelvis orientation, relative pelvic version (RPV: anteversion, aligned, moderate or severe retroversion) with analysis of patient-related outcome measures (PROMs), complications and spino-pelvic sagittal parameters. RESULTS At 6 weeks, 140 patients met the inclusion criteria, 5 (3.6%) patients had anteversion, 59 (42.1%) were aligned, 60 (42.9%) had moderate retroversion and 16 (11.4%) patients had severe retroversion. Follow-up after 2 years demonstrated increased RPV in all groups except the severe RPV group who were more likely to develop SVA > 50 mm. Complications occurred in all groups. Significant 2-year differences were observed between moderate and severe RPV for back pain and PROMs but not between other RPV groups. CONCLUSION Adult spinal deformity patients with a normal SVA after spino-pelvic instrumentation carry a significant risk of retroversion progression post-operatively, followed by increased positive sagittal balance. Relative pelvic version (RPV) measurements when categorised into anteversion, aligned, moderate retroversion and severe retroversion at 6 weeks were predictive of PROMs at 2 years.
Collapse
Affiliation(s)
- Derek T Cawley
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France. .,Mater Private Hospital, Eccles St, Dublin 1, Republic of Ireland.
| | - Louis Boissiere
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - Caglar Yilgor
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Daniel Larrieu
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - Takashi Fujishiro
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.,Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - David Kieser
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.,Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Ahmet Alanay
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | | | - Ferran Pellisé
- Spine Surgery Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | | |
Collapse
|
9
|
Cawley DT, Takemoto M, Boissiere L, Larrieu D, Kieser DC, Fujishiro T, Hayashi K, Bourghli A, Yilgor C, Alanay A, Perez Grueso FJ, Pelisse F, Kleinstück F, Vital JM, Obeid I. The Impact of Corrective Surgery on Health-Related Quality of Life Subclasses in Adult Scoliosis: Will Degree of Correction Prognosticate Degree of Improvement? 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; 30:2033-2039. [PMID: 33900475 DOI: 10.1007/s00586-021-06786-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/15/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Objectives in scoliosis corrective surgery include restoration of normal sagittal and coronal parameters to achieve patient satisfaction. HRQLs improvements remain limited after corrective surgery. The aim of this study was to evaluate the HRQL subclass variability specific to the sagittal and coronal correction in adult scoliosis surgery. METHODS This multi-centre prospective analysis of consecutive adult spinal deformity (ASD) patients, from five European centres, only included multilevel instrumentation for scoliosis. d-(delta) values for each parameter represented pre to post-operative changes. Parameters included demographics, baseline, 1- and 2-year. HRQL outcomes (Oswestry disability index (ODI), Scoliosis Research Society (SRS)-22 and Short Form (SF36)), sagittal correction including relative spinopelvic alignment (dRSA) and coronal correction including major Cobb (dCobb) angles. RESULTS A total of 353 patients reached 1-year and 2-year follow up. All HRQL total scores significantly improved postoperatively, including ODI, SRS-22 and SF36. HRQL subclasses which displayed persistent improvements correlated to dRSA included sex-life, self-image, fatigue, vitality, social functioning. The only HRQL subclass improvement that correlated with dCobb was self-image. CONCLUSION Adult scoliosis surgery improves overall HRQL, having a minimal effect on each variable. Importantly, greater coronal deformity correction affects only greater self-image scores, whereas with greater sagittal correction there are many greater HRQL sub-class impacts. Correction and restoration of coronal balance is one of the surgical goals in adult scoliosis but the degree to which Cobb angle is corrected, apart from self-image, does not correlate with gains in sub-classes of HRQL. These results need to be taken into account when planning surgery.
Collapse
Affiliation(s)
- D T Cawley
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France.
- Mater Private Hospital, Dublin 1, Ireland.
| | | | - L Boissiere
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - D Larrieu
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - D C Kieser
- Christchurch School of Medicine, University of Otago, Dunedin, New Zealand
| | - T Fujishiro
- Osaka Medical College, Takatsuki-shi, Osaka, Japan
| | - K Hayashi
- Osaka City University Graduate School of Medicine, Juso Hospital, Osaka, Japan
| | | | - C Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - A Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | | | - F Pelisse
- Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - J M Vital
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - I Obeid
- Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| |
Collapse
|
10
|
Kieser DC, Bourghli A, Larrieu D, Cawley DT, Hayashi K, Jakinapally S, Pizones J, Boissiere L, Obeid I. Impact of COVID-19 on the pain and disability of patients with adult spinal deformity. Spine Deform 2021; 9:1073-1076. [PMID: 33651340 PMCID: PMC7923403 DOI: 10.1007/s43390-021-00315-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/16/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the pain and functional effect of the COVID-19 pandemic on patients with ASD reflected by their response to SRS-22, ODI, and SF-36 questionnaires. METHODS Patients who had stable pain and functional outcome scores over the preceding 2 years were enrolled in a local prospectively collected adult spinal deformity (ASD) database. A reanalysis of their SRS22, ODI and SF-36 data 14 days into confinement were compared to their last pre-confinement scores. RESULTS 89 patients were included in this study (average age 60.7 years, 91% female) with an average time from last FU until confinement of 9.6 months. The ODI total score worsened by 5 points post-confinement with no difference seen in personal care, walking and social life. In contrast, the SRS-22 score showed small improvements in function/activity and satisfaction, but no significant differences for the other domains. Similarly, the SF-36 showed small improvements in physical function, physical and emotional role, vitality and PCS. CONCLUSION The global COVID-19 pandemic and ensuing confinement had variable overall effects on ASD patients, without the expected marked worsening. In addition, this study illustrates that the SRS-22 questionnaire is less influenced by environmental and psychological factors than the ODI supporting its objectivity and accuracy in the evaluation of the QoL of ASD patients.
Collapse
Affiliation(s)
- D. C. Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, 2 Riccarton Avenue, Christchurch, 8011 New Zealand
| | - A. Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O. Box 84400, Riyadh, 11671 Saudi Arabia
| | - D. Larrieu
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France
| | | | - K. Hayashi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - S. Jakinapally
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France
| | - J. Pizones
- Spine Unit, Hospital La Paz, Madrid, Spain
| | - L. Boissiere
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France ,ELSAN, Polyclinique Jean Villar, Avenue Maryse Bastie, 33520 Bruges, France
| | - I. Obeid
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, 33076 Bordeaux, France ,ELSAN, Polyclinique Jean Villar, Avenue Maryse Bastie, 33520 Bruges, France
| |
Collapse
|
11
|
Clinical Performance and Concurrent Validity of the Adult Spinal Deformity Surgical Decision-making Score. Spine (Phila Pa 1976) 2020; 45:E847-E855. [PMID: 32609469 DOI: 10.1097/brs.0000000000003434] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter, retrospective study. OBJECTIVE The aim of this study was to examine the performance and concurrent validity of the adult spinal deformity surgical decision-making (ASD-SDM) score compared to decision-making factors in the ASD population. SUMMARY OF BACKGROUND DATA The ASD-SDM score, which has been recently proposed, is a scoring system to guide the selection of treatment modality for the ASD population. To secure the justification for its clinical use, it is necessary to verify its clinical performance and concurrent validity. METHODS A multicenter prospective ASD database was retrospectively reviewed. The data were analyzed separately in younger (≤40 years) and older (≥41 years) age groups. The discriminating capacity of the ASD-SDM score in cases who selected surgical and nonsurgical management was compared using area under the receiver operator characteristic curves (AUROC). Concurrent validity was examined using Spearman correlation coefficients, comparing factors that are reported to be associated with the decision-making process for ASD, including baseline symptomatology, health-related quality of life measures, and the severity of radiographic spinal deformity. RESULTS There were 338 patients (mean age: 26.6 years; 80.8% female; 129 surgical and 209 nonsurgical) in the younger age group and 750 patients (mean age: 63.5 years; 84.3% female; 410 surgical and 340 nonsurgical) in the older age group. In both younger and older patients, the ASD-SDM score showed a significantly higher performance for discriminating the surgical and nonsurgical cases (AUROC: 0.767, standard error [SE]: 0.026, P < 0.001, 95% confidence interval [CI]: 0.712-0.813; AUROC: 0.781, SE: 0.017, P < 0.001, 95% CI: 0.747-0.812, respectively) compared to the decision-making factors analyzed. In addition, the ASD-SDM showed significant correlations with multiple decision-making factors. CONCLUSION The ASD-SDM score alone can effectively grade the indication for surgical management whilst considering multiple decision-making factors. LEVEL OF EVIDENCE 3.
Collapse
|
12
|
Acaroglu E, Yuksel S, Ates C, Ayhan S, Bahadir S, Nabi V, Vila-Casademunt A, Sanchez Perez-Grueso FJ, Obeid I. Decision Analysis in Quest of the Ideal Treatment in Adult Spinal Deformity Adjusted for Minimum Clinically Important Difference. World Neurosurg 2020; 142:e278-e289. [PMID: 32622065 DOI: 10.1016/j.wneu.2020.06.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgery appears to yield better results in adult spinal deformity treatment when fixed minimum clinically important difference values are used to define success. Our objective was to analyze utilities and improvement provided by surgical versus nonsurgical treatment at 2 years using Oswestry Disability Index with treatment-specific minimum clinically important difference values. METHODS From a multicenter database including 1452 patients, 698 with 2 years of follow-up were analyzed. Mean age of patients was 50.95 ± 19.44 years; 580 patients were women, and 118 were men. The surgical group comprised 369 patients, and the nonsurgical group comprised 329 patients. The surgical group was subcategorized into no complications (192 patients), minor complications (97 patients) and major complications (80 patients) groups to analyze the effect of complications on results. Minimum clinically important differences using Oswestry Disability Index were 14.31, 14.96, and 2.48 for overall, surgical, and nonsurgical groups. Utilities were calculated by visual analog scale mapping. RESULTS Surgical treatment provided higher utility (0.583) than nonsurgical treatment (0.549) that was sensitive to complications, being 0.634, 0.564, and 0.497 in no, minor, and major complications. Probabilities of improvement, unchanged, and deterioration were 38.3%, 39.2%, and 22.5% for surgical treatment and 39.4%, 10.5%, and 50.1% for nonsurgical treatment. Improvement in the surgical group was also sensitive to complications with rates of 40.1%, 39.3%, and 33.3%. CONCLUSIONS Our results suggest that surgical treatment has less disease burden and less chance of deterioration, but equal chances for improvement at 2 years of follow-up. As it appears to be a better modality in the absence of complications, future efforts need be directed to decreasing the complication rates.
Collapse
Affiliation(s)
- Emre Acaroglu
- Department of Orthopaedic Surgery, Ankara Spine Center, Ankara, Turkey.
| | - Selcen Yuksel
- Department of Biostatistics, Yildirim Beyazit University, Ankara, Turkey
| | - Can Ates
- Department of Biostatistics, Van Yuzuncu Yil University, Van, Turkey
| | - Selim Ayhan
- ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey
| | - Sinan Bahadir
- ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey
| | - Vugar Nabi
- ARTES Spine Center, Acibadem Ankara Hospital, Ankara, Turkey
| | - Alba Vila-Casademunt
- Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- Department of Orthopedic Surgery, Bordeaux University Hospital, Bordeaux, France
| | -
- Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|