1
|
Wang M, Wang X, Wu J, Shen Y, Qiu Y, Sun X, Zhou D, Jiang Y. Lumbar Apex Position as an Independent Risk Factor for Adjacent Segment Diseases in Patients Undergoing Short-Level Transforaminal Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2024; 49:1435-1444. [PMID: 38747237 PMCID: PMC11419276 DOI: 10.1097/brs.0000000000005043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/30/2024] [Indexed: 09/25/2024]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate whether lumbar apex position had an impact on the development of adjacent segment disease (ASD) following transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA Previous studies have demonstrated that solely concentrating on lumbar lordosis value is not suitable, and neglecting the significance of lumbar apex can lead to mechanical complications. However, the relationship between lumbar apex and ASD is still not well understood. METHODS In this retrospective study, 234 consecutive patients who underwent L3-5 or L4-5 TLIF for degenerative diseases were reviewed. The study evaluated the associations between sagittal parameters and pelvic incidence (PI). Patients were labeled "matched" when lumbar apex position aligned with the theoretical target, and "mismatched" when it did not. Multivariate analysis was applied to find the independent risk factors of ASD. In addition, a focused subanalysis was performed based on the lumbar apex position (ideal match, cranial from ideal, and caudal from ideal). RESULTS After an average follow-up period of 70.6 months, 68 cases were identified as having ASD. Postoperatively, 64.7% (44 of 68) of the patients with ASD exhibited a mismatched lumbar apex, compared with 41% (68 of 166) of those without ASD ( P < 0.001). PI correlated significantly with proximal lordosis (PL) and lordosis distribution index (LDI) but not with distal lordosis (DL). Multivariate analysis identified age, L3-5 fusion, postoperative DL, and postoperative mismatched lumbar apex as independent risk factors of ASD. Upon the subanalysis, it was discovered that there were unique compensatory strategies in the cranial and caudal groups, with notable variations in postoperative DL, PL, and LDI among three groups (all P value of <0.05). CONCLUSION Lumbar apex position significantly influenced the risk of ASD. To restore the lumbar apex to its ideal position, a proper value and distribution of DL should be attained. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Muyi Wang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Xin Wang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Jingbin Wu
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Yifei Shen
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Dong Zhou
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
- Department of Orthopedics, Affiliated Changzhou Children's Hospital of Nantong University, Changzhou, Jiangsu, China
| | - Yuqing Jiang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
| |
Collapse
|
2
|
Hills J, Mundis GM, Klineberg EO, Smith JS, Line B, Gum JL, Protopsaltis TS, Hamilton DK, Soroceanu A, Eastlack R, Nunley P, Kebaish KM, Lenke LG, Hostin RA, Gupta MC, Kim HJ, Ames CP, Burton DC, Shaffrey CI, Schwab FJ, Lafage V, Lafage R, Bess S, Kelly MP. The T4-L1-Hip Axis: Sagittal Spinal Realignment Targets in Long-Construct Adult Spinal Deformity Surgery: Early Impact. J Bone Joint Surg Am 2024:00004623-990000000-01201. [PMID: 39292767 DOI: 10.2106/jbjs.23.00372] [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] [Indexed: 09/20/2024]
Abstract
BACKGROUND Our understanding of the relationship between sagittal alignment and mechanical complications is evolving. In normal spines, the L1-pelvic angle (L1PA) accounts for the magnitude and distribution of lordosis and is strongly associated with pelvic incidence (PI), and the T4-pelvic angle (T4PA) is within 4° of the L1PA. We aimed to examine the clinical implications of realignment to a normal L1PA and T4-L1PA mismatch. METHODS A prospective multicenter adult spinal deformity registry was queried for patients who underwent fixation from the T1-T5 region to the sacrum and had 2-year radiographic follow-up. Normal sagittal alignment was defined as previously described for normal spines: L1PA = PI × 0.5 - 21°, and T4-L1PA mismatch = 0°. Mechanical failure was defined as severe proximal junctional kyphosis (PJK), displaced rod fracture, or reoperation for junctional failure, pseudarthrosis, or rod fracture within 2 years. Multivariable nonlinear logistic regression was used to define target ranges for L1PA and T4-L1PA mismatch that minimized the risk of mechanical failure. The relationship between changes in T4PA and changes in global sagittal alignment according to the C2-pelvic angle (C2PA) was determined using linear regression. Lastly, multivariable regression was used to assess associations between initial postoperative C2PA and patient-reported outcomes at 1 year, adjusting for preoperative scores and age. RESULTS The median age of the 247 included patients was 64 years (interquartile range, 57 to 69 years), and 202 (82%) were female. Deviation from a normal L1PA or T4-L1PA mismatch in either direction was associated with a significantly higher risk of mechanical failure, independent of age. Risk was minimized with an L1PA of PI × 0.5 - (19° ± 2°) and T4-L1PA mismatch between -3° and +1°. Changes in T4PA and in C2PA at the time of final follow-up were strongly associated (r2 = 0.96). Higher postoperative C2PA was independently associated with more disability, more pain, and worse self-image at 1 year. CONCLUSIONS We defined sagittal alignment targets using L1PA (relative to PI) and the T4-L1PA mismatch, which are both directly modifiable during surgery. In patients undergoing long fusion to the sacrum, realignment based on these targets may lead to fewer mechanical failures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Jeffrey Hills
- Department of Orthopedic Surgery, University of Texas, San Antonio, Texas
| | - Gregory M Mundis
- Division of Orthopedic Surgery, Scripps Clinic, La Jolla, California
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, California
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Breton Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Jeffrey L Gum
- Department of Orthopedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky
| | | | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alex Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Robert Eastlack
- Division of Orthopedic Surgery, Scripps Clinic, La Jolla, California
| | | | - Khaled M Kebaish
- Department of Orthopedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia College of Physicians and Surgeons, New York, NY
| | - Richard A Hostin
- Department of Orthopedic Surgery, Baylor Scoliosis Center, Dallas, Texas
| | - Munish C Gupta
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Han Jo Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Christopher P Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, California
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Christopher I Shaffrey
- Spine Division, Departments of Neurosurgery and Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Frank J Schwab
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Renaud Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine, Denver, Colorado
| | - Michael P Kelly
- Department of Orthopedic Surgery, Rady Children's Hospital, University of California San Diego, San Diego, California
| |
Collapse
|
3
|
Li Y, Zhang C, Sun J, Wang G. Spinopelvic morphology impacts on postoperative proximal junctional kyphosis in congenital scoliosis with thoracolumbar hemivertebrae. Spine Deform 2024; 12:1381-1391. [PMID: 38683284 DOI: 10.1007/s43390-024-00877-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/03/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE It aims to investigate the lumbar and pelvic morphology in congenital scoliosis with thoracolumbar hemivertebrae and its impact on proximal junctional kyphosis (PJK) incidence after hemivertebra resection and short fusion. METHODS 23 congenital scoliosis patients with thoracolumbar hemivertebra aged between 10 and 18 years were enrolled in the retrospective study. Spinopelvic sagittal parameters were analyzed on whole-spine standing lateral radiographs preoperatively, one-week postoperatively and at the final follow-up. Pearson correlations were calculated for local kyphosis (LK), lumbar and pelvic morphology parameters. Binary logistic regression and receiver operating characteristics (ROC) curve analysis were performed to identify the risk factors for PJK. RESULTS Thoracolumbar hemivertebra caused LK of 29.2° ± 17.3°, an increased lumbar lordosis (LL) (-64.7° ± 16.3°), lower LL apex (52.2% at L5), and small pelvic incidence (PI) (36.8° ± 6.6°). LK was correlated with lumbar morphology parameters, including LL (r = - 0.837), upper arc of LL (LLUA) (r = - 0.879), thoracolumbar kyphosis (TLK) (r = 0.933), thoracic kyphosis (TK) (r = 0.762) and TK apex (TKA) (r = - 0.749). Surgical treatment improved the lumbar morphology, but not pelvic morphology. At the final follow-up, LL had returned to its preoperative value (p = 0.158). PJK occurred in 30.4% of cases as a compensatory mechanism. Preoperatively, significant differences of parameters between non-PJK and PJK groups were observed in LK and TLK. Binary logistic regression identified three independent risk factors for PJK: preoperative LLA (OR = 0.005, 95%CI = 0.000-0.287, p = 0.011), preoperative TLK (OR = 1.134, 95%CI = 1.001-1.286, p = 0.048), and preoperative lumbar lordosis morphology type (OR = 5.507, 95%CI = 1.202-25.227, p = 0.028). However, residual LK after surgery was not correlated with PJK incidence. ROC curve analysis verified that preoperative TLK > 22.59° was associated with increased PJK incidence after surgery. CONCLUSIONS Lumbar morphology changes as a compensatory mechanism beneath the thoracolumbar hemivertebra. However, a stable pelvis tends to allow the LL to return to its preoperative value. PJK occurred as a cranial compensatory mechanism for increasing LL and corrected TLK. A larger TLK (> 22.59°) was an independent risk factor for PJK incidence in patients with type 2 and 3A lumbar lordosis morphology.
Collapse
Affiliation(s)
- Yang Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, Shandong, China
| | - Chenggui Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, Shandong, China
| | - Jianmin Sun
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, Shandong, China
| | - Guodong Wang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, Shandong, China.
| |
Collapse
|
4
|
Suzuki T, Yurube T. Distal Junctional Kyphosis and Failure in Adult Deformity Surgery Down to L5: Commentary on "Distal Junctional Failure After Fusion Stopping at L5 in Patients With Adult Spinal Deformity: Incidence, Risk Factors, and Radiographic Criteria". Neurospine 2024; 21:865-867. [PMID: 39363466 PMCID: PMC11456950 DOI: 10.14245/ns.2448882.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024] Open
Affiliation(s)
- Teppei Suzuki
- Department of Orthopedic Surgery, Kobe Medical Center, Kobe, Japan
| | - Takashi Yurube
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
5
|
Shen Y, Sardar ZM, Malka M, Reyes J, Katiyar P, Hassan F, Le Huec JC, Bourret S, Hasegawa K, Wong HK, Liu G, Dennis Hey HW, Riahi H, Kelly M, Lombardi JM, Lenke LG. Characteristics of Spinal Morphology According to the Global Alignment and Proportion (GAP) Score in a Diverse, Asymptomatic Cohort: Multi-Ethnic Alignment Normative Study. Spine (Phila Pa 1976) 2024; 49:979-989. [PMID: 38385537 DOI: 10.1097/brs.0000000000004966] [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: 12/12/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
STUDY DESIGN Multi-Ethnic Alignment Normative Study (MEANS) cohort: prospective, cross-sectional, multicenter. OBJECTIVE To analyze the distribution of GAP scores in the MEANS cohort and compare the spinal shape via stratification by GAP alignment category, age, and country. SUMMARY OF BACKGROUND DATA The GAP score has been used to categorize spinal morphology and prognosticate adult spinal deformity surgical outcomes and mechanical complications. We analyzed a large, multiethnic, asymptomatic cohort to assess the distribution of GAP scores. METHODS Four hundred sixty-seven healthy volunteers without spinal disorders were recruited in five countries. Sagittal radiographic parameters were measured via the EOS imaging system. The GAP total and constituent factor scores were calculated for each patient. Kruskal-Wallis rank sum test was performed to compare variables across groups, followed by the post hoc Games-Howell test. Fisher exact test was used to compare categorical variables. The significance level was set to P <0.05. RESULTS In the MEANS cohort, 13.7% (64/467) of volunteers were ≥60 years old, and 86.3% (403/467) were <60 years old. 76.9% (359/467) was proportioned, 19.5% (91/467) was moderately disproportioned, and 3.6% (17/467) was severely disproportioned. There was no significant difference in the frequency of proportioned, moderately, or severely disproportioned GAP between subjects from different countries ( P =0.060). Those with severely disproportioned GAP alignment were on average 14.5 years older ( P =0.016), had 23.1° lower magnitude lumbar lordosis (LL) ( P <0.001), 14.2° higher pelvic tilt ( P <0.001), 13.3° lower sacral slope ( P <0.001), and 24.1° higher pelvic-incidence (PI)-LL mismatch ( P <0.001), 18.2° higher global tilt ( P <0.001) than those with proportioned GAP; thoracic kyphosis and PI were not significantly different ( P >0.05). CONCLUSIONS The GAP system applies to a large, multiethnic, asymptomatic cohort. Spinal alignment should be considered on a spectrum, as 19.5% of the asymptomatic volunteers were classified as moderately disproportioned and 3.6% severely disproportioned. Radiographic malalignment does not always indicate symptoms or pathology. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Yong Shen
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Matan Malka
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Justin Reyes
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Prerana Katiyar
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Fthimnir Hassan
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Jean-Charles Le Huec
- Department of Orthopaedics and Traumatology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux University, Bordeaux, France
| | - Stephane Bourret
- Department of Orthopaedics and Traumatology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux University, Bordeaux, France
| | - Kazuhiro Hasegawa
- Division of Spine Surgery, Niigata Spine Surgery Center, Niigata City, Japan
| | - Hee Kit Wong
- Department of Orthopedic Surgery, National University Hospital (Singapore), Singapore, Singapore
| | - Gabriel Liu
- Department of Orthopedic Surgery, National University Hospital (Singapore), Singapore, Singapore
| | - Hwee Weng Dennis Hey
- Department of Orthopedic Surgery, National University Hospital (Singapore), Singapore, Singapore
| | - Hend Riahi
- Department of Radiology, Institut Kassab d'Orthopédie, Ksar Said La Manouba, Tunis, Tunisia
| | - Michael Kelly
- Division of Orthopedics and Scoliosis, Rady Children's Hospital, University of California, San Diego, San Diego, CA
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| |
Collapse
|
6
|
Stienen MN, Fischer G, Bättig L, Veeravagu A, Martens B. Minimally-invasive lateral thoracic and lumbar interbody fusion (LLIF) with expandable interbody cages - Considerations, complications & outcomes. BRAIN & SPINE 2024; 4:102870. [PMID: 39132256 PMCID: PMC11315114 DOI: 10.1016/j.bas.2024.102870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/25/2024] [Accepted: 07/12/2024] [Indexed: 08/13/2024]
Abstract
Introduction Reports about lateral lumbar or thoracic interbody fusion (LLIF) using expandable interbody spacers are sparse. Research question To report our experience with the use of expandable spacers for LLIF. Material and methods We reviewed all consecutive LLIF patients with use of an expandable titanium interbody implant (ELSA® Expandable Integrated LLIF Spacer, Globus Medical Inc, PA (USA)) between September 2018 and January 2024. Results We identified 503 patients, in which we performed LLIF at 732 levels. In 63 patients (12.5%) and 70 levels (9.6%) an expandable spacer was used. The mean age was 61.4 years, 57.1% were females. LLIF was performed between T11/12 - L4/5 in the setting of fusion procedures (mono-/bisegmental (20; 28.6%), 3-7 segments (29; 41.4%); >7 segments (21; 30.0%)), of which 21 (33.3%), 20 (31.8%) and 22 (34.9%) were for traumatic, deformity/revision and other diagnoses. Surgery included release of the anterior longitudinal ligament in 30 cases (42.9%). Intraoperative adverse events (AEs) were noted in 2 (3.2%), postoperative AEs in 27 (42.9%) at discharge, 17 (27.0%) at 3 months and 14 (22.2%) at 12 months. Segmental sagittal Cobb angle changed from 1.3° (preoperative) to 13.0° at discharge (p < 0.001), 12.7° at 3 months (p < 0.001) and 13.3° at 12 months (p < 0.001). Functional outcome was excellent/good in 43 (68.3%; 5 missing) at 3 months and in 37 (58.7%; 10 missing) at 12 months. Discussion and conclusion The use of LLIF with an expandable spacer was safe, promoted solid fusion and enabled powerful correction of sagittal segmental Cobb angle, which was maintained during follow-up.
Collapse
Affiliation(s)
- Martin N. Stienen
- Spine Center of Eastern Switzerland, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, St. Gallen, Switzerland
- Department of Neurosurgery, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, St. Gallen, Switzerland
| | - Gregor Fischer
- Spine Center of Eastern Switzerland, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, St. Gallen, Switzerland
- Department of Neurosurgery, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, St. Gallen, Switzerland
| | - Linda Bättig
- Spine Center of Eastern Switzerland, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, St. Gallen, Switzerland
- Department of Neurosurgery, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, St. Gallen, Switzerland
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Benjamin Martens
- Spine Center of Eastern Switzerland, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, St. Gallen, Switzerland
- Department of Orthopedic Surgery, Cantonal Hospital of St. Gallen & Medical School of St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
7
|
Bourghli A, Boissiere L, Larrieu D, Pizones J, Alanay A, Pellisé F, Kleinstück F, Obeid I. Proximal junctional kyphosis after adult spinal deformity operated patients with long fusion to the pelvis. Does the type of proximal anchor matter? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2832-2839. [PMID: 38844585 DOI: 10.1007/s00586-024-08332-4] [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: 10/17/2023] [Revised: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE To assess, in a large population of Adult Spinal Deformity (ASD) patients, the true interest of varying the upper anchors as a protective measure against Proximal Junctional Kyphosis (PJK), by analyzing and comparing 2 groups of patients defined according to their proximal construct. Another objective of the study is to look for any other factors, radiological or clinical, that would affect the occurrence of the proximal failure. METHODS Retrospective review of a prospective ASD database collected from 5 centers. Inclusion criteria were age of at least 18 years, presence of a spinal deformity with instrumentation from T12 or above to the pelvis, with minimum 2 years of follow-up. Demographic data, spinopelvic parameters, functional outcomes and complications were collected. Multiple logistic regression analysis was performed to identify the risk factors that would affect the occurrence of PJK. RESULTS 254 patients were included. 166 in the group "screws proximally" (SP) and 88 in the group "hooks proximally" (HP). There was no difference between both groups for PJK (p = 0.967). The occurrence of PJK was rather associated with greater age and BMI, higher preoperative kyphosis, worst preoperative SRS22 and SF36 scores, greater postoperative Sagittal Vertical Axis (SVA), coronal malalignment and kyphosis. CONCLUSION The use of proximal hooks was not effective to prevent PJK after ASD surgery, when compared to proximal screws. Worse preoperative functional outcomes and worse postoperative sagittal and also coronal malalignment were the main drivers for the occurrence of PJK regardless the type of proximal implant.
Collapse
Affiliation(s)
- Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Centre, P.O.Box 3354, 11211, Riyadh, Saudi Arabia.
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Daniel Larrieu
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| |
Collapse
|
8
|
Pizones J, Hills J, Kelly M, Yilgor C, Moreno-Manzanaro L, Perez-Grueso FJS, Kleinstück F, Obeid I, Alanay A, Pellisé F. Which sagittal plane assessment method is most predictive of complications after adult spinal deformity surgery? Spine Deform 2024; 12:1127-1136. [PMID: 38607513 DOI: 10.1007/s43390-024-00864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Different methods of sagittal alignment assessment compete for predicting adverse events after adult spinal deformity (ASD) surgery. We wanted to study which method provides greater benefit. METHODS Retrospective study of 391 patients operated for ASD, with > 6 instrumented levels, fused to the pelvis, and 2 years of follow-up. Three alignment methods were analyzed 6-week postoperatively: (1) Roussouly mismatch; (2) GAP score/GAP categories; (3) T4-L1-Hip axis. Binary logistic regression generated models that best predict the following adverse events: mechanical complications (MC): in general and isolated (PJK, PJF, rod breakage); reinterventions (in general and after MC); and readmissions. ROC/AUC analysis was also implemented. In a second regression round, we added different variables that were selected on univariate analysis-demographic, surgical, and radiographic-to complete the models. RESULTS The best predictor parameters in most models were T4-L1PA mismatch and GAP score; we could not prove a predictive ability of the Roussouly mismatch. The T4-L1PA mismatch best predicted general MC, PJK, PJK + PJF, and readmission, while the GAP score best predicted PJF and reinterventions (for MC and for any complication). However, the variance explained by these models was limited (Nagelkerke's R2 = 0.031-0.113), with odds ratios ranging from 1.070 to 1.456. ROC curves plotted an AUC between 0.57 and 0.70. Introducing additional variables (demographic, surgical, and radiographic) improved prediction in all the models (Nagelkerke's R2 = 0.082-0.329) and allowed predicting rod breakage. CONCLUSION The T4-L1-Hip axis and GAP score show potential in predicting adverse events, surpassing the Roussouly method. Despite partial efficacy in complication anticipation, recognizing postoperative sagittal alignment as a key modifiable risk factor, the crucial need arises to integrate diverse variables, both modifiable and non-modifiable, for enhanced predictive accuracy. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | | | - Michael Kelly
- Rady Children Hospital San Diego, University of California, San Diego, CA, USA
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
9
|
Sun W, Wang S, Wang B, Li Y, Chen X, Kong C, Wang P, Lu S. Surgical treatment of Roussouly type 1 with realigning Roussouly spinal shape and improving SRS-Schwab modifier: effect on minimal clinically important difference. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2486-2494. [PMID: 38632137 DOI: 10.1007/s00586-024-08245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/26/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To evaluate outcomes of choosing different Roussouly shapes and improving in Schwab modifiers for surgical Roussouly type 1 patients. METHODS Baseline (BL) and 2-year (2Y) clinical data of adult spinal deformity (ASD) patients presenting with Roussouly type 1 sagittal spinal alignment were isolated in the single-center spine database. Patients were grouped into Roussouly type 1, 2 and 3 with anteverted pelvis (3a) postoperatively. Schwab modifiers at BL and 2Y were categorized as follows: no deformity (0), moderate deformity (+), and severe deformity (++) for pelvic tilt (PT), sagittal vertical axis (SVA), and pelvic incidence and lumbar lordosis mismatch (PI-LL). Improvement in SRS-Schwab was defined as a decrease in the severity of any modifier at 2Y. RESULTS A total of 96 patients (69.9 years, 72.9% female, 25.2 kg/m2) were included. At 2Y, there were 34 type 1 backs, 60 type 2 backs and only 2 type 3a. Type 1 and type 2 did not differ in rates of reaching 2Y minimal clinically important difference (MCID) for health-related quality of life (HRQOL) scores (all P > 0.05). Two patients who presented with type 3a had poor HRQOL scores. Analysis of Schwab modifiers showed that 41.7% of patients improved in SVA, 45.8% in PI-LL, and 36.5% in PT. At 2Y, patients who improved in SRS-Schwab PT and SVA had lower Oswestry disability index (ODI) scores and significantly more of them reached MCID for ODI (all P < 0.001). Patients who improved in SRS-Schwab SVA and PI-LL had more changes of VAS Back and Short Form-36 (SF-36) outcomes questionnaire physical component summary (SF-36 PCS), and significantly more reached MCID (all P < 0.001). By 2Y, type 2 patients who improved in SRS-Schwab grades reached MCID for VAS back and ODI at the highest rate (P = 0.003, P = 0.001, respectively), and type 1 patients who improved in SRS-Schwab grades reached MCID for SF-36 PCS at the highest rate (P < 0.001). CONCLUSION For ASD patients classified as Roussouly type 1, postoperative improvement in SRS-Schwab grades reflected superior patient-reported outcomes while type 1 and type 2 did not differ in clinical outcomes at 2Y. However, development of type 3a should be avoided at the risk of poor functional outcomes. Utilizing both classification systems in surgical decision-making can optimize postoperative outcomes.
Collapse
Affiliation(s)
- Wenzhi Sun
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Shuaikang Wang
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Baobao Wang
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yongjin Li
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiaolong Chen
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Chao Kong
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Peng Wang
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Shibao Lu
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.
| |
Collapse
|
10
|
Pan C, Bourghli A, Li Y, Li L, Kuang L, Wang B, Sun J, Lv G, Obeid I. Predicting thoracic kyphosis morphology and the thoracolumbar inflection point determined by individual lumbar lordosis in asymptomatic adults. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1830-1839. [PMID: 37851162 DOI: 10.1007/s00586-023-07983-z] [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: 04/09/2023] [Revised: 07/31/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE The aims of this study were to explore the correlations between thoracic kyphosis (TK) and lumbar lordosis (LL) parameters and to build corresponding linear regressions to predict TK morphology and the thoracolumbar inflection point (IP) determined by individual LL parameters in asymptomatic adults. METHODS A total of 280 adult healthy volunteers were recruited, and full-spine X-rays were performed for each subject in a standing posture. The following sagittal parameters were measured: cumulative TK, LL, proximal LL (PLL), the apices of TK (TKA) and LL (LLA), the IP and the distance from the plumb line of the thoracic apex (TAPL) and the lumbar apex (LAPL) to the gravity line. The correlations between TK and LL parameters were analyzed, and the corresponding linear regressions were conducted. RESULTS Extensive variations existed in TK alignment, including angular and morphological parameters. In addition, there were statistical correlations of all cumulative TK angles with LL (r values from - 0.173 to - 0.708) and PLL (r values from - 0.206 to - 0.803), TKA and IP with LLA (rs = 0.359 and 0.582, respectively) and TAPL with LAPL (rs = 0.335). The common predictive formulas employed in ASD surgery could include T10-L1 = - 3.6-0.2*LL (R2 = 0.201), T4-L1 = 3.4-0.5*LL (R2 = 0.457), TKA = - 10.3 + 1.1*LLA (R2 = 0.180) and IP = - 12.7 + 1.6*LLA (R2 = 0.330). CONCLUSION There were intimate associations between TK and LL parameters in asymptomatic adults. Moreover, predictive models for thoracic alignment, particularly cumulative TK, based on LL parameters were proposed, which could better delineate anatomical relationships, guide thoracic construction during adult spinal deformity surgery and may help preventing proximal junctional failure.
Collapse
Affiliation(s)
- Changyu Pan
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yunchao Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Lei Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Lei Kuang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jianmin Sun
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China
| | - Guohua Lv
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
| |
Collapse
|
11
|
Philippi M, Shin C, Quevedo S, Weiner J, Chavarria J, Avramis I, Rizkalla JM. Roussouly classification of adult spinal deformity. Proc AMIA Symp 2024; 37:688-691. [PMID: 38910817 PMCID: PMC11188786 DOI: 10.1080/08998280.2024.2334548] [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: 02/21/2024] [Accepted: 03/12/2024] [Indexed: 06/25/2024] Open
Abstract
With an estimated prevalence of 68% among healthy adults without a previous diagnosis of scoliosis, adult spinal deformities are a growing concern as the population ages. Our understanding of this growing concern has been historically guided by previous studies performed on the pediatric population. Over time, different classifications have been developed with their own respective limitations. The Roussouly classification was the first classification to describe the shapes of an asymptomatic spine. It considers lumbar lordosis, pelvic incidence, and the inflection point from lumbar lordosis to thoracic kyphosis to attempt to stratify the shapes of an asymptomatic spine. This classification aims to guide treatment, provide information regarding prognosis, allow stratification for research, and be highly reproducible. Overall, the Roussouly classification is a novel way to think about sagittal malalignment, considering the patient's individual anatomy, while allowing for communication between surgeons. Additionally, it has proven to be a reliable system that provides prognostic value for clinicians and may minimize complications when a patient's sagittal alignment is optimized using this classification system.
Collapse
Affiliation(s)
- Matthew Philippi
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Caleb Shin
- Department of Orthopaedics, Baylor University Medical Center, Dallas, Texas, USA
| | - Santiago Quevedo
- Department of Orthopaedics, Baylor University Medical Center, Dallas, Texas, USA
| | - Joseph Weiner
- Department of Orthopaedics, Kansas University Medical Center, Kansas City, Missouri, USA
| | - Joseph Chavarria
- Department of Orthopaedics, Baylor University Medical Center, Dallas, Texas, USA
| | - Ioannis Avramis
- Department of Orthopaedics, Baylor University Medical Center, Dallas, Texas, USA
| | - James M. Rizkalla
- Department of Orthopaedics, Baylor University Medical Center, Dallas, Texas, USA
| |
Collapse
|
12
|
Shen Y, Sardar ZM, Malka M, Katiyar P, Greisberg G, Hassan F, Reyes JL, Le Huec JC, Bourret S, Hasegawa K, Wong HK, Liu G, Dennis Hey HW, Riahi H, Kelly M, Lombardi JM, Lenke LG. Characteristics of Spinal Morphology According to the "Current" and "Theoretical" Roussouly Classification Systems in a Diverse, Asymptomatic Cohort: Multi-Ethnic Alignment Normative Study (MEANS). Global Spine J 2024:21925682241235611. [PMID: 38417069 DOI: 10.1177/21925682241235611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
STUDY DESIGN Cross-sectional cohort study. OBJECTIVE To classify spinal morphology using the "current" and "theoretical" Roussouly systems and assess sagittal alignment in an asymptomatic cohort. METHODS 467 asymptomatic volunteers were recruited from 5 countries. Radiographic parameters were measured via the EOS imaging system. "Current" and "theoretical" Roussouly classification was assigned with sagittal whole spine imaging using sacral slope (SS), pelvic incidence (PI), and the lumbar apex. One-way analysis of variance (ANOVA) was performed to compare subject characteristics across Roussouly types, followed by post hoc Bonferroni correction. RESULTS Volunteers were categorized into 4 groups (Types 1-4) and 1 subgroup (Type 3 AP) using the "current" and "theoretical" Roussouly systems. The mean PI in "current" Roussouly groups was 40.8° (Type 1), 43.6° (Type 2), 52.4° (Type 3), 62.4° (Type 4), and 43.7° (Type 3AP). The mean PI in "theoretical" Roussouly groups was 36.5° (Type 1), 39.1°(Type 2), 52.5° (Type 3), 67.3° (Type 4), and 51.0° (Type 3AP). The difference in PI between "current" and "theoretical" Roussouly types was significant for Type 1 (P = .02), Type 2 (P < .001), Type 4 (P < .001), and Type 3AP (P < .001). 34.7% of subjects had a "current" Roussouly type different from the "theoretical" type. Type 3 theoretical shape had the most frequent mismatch, constituting 61.1% of the mismatched subjects. 51.5% of mismatched Type 3 become "current" Type 4. CONCLUSION The distribution of Roussouly types differs depending on whether the "current" or "theoretical" classification are employed. A sizeable proportion of volunteers exhibited current and theoretical type mismatch, highlighting the need to interpret sagittal alignment cautiously when utilizing the Roussouly system.
Collapse
Affiliation(s)
- Yong Shen
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Matan Malka
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Prerana Katiyar
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Gabriella Greisberg
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Fthimnir Hassan
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Justin L Reyes
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | | | - Stephane Bourret
- Bordeaux University, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | - Hee Kit Wong
- Department of Orthopedic Surgery, National University Hospital, Singapore
| | - Gabriel Liu
- Department of Orthopedic Surgery, National University Hospital, Singapore
| | | | - Hend Riahi
- Institut Kassab d'Orthopédie, La Manouba, Tunisia
| | - Michael Kelly
- Rady Children's Hospital, University of California, San Diego, CA, USA
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, The Spine Hospital at New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
13
|
Zhang Z, Zhou Q, Zhu C, Liu LM, Song YM, Yang X. Restoring the ideal Roussouly sagittal alignment in Lenke 5 adolescent idiopathic scoliosis patients: a method for decreasing the risk of proximal junctional kyphosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:695-705. [PMID: 37874394 DOI: 10.1007/s00586-023-07992-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/01/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE Although the Roussouly classification has been widely used in surgical planning for adult scoliosis patients, little is known about whether it can be used to guide sagittal correction for adolescent idiopathic scoliosis (AIS) patients. The purpose of this study was to explore whether the Roussouly classification could be used to help surgeons restore the ideal sagittal alignment for AIS patients to avoid the development of proximal junctional kyphosis (PJK). METHODS In this retrospective cohort study, eighty-seven patients with Lenke 5 AIS who underwent surgery from January 2010 to August 2020 were enrolled and divided into two groups: the PJK group and the non-PJK group. All patients were classified into "current types" and "ideal types" according to two versions of the Roussouly classification, and the mismatch rate was evaluated in terms of the consistency between their current type and ideal type. Student's t test, Mann‒Whitney U test, Pearson's Chi-square test, and others were used to compare the two groups regarding patient demographic characteristics (age, sex, Risser sign, etc.) and radiographic parameters (sagittal vertical axis [SVA]; thoracic kyphosis [TK]; thoracolumbar junctional kyphosis [TLK]; lumbar lordosis [LL]; pelvic incidence [PI]; pelvic tilt [PT]; sacral slope [SS]; upper instrumented vertebra [UIV]; lower instrumented vertebra [LIV]; etc.). Multivariate logistic regression with backwards stepwise selection was performed to identify the risk factors for PJK. RESULTS PJK was observed in 16 out of 87 patients (18.4%) until the final follow-up. The incidence of PJK was significantly higher in the patients not matching their ideal type than in those who did after surgery (60.9% vs. 3.1%, p = 0.000). The patients with ideal Type 1 had the highest incidence of PJK, while the lowest incidence was observed in patients with ideal Type 2 (50.0% vs. 5.1%, p = 0.000). The PJK group had greater TK, LL, and PI-LL than the non-PJK group before and after surgery. The postoperative PJA in the PJK group was also larger than that in the non-PJK group. Multivariate logistic regression revealed that postoperative Roussouly type mismatch was significantly associated with the occurrence of PJK (OR = 64.2, CI = 9.6-407.1, p = 0.000). CONCLUSIONS The Roussouly classification could serve as a prognostic tool for PJK in Lenke 5 AIS patients. Corrective surgery should restore sagittal alignment with respect to the patient's ideal sagittal profile (according to the Roussouly classification based on the PI) to decrease the incidence of PJK in AIS patients.
Collapse
Affiliation(s)
- Zhuang Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China
| | - Quan Zhou
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China
| | - Li-Min Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China
| | - Yue-Ming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China.
| | - Xi Yang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China.
| |
Collapse
|
14
|
Wang G, Li Y, Zhang C, Liu P, Sun J. Erector Spinae Atrophy Correlates with Global Sagittal Imbalance and Postoperative Proximal Junctional Kyphosis Incidence in Lumbar Degenerative Kyphosis. Asian Spine J 2024; 18:50-57. [PMID: 38379145 PMCID: PMC10910147 DOI: 10.31616/asj.2023.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 02/22/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE This study aimed to investigate the relationship between lumbar erector muscle atrophy and global sagittal imbalance in lumbar degenerative kyphosis (LDK) and with postoperative proximal junctional kyphosis. OVERVIEW OF LITERATURE Lumbar erector muscle atrophy has been studied in LDK. However, its role in the compensatory mechanism is still under intense discussion, and the role of erector spinae (ES) muscle is always overlooked. METHODS This study enrolled 51 patients with LDK out of 382 patients with adult degenerative spinal deformity. Baseline information was reviewed including demographic data and complications. Sagittal spinopelvic alignments and global imbalance parameters were assessed on full-length X-ray images of the spine. Muscularity and the fatty infiltration area of the ES and multifidus (MF) were measured at the L4/5 level on preoperative magnetic resonance image to evaluate the lumbar erector muscle atrophy. Stratification by sagittal vertical axis (SVA) was performed: group 1 with SVA <100 mm and group 2 with SVA >100 mm, and these groups were compared. Spearman correlation and multivariable logistic regression analyses were performed to analyze and define risk factors of postoperative proximal junctional kyphosis (PJK). RESULTS Group 2 had lower ES and MF muscularity than group 1. ES muscularity correlated with SVA (r=-0.510, p<0.003), lumbar lordosis (r=-0.415, p<0.018), and postoperative PJK (r=-0.508, p<0.022). MF muscularity did not correlate with the above parameters. Multivariable logistic regression analysis verified ES muscularity (odds ratio [OR], 0.001; p<0.039) and SVA (OR, 1.034; p<0.048) as the risk factors for postoperative PJK. CONCLUSIONS ES atrophy, besides the MF, is an important predictor in distinguishing decompensated LDK from well-compensated ones. It plays an important role in compensatory mechanism, not only correlates with global sagittal imbalance but also ties to PJK after deformity corrective surgery.
Collapse
Affiliation(s)
- Guodong Wang
- Department of Spinal Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yang Li
- Department of Spinal Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Chenggui Zhang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ping Liu
- The Base of Achievement Transformation, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Jianmin Sun
- Department of Spinal Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| |
Collapse
|
15
|
Pan C, Anouar B, Yang Y, Li L, Kuang L, Wang B, Lv G, Obeid I. Relationships between lumbar lordosis correction and the change in global tilt (GT) in adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:610-619. [PMID: 38104044 DOI: 10.1007/s00586-023-08066-9] [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: 07/24/2023] [Revised: 07/24/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE This study aimed to explore the relationships between lumbar lordosis (LL) correction and improvement of postoperative global sagittal alignment and to establish corresponding linear regressions to predict the change in global tilt (GT) based on the corrected LL following adult spinal deformity (ASD) surgery. METHODS A total of 240 ASD patients who underwent lumbar correction were enrolled in this multicentre study. The following sagittal parameters were measured pre- and postoperatively: thoracic kyphosis (TK), LL, upper and lower LL (ULL and LLL), pelvic tilt (PT), sagittal vertical axis (SVA) and GT. The correlations among the changes in GT (△GT), SVA (△SVA), PT (△PT), TK (△TK), LL (△LL), ULL (△ULL) and LLL (△LLL) were assessed, and linear regressions were conducted to predict △GT, △SVA, △PT and △TK from △LL, △ULL and △LLL. RESULTS △LL was statistically correlated with △GT (r = 0.798, P < 0.001), △SVA (r = 0.678, P < 0.001), △PT (r = 0.662, P < 0.001) and △TK (r = - 0.545, P < 0.001), and the outcomes of the linear regressions are: △GT = 3.18 + 0.69 × △LL (R2 = 0.636), △SVA = 4.78 + 2.57 × △LL (R2 = 0.459), △PT = 2.57 + 0.34 × △LL (R2 = 0.439), △TK = 7.06-0.43 × △LL (R2 = 0.297). In addition, △LLL had more correlations with △GT, △SVA and △PT, while △ULL had more correlations with △TK. CONCLUSION Surgical correction of LL could contribute to the restoration of global sagittal morphology following ASD surgery. These models were established to predict the changes in sagittal parameters, in particular △GT, determined by △LL, which has not been previously done and may help to customize a more precise correction plan for ASD patients.
Collapse
Affiliation(s)
- Changyu Pan
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Bourghli Anouar
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yue Yang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Lei Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Lei Kuang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Guohua Lv
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
| |
Collapse
|
16
|
Gessara A, Patel MS, Estefan M, Koch JEJ, Gutman N, Mardashti A, Shetaiwi A, Quraishi NA. Restoration of the sagittal profile according to the Roussouly classification reduces mechanical complications and revision surgery in older patients undergoing surgery for adult spinal deformity (ASD). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:563-570. [PMID: 37768339 DOI: 10.1007/s00586-023-07885-0] [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: 02/24/2023] [Revised: 07/14/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The mechanical complications related to ASD remain a concern due to their morbidity and associated revision surgery. Restoration of each patient's Roussouly profile may reduce these. Our aim was to examine if the restoration of the Roussouly profile reduced these complications and revision rates in older patients operated for degenerative ASD. METHODS Retrospective analysis of a single-centre, 2-year minimum follow-up patient database. All patients undergoing corrective surgery (≥ 4 levels) for ASD were included with analysis of demographic data, operative records, restoration of Roussouly sagittal profile, mechanical complications and revision rates. Univariate and multivariate analysis was conducted. RESULTS Fifty-two patients were included (mean age was 72.3 years, average follow-up 56.3 months). Twenty-six patients had a "restored" profile (50%) and 26 an "unrestored" profile (50%). The incidence of mechanical complications was 7 (27%) and 23 (88%) for the restored and unrestored groups, respectively (p < 0.001). Revision rates were 4 (15.4%) and 18 (69.2%), respectively (p < 0.000), in the restored and unrestored profiles. Univariate analysis determined that profile restoration and BMI were associated with mechanical complications and revision surgery, whilst only the profile restoration status maintained its statistical power in multivariate analysis (p = 0.002 and p = 0.002, respectively). Age was not a significant factor in univariate analysis. The relative risk for mechanical failure and revision surgery was 5.6 times (CI 1.929-16.39) and 3.08 times (CI 1.642-5.734) greater if the profile was not restored. CONCLUSIONS Achieving each patient's ideal Roussouly profile is associated with a reduced incidence of mechanical complications and revision rates in the older population after surgery for degenerative ASD.
Collapse
Affiliation(s)
- Alan Gessara
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK.
| | | | - Martin Estefan
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Jonathan E J Koch
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Nadav Gutman
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Ali Mardashti
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Ali Shetaiwi
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| | - Nasir Ali Quraishi
- Queens Medical Centre, Centre for Spinal Studies and Surgery, Nottingham, UK
| |
Collapse
|
17
|
Wang M, Wang X, Wang H, Shen Y, Qiu Y, Sun X, Zhou D, Jiang Y. Validation of Roussouly classification in predicting the occurrence of adjacent segment disease after short-level lumbar fusion surgery. J Orthop Traumatol 2024; 25:2. [PMID: 38217751 PMCID: PMC10787724 DOI: 10.1186/s10195-023-00744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/27/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Recent studies demonstrated that restoring sagittal alignment to the original Roussouly type can remarkably reduce complication rates after adult spinal deformity surgery. However, there is still no data proving the benefit of maintaining ideal Roussouly shape in the lumbar degenerative diseases and its association with the development of adjacent segment disease (ASD). Thus, this study was performed to validate the usefulness of Roussouly classification to predict the occurrence of ASD after lumbar fusion surgery. MATERIALS AND METHODS This study retrospectively reviewed 234 consecutive patients with lumbar degenerative diseases who underwent 1- or 2-level fusion surgery. Demographic and radiographic data were compared between ASD and non-ASD groups. The patients were classified by both "theoretical" [based on pelvic incidence (PI)] and "current" (based on sacral slope) Roussouly types. The patients were defined as "matched" if their "current" shapes matched the "theoretical" types and otherwise as "mismatched". The logistic regression analysis was performed to identify the factors associated with ASD. Finally, clinical data and spinopelvic parameters of "theoretical" and "current" types were compared. RESULTS With a mean follow-up duration of 70.6 months, evidence of ASD was found in the 68 cases. Postoperatively, ASD group had more "current" shapes classified as type 1 or 2 and fewer as type 3 than the non-ASD group (p < 0.001), but the distribution of "theoretical" types was similar between groups. Moreover, 80.9% (55/68) of patients with ASD were mismatched, while 48.2% (80/166) of patients without ASD were mismatched (p < 0.001). A multivariate analysis identified age [odds ratio (OR) = 1.058)], 2-level fusion (OR = 2.9830), postoperative distal lordosis (DL, OR = 0.949) and mismatched Roussouly type (OR = 4.629) as independent risk factors of ASD. Among the four "theoretical" types, type 2 had the lowest lumbar lordosis, DL, and segmental lordosis. When considering the "current" types, current type 2 was associated with higher rates of 2-level fusion, worse DL, and greater pelvic tilt compared with other current types. CONCLUSIONS DL loss and mismatched Roussouly type were significant risk factors of ASD. To decrease the incidence of ASD, an appropriate value of DL should be achieved to restore sagittal alignment back to the ideal Roussouly type. LEVEL OF EVIDENCE Level 4.
Collapse
Affiliation(s)
- Muyi Wang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Xin Wang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Hao Wang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Yifei Shen
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Dong Zhou
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China
- Department of Orthopedics, Changzhou No.6 People's Hospital, Changzhou, Jiangsu Province, China
| | - Yuqing Jiang
- Department of Orthopedics, Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Gehu Middle Road 68, Changzhou, 213000, Jiangsu Province, China.
- Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu Province, China.
| |
Collapse
|
18
|
Passias PG, Williamson TK, Kummer NA, Pellisé F, Lafage V, Lafage R, Serra-Burriel M, Smith JS, Line B, Vira S, Gum JL, Haddad S, Sánchez Pérez-Grueso FJ, Schoenfeld AJ, Daniels AH, Chou D, Klineberg EO, Gupta MC, Kebaish KM, Kelly MP, Hart RA, Burton DC, Kleinstück F, Obeid I, Shaffrey CI, Alanay A, Ames CP, Schwab FJ, Hostin RA, Bess S. Cost Benefit of Implementation of Risk Stratification Models for Adult Spinal Deformity Surgery. Global Spine J 2023:21925682231212966. [PMID: 38081300 DOI: 10.1177/21925682231212966] [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: 12/22/2023] Open
Abstract
STUDY DESIGN/SETTING Retrospective cohort study. OBJECTIVE Assess the extent to which defined risk factors of adverse events are drivers of cost-utility in spinal deformity (ASD) surgery. METHODS ASD patients with 2-year (2Y) data were included. Tertiles were used to define high degrees of frailty, sagittal deformity, blood loss, and surgical time. Cost was calculated using the Pearl Diver registry and cost-utility at 2Y was compared between cohorts based on the number of risk factors present. Statistically significant differences in cost-utility by number of baseline risk factors were determined using ANOVA, followed by a generalized linear model, adjusting for clinical site and surgeon, to assess the effects of increasing risk score on overall cost-utility. RESULTS By 2 years, 31% experienced a major complication and 23% underwent reoperation. Patients with ≤2 risk factors had significantly less major complications. Patients with 2 risk factors improved the most from baseline to 2Y in ODI. Average cost increased by $8234 per risk factor (R2 = .981). Cost-per-QALY at 2Y increased by $122,650 per risk factor (R2 = .794). Adjusted generalized linear model demonstrated a significant trend between increasing risk score and increasing cost-utility (r2 = .408, P < .001). CONCLUSIONS The number of defined patient-specific and surgical risk factors, especially those with greater than two, were associated with increased index surgical costs and diminished cost-utility. Efforts to optimize patient physiology and minimize surgical risk would likely reduce healthcare expenditures and improve the overall cost-utility profile for ASD interventions.Level of evidence: III.
Collapse
Affiliation(s)
- Peter G Passias
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, NY, NY, USA
| | - Tyler K Williamson
- Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Nicholas A Kummer
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, NY, NY, USA
| | - Ferran Pellisé
- Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Miguel Serra-Burriel
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Breton Line
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Shaleen Vira
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Sleiman Haddad
- Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Dean Chou
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, Missouri, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, CA, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Frank Kleinstück
- Spine Center Division, Department of Orthopedics and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
| | - Ibrahim Obeid
- Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Christopher I Shaffrey
- Spine Division, Departments of Neurosurgery and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acıbadem University, Istanbul, Turkey
| | - Christopher P Ames
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Frank J Schwab
- Department of Orthopaedics, Lenox Hill Hospital, New York, NY, USA
| | - Richard A Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX, USA
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| |
Collapse
|
19
|
Achonu JU, Ling K, Bhan R, Garcia A, Komatsu DE, Pallotta NA. Pelvic index: A new pelvic parameter for assessing sagittal spinal alignment. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100274. [PMID: 37869546 PMCID: PMC10587509 DOI: 10.1016/j.xnsj.2023.100274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 10/24/2023]
Abstract
Background The incidence of correctional surgery for adult spinal deformity (ASD) has increased significantly over the past 2 decades. Pelvic incidence, an angular measurement, is the gold standard pelvic parameter and is used to classify spinal shapes into Roussouly types. Current literature states that restoration of the spine to its original Roussouly classification optimizes outcomes. We propose a new pelvic parameter, pelvic index, as a length measurement to complement pelvic incidence in more accurately characterizing Roussouly types. Methods This study is a retrospective evaluation of sagittal spinal radiographs of 208 patients who were assessed by a single fellowship trained orthopedic spine surgeon between January and December 2020. Measurements included pelvic incidence, sacroacetabular distance, and L5 vertebral height. Pelvic index was calculated as the ratio of sacroacetabular distance to L5 height. Each spine was also classified into one of the Roussouly types: 1, 2, 3 anteverted pelvis (AP), 3, or 4. The 2 pelvic parameters were compared between groups to assess their ability to differentiate between Roussouly types. Results Of the 208 patients included, 103 (49.5%) were female and 105 (50.5%) were male. The mean pelvic incidence was 54.9 ± 12.3° and the mean pelvic index was 3.99 ± 0.38. The difference in mean pelvic index was statistically significant between types 1 and 2 (0.15; p=.046) and between types 1 and 3 AP (0.19; p=.029). It was not statistically significant between types 3 and 4 (0.05; p=.251). However, in terms of pelvic incidence, the mean difference was statistically significant only between types 3 and 4 (10.4; p<.001). Conclusions Pelvic index is the ratio of the sacroacetabular distance to the height of the L5 vertebra. In conjunction with pelvic incidence, pelvic index can help to distinguish between Roussouly types 1 and 2 and between types 1 and 3 AP, the low-pelvic incidence types.
Collapse
Affiliation(s)
- Justice U. Achonu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, HSC-T18, Room 085, Stony Brook, NY 11794-8181, United States
| | - Kenny Ling
- Department of Orthopaedics and Rehabilitation, Stony Brook University, HSC-T18, Room 085, Stony Brook, NY 11794-8181, United States
| | - Rohit Bhan
- Department of Orthopaedics and Rehabilitation, Stony Brook University, HSC-T18, Room 085, Stony Brook, NY 11794-8181, United States
| | - Alexander Garcia
- Department of Orthopaedics and Rehabilitation, Stony Brook University, HSC-T18, Room 085, Stony Brook, NY 11794-8181, United States
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, HSC-T18, Room 085, Stony Brook, NY 11794-8181, United States
| | - Nicholas A. Pallotta
- Department of Orthopedic Surgery, Washington University School of Medicine, Campus Box 8233660, South Euclid Avenue, Saint Louis, MO 63110, United States
| |
Collapse
|
20
|
Yagi M, Yamanouchi K, Fujita N, Funao H, Ebata S. Proximal Junctional Failure in Adult Spinal Deformity Surgery: An In-depth Review. Neurospine 2023; 20:876-889. [PMID: 37798983 PMCID: PMC10562237 DOI: 10.14245/ns.2346566.283] [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: 05/19/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 10/07/2023] Open
Abstract
Adult spinal deformity (ASD) surgery aims to correct abnormal spinal curvature in adults, leading to improved functionality and reduced pain. However, this surgery is associated with various complications, one of which is proximal junctional failure (PJF). PJF can have a significant impact on a patient's quality of life, necessitating a comprehensive understanding of its causes and the development of effective management strategies. This review aims to provide an in-depth understanding of PJF in ASD surgery. PJF is a complex complication resulting from a multitude of factors including patient characteristics, surgical techniques, and postoperative management. Age, osteoporosis, overcorrection of sagittal alignment, and poor bone quality are identified as significant risk factors. The clinical implications of PJF are substantial, often requiring revision surgery and causing a considerable decrease in patients' quality of life. Prevention strategies include careful preoperative planning, appropriate patient selection, and optimization of surgical techniques. Treatment often necessitates a multifaceted approach, including surgical intervention and the management of underlying risk factors. Predictive modeling is an emerging field that may offer a promising avenue for the risk stratification of patients and individualized preventive strategies. A thorough understanding of PJF's pathogenesis, risk factors, and clinical implications is essential for surgeons involved in ASD surgery. Current preventive measures and treatment strategies aim to mitigate the risk and manage the complications of PJF, but the complication cannot be entirely prevented. Future research should focus on the development of more effective preventive and treatment strategies, and predictive models could be valuable in this pursuit.
Collapse
Affiliation(s)
- Mitsuru Yagi
- Department of Orthopaedic Surgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Kento Yamanouchi
- Department of Orthopaedic Surgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Naruhito Fujita
- Department of Orthopaedic Surgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Shigeto Ebata
- Department of Orthopaedic Surgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| |
Collapse
|
21
|
Raganato R, Pizones J, Yilgor C, Moreno-Manzanaro L, Vila-Casademunt A, Sánchez-Márquez JM, Fernández-Baíllo N, Sánchez Pérez-Grueso FJ, Kleinstück F, Alanay A, Obeid I, Pellisé F. Sagittal realignment: surgical restoration of the global alignment and proportion score parameters: a subgroup analysis. What are the consequences of failing to realign? 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; 32:2238-2247. [PMID: 37000217 DOI: 10.1007/s00586-023-07649-w] [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: 12/28/2022] [Revised: 02/18/2023] [Accepted: 03/09/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION The Global Alignment and Proportion (GAP) score incorporates three domains directly modified with surgery (relative pelvic version-RPV, relative lumbar lordosis-RLL, lumbar distribution index-LDI) and one indirectly restored (relative spinopelvic alignment-RSA). We analyzed our surgical realignment performance and the consequences of domain-specific realignment failure on mechanical complications and PROMs. MATERIALS AND METHODS From an adult spinal deformity prospective multicenter database, we selected patients: fused to pelvis, upper instrumented vertebra at or above L1, and 2 years of follow-up. Descriptive, univariate and multivariate analyses were employed. RESULTS The sample included 333 patients. RLL-6w showed the highest success rate (58.3% aligned), but 16.5% of patients were classified in the "Severe hypolordosis" and "Hyperlordosis" subgroups. RPV-6w was the most challenging to realign, with 51.6% moderate or severe retroversion. Regarding RSA-6w, 21.9% had severe positive malalignment. Correct alignment of RPV-6w (p = 0.025) and RSA-6w (p = 0.002) proved to be protective factors against the development of mechanical complications. Severe pelvic retroversion (p = 0.026) and severe positive malalignment (p = 0.007) were risk factors for mechanical complications. RSA-6w "Severe positive malalignment" was associated with less improvement in PROMs: ∆ODI (8.83 vs 17.2; p = 0.011), ∆SRS-22 total (0.54 vs 0.87; p = 0.007), and ∆SF-36PCS (3.47 vs 7.76; p = 0.04); MCID for ODI (37.0 vs 55.5%; p = 0.023), and SRS-22 (40.8 vs 60.1%; p = 0.015); and PASS for ODI (17.6 vs 31.7%; p = 0.047). CONCLUSIONS RPV was the most underperformed modifiable parameter. Severe pelvic retroversion and severe positive malalignment influenced the occurrence of mechanical complications. Severe positive malalignment affected PROMs improvement.
Collapse
Affiliation(s)
- Riccardo Raganato
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain.
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | | | - José Miguel Sánchez-Márquez
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Nicomedes Fernández-Baíllo
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | | | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
22
|
Hiyama A, Katoh H, Nomura S, Sakai D, Sato M, Watanabe M. An Analysis of Whether a New Formula Can Predict Proximal Junctional Failure in Adult Spinal Deformity Patients with Global Kyphosis. World Neurosurg 2023; 170:e271-e282. [PMID: 36334711 DOI: 10.1016/j.wneu.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A new formula containing terms for age and sagittal curvature reported by the International Spine Study Group is ideal lumbar lordosis (iLL) = pelvic incidence - 0.3 thoracic kyphosis - 0.5Age + 10. However, there are no reports of whether proximal junctional failure (PJF) can be predicted using this formula. We assessed the utility of this formula in PJF in patients with adult spinal deformity with global kyphosis using the Roussouly classification. METHODS Forty-four patients with adult spinal deformity global kyphosis (mean age 70.0 years) who underwent multiple levels of lateral lumbar interbody fusion combined with posterior instrumentation were included. Patients were divided into 2 groups: PJF and non-PJF. Demographic, surgical, and radiological parameters were compared. The iLL was calculated according to the new formula, and spinal parameters were compared preoperatively, immediately after, and at the final follow-up. RESULTS PJF occurred in 11 of 44 (25.0%) patients. Patients with PJF had a large preoperative and postoperative TK, but there was no statistically significant difference in iLL between PJF and non-PJF patients (33.4° vs. 30.2°, P = 0.357). In addition, there was no statistically significant difference in LL and iLL changes (ΔiLL) immediately after surgery (19.0° vs. 23.4°, P = 0.379). Furthermore, there was no correlation between ΔiLL immediately after surgery and at the final follow-up and the proximal junctional angle at the final follow-up. CONCLUSIONS The results of ΔiLL suggest that overcorrection needs to be addressed but that this new formula, including age adjustment, may not predict PJF.
Collapse
Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Satoshi Nomura
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| |
Collapse
|
23
|
The postoperative course of mechanical complications in adult spinal deformity surgery. Spine Deform 2023; 11:175-185. [PMID: 36063294 DOI: 10.1007/s43390-022-00576-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE (a) Describe the time course of each mechanical complication, and (b) compare radiographic measurements and preoperative patient-reported outcome measures (PROMs) among each mechanical complication type. METHODS A single-institution case-control study was undertaken of patients undergoing adult spinal deformity (ASD) surgery from 2009-2017. Exposure variables included patient demographics, operative variables, radiographic measurements, and preoperative PROMs, including Oswestry Disability Index (ODI), Numeric Rating Scale Back/Leg-pain scores (NRS-Back/Leg), and EuroQol-5D (EQ-5D). The primary outcomes were occurrence of a mechanical complication and time to complication. Due to overlapping occurrence, rod fracture and pseudarthrosis were grouped into one composite category. RESULTS 145 patients underwent ASD surgery and were followed for at least 2 years. 30/47 (63.8%) patients with proximal junctional kyphosis (PJK) required reoperation, whereas 27/31 (87.1%) patients with pseudarthrosis/rod fracture required reoperation (63.8% vs. 87.1%, Χ2 = -0.23, 95% CI -0.41, -0.05, p = 0.023). Cox regression showed no significant difference in time to reoperation between PJK and rod fracture/pseudarthrosis (HR = 0.97, 95% CI 0.85-1.11, p = 0.686). Distal junctional kyphosis (DJK) (N = 3; 2 reoperation) and implant failures (N = 4; 0 reoperations) were rare. Patients with PJK had significantly lower Hounsfield Units preoperatively compared to those with pseudarthrosis/rod fracture (138.2 ± 43.8 vs. 160.3 ± 41.0, mean difference (MD) = -22.1, 95% CI -41.8, -2.4, p = 0.028), more prior fusions (51.1% vs. 25.8%, Χ2 = 0.253, 95% CI 0.41, 0.46, p = 0.026), fewer instrumented vertebrae (9.2 ± 2.6 vs. 10.7 ± 2.5, MD = -1.5, 95% CI -2.7, -0.31, p = 0.013), and higher postoperative thoracic kyphosis (TK) (46.3 ± 12.7 vs. 34.9 ± 10.6, MD = 11.4, 95% CI 5.9, 16.9, p < 0.001). Higher postoperative C7 sagittal vertical axis (SVA) did not achieve a significant difference (80.7 ± 72.1 vs. 51.9 ± 57.3, MD = 28.8, 95% CI -1.9, 59.5, p = 0.066). No differences were seen in preoperative PROMs. CONCLUSION Patients with pseudarthrosis/rod fracture had a higher reoperation rate compared to those with PJK with similar time to reoperation. Moreover, patients with PJK had higher postoperative TK, lower Hounsfield Units, more prior fusions, and fewer instrumented levels compared to those with pseudarthrosis/rod fracture. The results of this single-institution study suggest that even though mechanical complications are often analyzed as a single group, important differences may exist between them. LEVEL OF EVIDENCE III.
Collapse
|
24
|
Camino-Willhuber G, Guiroy A, Servidio M, Astur N, Nin-Vilaró F, Alvarado-Gomez F, Daher M, Saciloto B, Ono A, Letaif O, Zarate-Kalfopulos B, Yurac R, Vialle E, Valacco M. Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study. Global Spine J 2023; 13:74-80. [PMID: 33504208 PMCID: PMC9837501 DOI: 10.1177/2192568221991101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN Multicentric retrospective study, Level of evidence III. OBJECTIVE The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. METHODS Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. RESULTS 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively (P 0.0001). CONCLUSION The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay.
Collapse
Affiliation(s)
- Gaston Camino-Willhuber
- Institute of Orthopedics “Carlos E.
Ottolenghi,” Hospital Italiano de Buenos Aires, Buenos Aires, Argentina,AOSpine Latin America Study Group,
Curitiba, Brazil,Gaston Camino-Willhuber, Orthopaedic and
Traumatology Department. Institute of Orthopedics “Carlos E. Ottolenghi,”
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Alfredo Guiroy
- AOSpine Latin America Study Group,
Curitiba, Brazil,Spine Unit, Orthopedic Department,
Hospital Español de Mendoza, Mendoza, Argentina
| | | | - Nelson Astur
- AOSpine Latin America Study Group,
Curitiba, Brazil,Santa Casa de Misericordia de San Pablo,
São Paulo, Brazil,Hospital Israelita Albert Einstein,
Morumbi, São Paulo, Brazil
| | | | | | - Murilo Daher
- Departamento de Ortopedia e
Traumatologia, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO,
Brasil
| | - Bruno Saciloto
- Clínica Bambina Pontifícia
Universidade Católica do Paraná, Brasil
| | - Allan Ono
- Hospital das Clínicas da Faculdade de
Medicina da Universidade de São Paulo (IOT-HCFMUSP), Instituto de Ortopedia e
Traumatología, Spine Surgery Division, São Paulo, SP, Brazil
| | - Olavo Letaif
- Department of Orthopedics and
Traumatology, IOT HCFMUSP, São Paulo, Brazil
| | - Baron Zarate-Kalfopulos
- AOSpine Latin America Study Group,
Curitiba, Brazil,Instituto Nacional de Rehabilitación,
Distrito Federal, Mexico
| | - Ratko Yurac
- AOSpine Latin America Study Group,
Curitiba, Brazil,Department of Orthopedic and
Traumatology, University del Desarrollo, Santiago, Chile,Spine Unit, Department of
Traumatology, Clínica Alemana, Santiago, Chile
| | - Emiliano Vialle
- AOSpine Latin America Study Group,
Curitiba, Brazil,Cajuru Hospital, Catholic University
of Parana, Caritiba, Brazil
| | - Marcelo Valacco
- AOSpine Latin America Study Group,
Curitiba, Brazil,Hospital Churruca Visca, Buenos Aires,
Argentina
| |
Collapse
|
25
|
Qiu H, Chu TW, Niu XJ, Zhang Y, Yang SZ, Chen WG. Multisegment transforaminal lumbar interbody fusion (TLIF) combined with Ponte osteotomy in degenerative lumbar scoliosis (DLS) surgery: a minimum of five years' follow-up. INTERNATIONAL ORTHOPAEDICS 2022; 46:2897-2906. [PMID: 36153365 PMCID: PMC9674761 DOI: 10.1007/s00264-022-05572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/31/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the long-term clinical outcomes of degenerative lumbar scoliosis (DLS) with the administration of multisegment transforaminal lumbar interbody fusion (TLIF) combined with Ponte osteotomy long-level fixation fusion, as well as to identify the factors affecting health-related quality of life (HRQOL). METHODS This was a retrospective single-centre study involving comprehensive clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) outcomes, and Scoliosis Research Society (SRS-22) questionnaire were recorded to assess HRQOL. A correlation analysis was performed to determine the association between HRQOL and radiographic parameters. RESULTS A total of 41 consecutive patients (15 males and 26 females) met the inclusion criteria with a follow-up of 8.62 ± 1.20 years. Factors associated with HRQOL were significantly improved post-operation. Global sagittal parameters, including the sagittal vertebral axis (SVA) and T1 pelvic angle (TPA), and local parameters, including apical vertebral translation (AVT) and apical vertebral rotation (AVR), were significantly improved at the last follow-up. Significantly strong correlations between each clinical and radiographic parameter were demonstrated. Moreover, a multiple linear regression analysis demonstrated that the differences in AVT and AVR were significantly correlated with the difference in lumbar lordosis (LL), which was significantly correlated with the differences in SVA and TPA. CONCLUSION The surgical treatment of DLS with multisegment TLIF accompanied by Ponte osteotomy and long-level fixations improved the quality of life of patients with a long-term effect. AVR correction is an important factor for LL restoration that significantly correlates with improvements in the sagittal balance parameters SVA and TPA, which are key factors for guaranteeing good HRQOL.
Collapse
Affiliation(s)
- Hao Qiu
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Tong-wei Chu
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Xiao-Jian Niu
- Department of Orthopedics, 907 Hospital of The Joint Logistics Team, Nanping, Fujian Province People’s Republic of China 353000
| | - Ying Zhang
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Si-Zhen Yang
- grid.417298.10000 0004 1762 4928Department of Orthopedics, Xinqiao Hospital, Army Medical University, No. 83, Xinqiao Street, Shapingba District, Chongqing, People’s Republic of China 400037
| | - Wu-Gui Chen
- Department of Spinal Surgery, Mindong Hospital, Ningde, Fujian Province People’s Republic of China 355000
| |
Collapse
|
26
|
Sun W, Li Y, Chen X, Wang B, Kong C, Wang P, Lu S. Roussouly type 2 could evolve into type 1 shape as sagittal spinal alignment deterioration progresses with age. Front Surg 2022; 9:1049020. [PMID: 36439527 PMCID: PMC9681925 DOI: 10.3389/fsurg.2022.1049020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 09/04/2023] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To identify whether Roussouly type 2 could evolve into type 1 as the deterioration progresses. METHODS The study group comprised subjects with a low pelvic incidence (PI). All subjects underwent a standing whole spinal radiograph and sagittal parameters were measured: T1 pelvic angle (TPA), lumbar lordosis (LL), PI, pelvic tilt (PT), L4-S1 angle, thoracolumbar kyphosis (TLK), thoracic kyphosis (TK), lumbar sagittal apex (LSA), lordosis distribution index (LDI) and number of vertebrae included in the lordosis (NVL). All subjects were distributed into two groups; with primary (de novo) degenerative scoliosis (PDS) and without PDS. Subjects without PDS were divided into young adult, adult, middle-aged and elderly groups. The differences in sagittal parameters of each subgroup were compared. RESULTS In total, 270 subjects were included with a mean age of 58.6 years (range 20-87 years). There was a stepwise increase in the proportion of type 1 with age, whereas type 2 decreased. The TPA, PT, PI-LL, TK, TLK and LDI increased with age in subjects without PDS. The TPA, LDI, TLK and TK increased with age in subjects who displayed type 1, whereas the PT, LL, L4-S1 and PI-LL were unchanged. The TPA, PT, PI-LL and TLK increased with age in subjects who displayed type 2, whereas LL and L4-S1 were decreased, while the LDI and TK remained unchanged. The LSA of subjects without PDS became lower and the NVL decreased with age, with similar phenomena found in the subjects with type 2. There was no statistical difference among the groups for the LSA or NVL distribution of subjects with type 1. The TPA, PT and PI-LL of subjects with PDS were greater than those in Group IV, while the SS, LL and TK were less. The Roussouly-type, NVL and LSA distribution were identical between these two groups. CONCLUSION Roussouly type 1 shape may not be an actual individual specific spine type. Rather, type 2 could evolve into the "type 1" shape as deterioration of the sagittal spinal alignment progresses with age. Primary (de novo) degenerative scoliosis had little effect on whether type 2 became type 1. This should be taken into consideration during the assessment and restoration of sagittal balance.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Shibao Lu
- Department of Orthopaedics, Capital Medical University XuanWu Hospital, Beijing, China
| |
Collapse
|
27
|
Age and Gender Based Spinopelvic and Regional Spinal Alignment in Asymptomatic Adult Volunteers: Results of the Multi-Ethnic Alignment Normative Study (MEANS). Spine (Phila Pa 1976) 2022; 47:1382-1390. [PMID: 35797462 DOI: 10.1097/brs.0000000000004415] [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: 06/22/2021] [Accepted: 03/17/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Spinal alignment can have a significant impact on a patient's overall quality of life. Predicting the ideal sagittal spinal alignment of a specific individual is still a difficult task. The Multi-Ethnic Alignment Normative Study (MEANS) investigated skeletal alignment, including the spine and lower extremities, of the largest multi-ethnic cohort of asymptomatic adult volunteers. In this analysis, the authors aim to assess normative values of spinopelvic parameters and the regional cervical, thoracic, and lumbar spinal alignment in asymptomatic volunteers stratified by age and sex. MATERIALS AND METHODS Asymptomatic volunteers between ages 18 and 80 years were enrolled prospectively from centers in France, Japan, Singapore, Tunisia, and the United States. Volunteers included reported no significant neck or back pain (Visual Analog Scale ≤2), nor any known spinal disorder(s). All volunteers underwent a standing full-body or full-spine low-dose stereoradiograph. RESULTS MEANS consisted of 468 volunteers with a mean age of 40.4±14.8 years. Mean cervical lordosis from C2 to C7 was -0.4±12.7°. The T1-slope averaged 23.0±7.9° and showed strong correlation ( r =0.87) with the C7-slope mean of 19.8±8.6°. Thoracic kyphosis (TK) from T4 to T12 showed a mean of 37.4±10.9°. Average L1-S1 lumbar lordosis (LL) was -57.4±11.3°. The mean pelvic incidence (PI) measured 52.0±10.7° and pelvic tilt was 12.5±7.3°. Sacral slope averaged 39.5±8.2°. The average PI-LL was -5.4±10.7°. Approximately 60% of volunteers met the PI-LL criteria within ±10°, 8.3% were ≥10°, while 32.1% were ≤-10°. LL showed moderate correlation with PI ( r =0.53) and TK ( r =0.50), while there was no correlation between TK and PI. Multiple linear regression including PI, TK, and age resulted in the following equation LL=14.6+0.57 (PI)+0.57 (TK)-0.2 (age) ( r =0.75). CONCLUSIONS LL did not change with increasing age in asymptomatic volunteers. However, TK did increase with age leading to an increase in T1-slope and a compensatory increase in cervical lordosis. TK did not correlate with PI and was an independent variable in the prediction of LL. LEVEL OF EVIDENCE Level II-prospective cohort study.
Collapse
|
28
|
Wang J, Zhang Q, Liu F, Yuan H, Zhang Y, Wang X, Li J. Predicting the ideal apex of lumbar lordosis based on individual pelvic incidence and inflection point in asymptomatic adults. Front Surg 2022; 9:912357. [PMID: 36248369 PMCID: PMC9556969 DOI: 10.3389/fsurg.2022.912357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022] Open
Abstract
Objective The main aim of this study was to comprehensively explore the relationship among pelvic incidence (PI), inflection point (IP), and apex of lumbar lordosis (LLA), and establish a predictive formula for LLA based on individual PI and IP in asymptomatic Chinese adults. Methods A total of 385 asymptomatic adults with average age 38.3 ± 11.9 years (range 20–73 years) were recruited between November 2020 and October 2021. Full-spine, standing x-rays were then obtained from each participant. Next, the following sagittal parameters were measured: PI, IP, LLA, the horizontal offset between the plumb line of the lumbar apex and that of the posterosuperior corner of S1 (LASO), the upper lumbar lordosis (ULL) and lower lumbar lordosis (LLL), lumbar lordosis (LL), and thoracic kyphosis (TK). Moreover, the association among PI, IP, and the other sagittal parameters was evaluated, followed by linear regression analyses. A P-value of <0.05 was considered statistically significant. Results PI showed statistically significant correlations with LLA (rs = −0.629; P < 0.01), LASO (rs = 0.537; P < 0.01), LLL (rs = 0.788; P < 0.01), and LL (rs = 0.663; P < 0.01). On the other hand, IP also showed statistically significant correlations with LLA (rs = 0.671; P < 0.01), LASO (rs = −0.493; P < 0.01), LLL (rs = −0.402; P < 0.01), and LL (rs = −0.283; P < 0.01). The corresponding predictive formulae were displayed as follows: LLA = −0.03 * PI + 0.23 * IP + 14.45 (R2 = 0.669); LASO = 0.38 * PI−2.09 * IP + 53.62 (R2 = 0.460); and LLL = 0.58 * PI−0.88 * IP + 18.86 (R2 = 0.659). Conclusion The specific lumbar shape should be modulated by pelvic morphology and IP level. In addition, we established predictive formulae for ideal sagittal lumbar profile based on individual PI and IP, with the overarching goal of helping surgeons to better comprehend the regulatory mechanisms of the individual sagittal lumbar alignment, and design a precise and personalized corrective plan.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jing Li
- Correspondence: Xiaobin Wang ; Jing Li
| |
Collapse
|
29
|
Ng SY, Lung THA, Cheng LYJ, Ng YLE. Brace Prescription for Adult Scoliosis - Literature Review. Open Orthop J 2022. [DOI: 10.2174/18743250-v16-e2205270] [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] [Indexed: 02/22/2023] Open
Abstract
Purpose:
The 2021 SOSORT guidelines stipulated that braces be prescribed for adult scoliosis with chronic pain and progressive curve. Yet, there have been no objective protocols relating to the prescription of the brace. Therefore, this review investigates if there are any objective criteria or generally agreed on protocols for brace prescription in adult scoliosis patients.
Methods:
Relevant papers were searched in PUBMED. Only articles that are in English and cover the clinical aspect of adult scoliosis bracing are included.
Results:
A total of twelve papers were identified. They include different adult scoliosis braces, ranging from elastic belts to rigid braces. The treatment protocol varied tremendously. No objective criteria were found concerning the prescription of a brace, daily wearing time, duration of the intervention, and weaning protocol. The brace treatment was primarily employed to manage low back pain.
Conclusion:
Our search showed no objective criteria and clear indications for bracing and no consensus concerning the prescription of braces, daily wearing time, and duration of the intervention for patients with adult scoliosis.
The authors proposed prescription of a brace be based on more objective radiological criteria and severity of low back pain. Brace prescription should depend on the flexibility of the curve and can range from accommodative to rigid braces of corrective design. “Corrective” brace has to be worn at least 14 hours daily for six months or until the low back pain subsides to the extent that permits daily activities with minimal discomfort. “Accommodative” brace can be worn when required.
Collapse
|
30
|
Ke W, Wang B, Hua W, Wang K, Li S, Yang C. Evaluation of the Radiographic Risk Factors of Postoperative Shoulder Imbalance in Adult Scoliosis. Front Surg 2022; 9:885949. [PMID: 35756474 PMCID: PMC9218346 DOI: 10.3389/fsurg.2022.885949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/23/2022] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to evaluate the radiographic risk factors of postoperative shoulder imbalance (PSI) after adult scoliosis (AS) correction surgery. Methods Seventy-nine patients with AS undergoing correction surgery at a single institution were reviewed. The mean follow-up was 28 months. Patients were divided into two groups based on their radiographic shoulder height (RSH): (1) the balanced group (RSH <10 mm) and (2) the unbalanced group (RSH ≥10 mm). The preoperative and postoperative Cobb angles of the proximal thoracic (PT), main thoracic (MT), thoracolumbar/lumbar (TL/L) and upper instrumented vertebra (UIV) were measured. Results No significant difference was found between the balanced and unbalanced groups when the UIV was T1–2, T3–4, or below T4. Univariate analysis indicated that the unbalanced group had significantly higher postoperative RSH, lower percentage PT correction, and greater percentage MT correction. The classification and regression tree analysis revealed that when the correction percentage of PT curve was more than 55.3%, 84.4% of patients acquired shoulder balance. However, when the correction percentage of PT curve was less than 55.3%, and the correction percentage of MT curve was more than 56%, 65.7% of the patients developed PSI. Conclusions In AS correction surgery, a lower percentage correction of the PT curve and greater percentage correction of the MT curve were independent radiographic risk factors of PSI, regardless of the UIV level. Sufficient PT correction is required to achieve postoperative shoulder balance in AS correction surgery when the MT curve is overcorrected.
Collapse
|
31
|
Yilgor C, Kindan P, Yucekul A, Zulemyan T, Alanay A. Osteotomies for the Treatment of Adult Spinal Deformities: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202205000-00010. [PMID: 35613311 DOI: 10.2106/jbjs.rvw.21.00226] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Spinal osteotomies are powerful deformity correction techniques that may be associated with serious complications. » The anatomical spinal osteotomy classification system proposes 6 grades of resection corresponding to different anatomic bone, disc, facet, and ligament interventions. » Surgeons should be aware of the nuances of 3-column osteotomies with regard to spinal level selection, construct composition, and posterior column reconstruction and closure techniques. » There is a global tendency toward avoiding 3-column osteotomies as much as possible because of the growing evidence regarding the effectiveness of posterior column osteotomies and halo-gravity traction.
Collapse
Affiliation(s)
- Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Peri Kindan
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Altug Yucekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| |
Collapse
|
32
|
Wang J, Zhang Q, Liu F, Yuan H, Zhang Y, Wang X, Li J. Restoring Theoretically Optimal Lumbar Lordosis Deduced from Pelvic Incidence and Thoracic Kyphosis has Advantages to Decrease the Risk of Postoperative Mechanical Complications in Adult Spinal Deformity. Front Surg 2022; 9:860564. [PMID: 35478724 PMCID: PMC9035901 DOI: 10.3389/fsurg.2022.860564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo establish a regression formula for LL based on individual PI and TK in asymptomatic population aged over 50 years and evaluate its predictive power for the occurrence of postoperative mechanical complications in patients with adult spinal deformity (ASD).MethodsA total of 178 asymptomatic adults were recruited for the study. The association between LL and PI, LL and TK, was investigated to establish a predictive formula for ideal LL based on PI and TK. Additionally, 93 ASD patients undergoing posterior correction surgery were retrospectively analyzed. The absolute value of the gap between postoperative actual LL and theoretical LL was defined as ΔLL. Patients were classified into two groups depending on the presence or absence of mechanical complications. The demographic and radiological data of patients were compared between the two groups.ResultsA significant association was found between LL and PI (r = 0.599, P < 0.001), LL and TK (r = 0.523, P < 0.001). A novel formula was developed as follows: LL = 0.7*PI + 0.4*TK + 1 (R2 = 0.524). In the validation cohort, 29 patients developed mechanical complications. Postoperative ΔLL (12.5 ± 7.6° vs. 7.0 ± 5.4°, P = 0.001) significantly increased the incidence of mechanical complications. The most appropriate threshold of ΔLL for predicting mechanical complications was 9.8°. For patients whose ΔLL were <9.8° and >9.8°, the incidence of mechanical complications was 19.4% and 54.8%, respectively.ConclusionIdeal lumbar lordosis should be matched for PI and TK. The developed prediction formula for LL based on PI and TK in asymptomatic adults may help surgeons to understand the mechanisms of lumbar alignment generation and predict occurrence of mechanical complications after ASD surgery.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jing Li
- Correspondence: Xiaobin Wang Jing Li
| |
Collapse
|
33
|
Pellisé F, Serra-Burriel M, Vila-Casademunt A, Gum JL, Obeid I, Smith JS, Kleinstück FS, Bess S, Pizones J, Lafage V, Pérez-Grueso FJS, Schwab FJ, Burton DC, Klineberg EO, Shaffrey CI, Alanay A, Ames CP. Quality metrics in adult spinal deformity surgery over the last decade: a combined analysis of the largest prospective multicenter data sets. J Neurosurg Spine 2022; 36:226-234. [PMID: 34598152 DOI: 10.3171/2021.3.spine202140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The reported rate of complications and cost of adult spinal deformity (ASD) surgery, associated with an exponential increase in the number of surgeries, cause alarm among healthcare payers and providers worldwide. The authors conjointly analyzed the largest prospective available ASD data sets to define trends in quality-of-care indicators (complications, reinterventions, and health-related quality of life [HRQOL] outcomes) since 2010. METHODS This is an observational prospective longitudinal cohort study. Patients underwent surgery between January 2010 and December 2016, with > 2 years of follow-up data. Demographic, surgical, radiological, and HRQOL (i.e., Oswestry Disability Index, SF-36, Scoliosis Research Society-22r) data obtained preoperatively and at 3, 6, 12, and 24 months after surgery were evaluated. Trends and changes in indicators were analyzed using local regression (i.e., locally estimated scatterplot smoothing [LOESS]) and adjusted odds ratio (OR). RESULTS Of the 2286 patients included in the 2 registries, 1520 underwent surgery between 2010 and 2016. A total of 1151 (75.7%) patients who were treated surgically at 23 centers in 5 countries met inclusion criteria. Patient recruitment increased progressively (2010-2011 vs 2015-2016: OR 1.64, p < 0.01), whereas baseline clinical characteristics (age, American Society of Anesthesiologists class, HRQOL scores, sagittal deformity) did not change. Since 2010 there has been a sustained reduction in major and minor postoperative complications observed at 90 days (major: OR 0.59; minor: OR 0.65; p < 0.01); at 1 year (major: OR 0.52; minor: 0.75; p < 0.01); and at 2 years of follow-up (major: OR 0.4; minor: 0.80; p < 0.01) as well as in the 2-year reintervention rate (OR 0.41, p < 0.01). Simultaneously, there has been a slight improvement in the correction of sagittal deformity (i.e., pelvic incidence-lumbar lordosis mismatch: OR 1.11, p = 0.19) and a greater gain in quality of life (i.e., Oswestry Disability Index 26% vs 40%, p = 0.02; Scoliosis Research Society-22r, self-image domain OR 1.16, p = 0.13), and these are associated with a progressive reduction of surgical aggressiveness (number of fused segments: OR 0.81, p < 0.01; percent pelvic fixation: OR 0.66, p < 0.01; percent 3-column osteotomies: OR 0.63, p < 0.01). CONCLUSIONS The best available data show a robust global improvement in quality metrics in ASD surgery over the last decade. Surgical complications and reoperations have been reduced by half, while improvement in disability increased and correction rates were maintained, in patients with similar baseline characteristics.
Collapse
Affiliation(s)
- Ferran Pellisé
- 1Spine Research Unit, Vall d'Hebron Research Institute, Barcelona
- 2Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Miquel Serra-Burriel
- 3Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | | | - Jeffrey L Gum
- 4Norton Leatherman Spine Center, Louisville, Kentucky
| | - Ibrahim Obeid
- 5Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Justin S Smith
- 6Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | | | - Shay Bess
- 8Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Javier Pizones
- 9Spine Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Virginie Lafage
- 10Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Frank J Schwab
- 10Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Douglas C Burton
- 11Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric O Klineberg
- 12Department of Orthopedic Surgery, University of California, Davis, Sacramento, California
| | | | - Ahmet Alanay
- 14Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey; and
| | - Christopher P Ames
- 15Department of Neurosurgery, University of California, San Francisco, California
| |
Collapse
|
34
|
Zhang H, Hai Y, Meng X, Zhang X, Jiang T, Xu G, Zou C, Xing Y. Validity of the Roussouly classification system for assessing distal junctional problems after long instrumented spinal fusion in degenerative scoliosis. 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; 31:258-266. [PMID: 35018495 DOI: 10.1007/s00586-021-07083-w] [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: 05/07/2021] [Revised: 09/07/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the validity of the Roussouly classification system for assessing distal junctional problems (DJP) after long instrumented spinal fusion in degenerative scoliosis. METHODS Sixty-four patients with degenerative scoliosis and long-segment fixation receiving treatment at our hospital between December 2012 and December 2018 were retrospectively analyzed. Patients were classified preoperatively and postoperatively (Roussouly classification) and divided into DJP and control groups. We observed whether patients restored to their preoperative Roussouly classification (based on pelvic incidence [PI]) postoperatively. RESULTS The incidences of DJP were 11.11% and 50% in patients who did and did not match their sagittal Roussouly classification immediately postoperatively, respectively. The adjusted Chi-square test that showed whether the sagittal profile matched the Roussouly classification immediately after surgery was statistically significant (P = 0.012). PIs were 55.83 ± 4.94 and 47.21 ± 10.81 in the DJP and non-DJP groups, respectively (t' = 4.367, P < 0.001). Distal junctional kyphosis angles were 6.33 ± 4.19° and 11.56 ± 5.02° in the DJP and non-DJP groups, respectively (t = - 2.595, P = 0.015). Preoperative PI-lumbar lordosis values were 29.14 ± 13.82 and 16.67 ± 11.39 in the DJP and non-DJP groups, respectively (t = - 2.626, P = 0.013). The logistic regression model showed that patients whose Roussouly classification did not match the postoperative PI value were more likely to have DJP (odds ratio [OR] = 4.01, 95% confidence interval [CI]: 0.51-31.61) and preoperative distal junctional kyphotic changes. CONCLUSION If the postoperative sagittal profile can be restored to match the patient's own PI value, use of the Roussouly classification can greatly reduce the possibility of postoperative DJP.
Collapse
Affiliation(s)
- Hanwen Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Chaoyang District, Beijing, China.
| | - Xianglong Meng
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| | - Xinuo Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| | - Tinghua Jiang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| | - Gang Xu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| | - Congying Zou
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| | - Yaozhong Xing
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 8 Gong Ti Nan Road, Chaoyang District, Beijing, China
| |
Collapse
|
35
|
Predictive formulae of ideal lumbar lordosis determined by individual pelvic incidence and thoracic kyphosis in asymptomatic adults. J Orthop Sci 2022; 27:101-107. [PMID: 33419627 DOI: 10.1016/j.jos.2020.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The precise prediction of ideal lumbar lordosis (LL) has become increasingly important in clinical practice. The aim of this study was to explore the regulatory mechanisms of sagittal spinopelvic alignment and to predict ideal LL based on individual pelvic incidence (PI) and thoracic kyphosis (TK) parameters in asymptomatic adults. METHODS A total of 233 asymptomatic subjects older than 18 years were consecutively enrolled in our study between April 2017 and December 2019. A full-spine, standing X-ray was performed for each subject. The following parameters were measured in the sagittal plane: the apex of lumbar lordosis (LLA), the distance between the plumb line of the lumbar apex (LAPL) and the gravity plumb line, the inflection point (IP), LL, the upper arc and lower arc of lumbar lordosis (LLUA and LLLA, respectively), PI and TK. Stepwise multiple linear regressions were conducted, and the statistical significance level was P < 0.05. RESULTS Both PI and TK were two important predictive variables for LLA, LAPL, IP and LL. In addition, the LLUA was mainly explained by TK, while the LLLA was explained by PI. The corresponding predictive models are listed as follows: LLA = 17.110 - 0.040∗PI + 0.023∗TK (R2 = 0.380), LAPL = 31.296 + 0.467∗PI - 0.126∗TK (R2 = 0.309), IP = 10.437 + 0.091∗TK - 0.029∗PI (R2 = 0.227), LL = 2.035 + 0.618∗PI + 0.430∗TK (R2 = 0.595), LLUA = 0.893 + 0.418∗TK (R2 = 0.598), LLLA = 3.543 + 0.576∗PI (R2 = 0.433). CONCLUSION The specific sagittal lumbar profile should be regulated by both pelvic and thoracic morphology. Such predictive models for lumbar parameters determined by individual PI and TK parameters have been established, which are meaningful for surgeons to better understand the regulatory mechanisms of sagittal spinopelvic alignment and reconstruct a satisfactory lumbar alignment.
Collapse
|
36
|
Pizones J, Perez-Grueso FJS, Moreno-Manzanaro L, Escámez F, Yilgor C, Vila-Casademunt A, Fernández-Baíllo N, Sánchez-Márquez JM, Obeid I, Kleinstück F, Alanay A, Pellisé F. Compensatory mechanisms recruited against proximal junctional kyphosis by patients instrumented from the thoracolumbar junction to the iliac. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:112-122. [PMID: 34750669 DOI: 10.1007/s00586-021-07042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The compensatory mechanisms recruited by un-instrumented patients against sagittal imbalance are well documented. However, there is a lack of information regarding instrumented patients. MATERIAL AND METHODS We performed a retrospective analysis of data collected prospectively in a multicenter adult spinal deformity database. We included patients suffering PJK/PJF after (T8-L2) to iliac instrumentation with minimum two-year follow-up. We measured quantitative sagittal spinopelvic and qualitative sagittal distribution parameters in the immediate postoperative period (6w) and at the time of PJK/PJF appearance. We analyzed how these parameters changed comparing these two time points with univariate and multivariate logistic regression analyses. RESULTS A total of 69 patients were included. Two different patterns at PJK/PJF were found: 36 patients activated compensation (defined as an increase in pelvic retroversion (ΔRPV > 5º), and 33 did not (ΔRPV < 5º). The difference in behavior relied mostly on the amount of not surgically restored pelvic rotation at 6w (OR: 0.6; CI95%: 0.4-9.2; P = 0.017). Non-compensators had less rotation reserve (PTx100/PI = 33.9% vs 47.8%;P < 0.001) associated with worse 6w relative pelvic version and lower lumbar arc restoration, worse 6w relative sagittal alignment and GAP-score, compared with compensators (P < 0.001). Compensators' response was based on pelvic retroversion, causing lower lumbar arc decrease, lumbar apex caudal migration, and upper lumbar arc posterior inclination. Despite compensation, a thoracic kyphosis increase in both upper and lower arches gradually evolved into a PJK/PJF. Non-compensators did not react to PJK/PJF, which forced them into kyphosis from the lumbar apex and extending cranially, mainly throughout the upper thoracic arc. CONCLUSIONS In patients fused from the TL junction to the iliac, those having greater postoperative pelvic rotation reserve showed greater capacity to recruit compensatory mechanisms against PJK/PJF.
Collapse
Affiliation(s)
- Javier Pizones
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | | | - Lucía Moreno-Manzanaro
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Fernando Escámez
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Nicomedes Fernández-Baíllo
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - José Miguel Sánchez-Márquez
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | |
Collapse
|
37
|
Sun X, Sun W, Sun S, Hu H, Zhang S, Kong C, Lu S. Which sagittal evaluation system can effectively predict mechanical complications in the treatment of elderly patients with adult degenerative scoliosis? Roussouly classification or Global Alignment and Proportion (GAP) Score. J Orthop Surg Res 2021; 16:641. [PMID: 34702333 PMCID: PMC8549320 DOI: 10.1186/s13018-021-02786-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/11/2021] [Indexed: 12/22/2022] Open
Abstract
Background To achieve the proper sagittal alignment, previous studies have developed different assessment systems for adult degenerative scoliosis (ADS) which could help the spine surgeon in making treatment strategies. The purpose of our study is to evaluate whether Roussouly classification or global alignment and proportion (GAP) score is more appropriate in the prediction of mechanical complications after surgical treatment of ADS. Methods ADS patients who received long segmental fusion in the treatment during the period from December 2016 to December 2018 were evaluated in this study. Basic information and radiologic measurements were collected for analysis. Patients were divided into two groups according to occurrence or absence of mechanical complications for comparison. Mechanical complications included proximal junctional kyphosis (PJK), proximal junctional failure (PJF). GAP categories divided GAP score into proportioned spinopelvic position, moderately disproportioned position, and severely disproportioned position according to the cut-off values. The correlation between evaluation systems and mechanical complications was analyzed through a logistic regression model via stepwise backward elimination based on the Wald statistics. Receiver operator characteristic (ROC) curve was used to determine the predictability of the evaluation systems in the occurrence of mechanical complications and calculate their cut-off value. Area under the curve (AUC) was used to evaluate the validity of the thresholds. Results A total of 80 patients were included in this study. There were 41 patients in mechanical complication group and 39 patients in no mechanical complication group. GAP score (P = 0.008) and GAP categories (P = 0.007) were positively correlated with mechanical complications; Roussouly score was negatively correlated with mechanical complications (P = 0.034); GAP score was positively correlated with PJK (P = 0.021); Roussouly score was negatively correlated with implant-related complications (P = 0.018); GAP categories were correlated with implant loosening (P = 0.023). Results of ROC showed that GAP score was more effective in predicting PJK (AUC = 0.863) and PJF (AUC = 0.724) than Roussouly score; GAP categories (AUC = 0.561) was more effective than GAP score (AUC = 0.555) in predicting implant-related complications. Conclusions Roussouly classification could only be a rough estimate of optimal spinopelvic alignment. Quantitative parameters in GAP score made it more effective in predicting mechanical complications, PJK and PJF than Roussouly classification. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02786-8.
Collapse
Affiliation(s)
- Xiangyao Sun
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
| | - Wenzhi Sun
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Siyuan Sun
- Department of Interdisciplinary, Life Science, Purdue University, West Lafayette, IN, 47907, USA
| | - Hailiang Hu
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Sitao Zhang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Chao Kong
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
| |
Collapse
|
38
|
Bari TJ, Heegaard M, Bech-Azeddine R, Dahl B, Gehrchen M. Lordosis Distribution Index in Short-Segment Lumbar Spine Fusion - Can Ideal Lordosis Reduce Revision Surgery and Iatrogenic Deformity? Neurospine 2021; 18:543-553. [PMID: 34610685 PMCID: PMC8497240 DOI: 10.14245/ns.2040744.372] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/02/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The demand for spinal fusion is increasing, with concurrent reports of iatrogenic adult spinal deformity (flatback deformity) possibly due to inappropriate lordosis distribution. This distribution is assessed using the lordosis distribution index (LDI) which describes the upper and lower arc lordosis ratio. Maldistributed LDI has been associated to adjacent segment disease following interbody fusion, although correlation to later-stage deformity is yet to be assessed. We therefore aimed to investigate if hypolordotic lordosis maldistribution was associated to radiographic deformity-surrogates or revision surgery following instrumented lumbar fusion. METHODS All patients undergoing fusion surgery ( ≤ 4 vertebra) for degenerative lumbar diseases were retrospectively included at a single center. Patients were categorized according to their postoperative LDI as: "normal" (LDI 50-80), "hypolordotic" (LDI < 50), or "hyperlordotic" (LDI > 80). RESULTS We included 149 patients who were followed for 21 ± 14 months. Most attained a normally distributed lordosis (62%). The hypolordotic group had increased postoperative pelvic tilt (PT) (p < 0.001), pelvic incidence minus lumbar lordosis (PI-LL) mismatch (p < 0.001) and decreased global lordosis (p = 0.007) compared to the normal group. Survival analyses revealed a significant difference in revision surgery (p = 0.03), and subsequent multivariable logistic regression showed increased odds of 1-year revision in the hypolordotic group (p = 0.04). There was also a negative, linear correlation between preoperative pelvic incidence (PI) and postoperative LDI (p < 0.001). CONCLUSION In patients undergoing instrumented lumbar fusion surgery, hypolordotic lordosis maldistribution (LDI < 50) was associated to increased risk of revision surgery, increased postoperative PT and PI-LL mismatch. Lordosis distribution should be considered prior to spinal fusion, especially in high PI patients.
Collapse
Affiliation(s)
- Tanvir Johanning Bari
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Heegaard
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rachid Bech-Azeddine
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Spine Research Unit (CSRU), Rigshospitalet, Glostrup, Denmark
| | - Benny Dahl
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital & Baylor College of Medicine, Houston, TX, USA
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
39
|
de Andrada Pereira B, Sawa AGU, Godzik J, Lehrman JN, Uribe JS, Turner JD, Kelly BP. Influence of Lumbar Lordosis on Posterior Rod Strain in Long-Segment Construct During Biomechanical Loading: A Cadaveric Study. Neurospine 2021; 18:635-643. [PMID: 34610695 PMCID: PMC8497261 DOI: 10.14245/ns.2142368.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
Objective The lordotic shape of the lumbar spine differs substantially between individuals. Measuring and recording strain during spinal biomechanical tests is an effective method to infer stresses on spinal implants and predict failure mechanisms. The geometry of the spine may have a significant effect on the resultant force distribution, thereby directly affecting rod strain.
Methods Seven fresh-frozen cadaveric specimens (T12-sacrum) underwent standard (7.5 Nm) nondestructive sagittal plane tests: flexion and extension. The conditions tested were intact and pedicle screws and rods (PSR) at L1-sacrum. The posterior right rod was instrumented with strain gauges between L3–4 (index level) and the L5–S1 pedicle screw. All specimens underwent lateral radiographs before testing. Lordotic angles encompassing different levels (L5–S1, L4–S1, L3–S1, L2–S1, and L1–S1) were measured and compared with rod strain. Data were analyzed using Pearson correlation analyses.
Results Strong positive correlations were observed between lordosis and posterior rod strain across different conditions. The L3–S1 lordotic angle in the unloaded intact condition correlated with peak rod strain at L3–4 with PSR during flexion (R=0.76, p=0.04). The same angle in the unloaded PSR condition correlated with peak strain in the PSR condition during extension (R=-0.79, p=0.04). The unloaded intact L2–S1 lordotic angle was significantly correlated with rod strain at L3–4 in the PSR condition during flexion (R=0.85, p=0.02) and extension (R=-0.85, p=0.02) and with rod strain at L5–S1 in the PSR condition during flexion (R=0.84, p=0.04).
Conclusion Lordosis measured on intact and instrumented conditions has strong positive correlations with posterior rod strain in cadaveric testing.
Collapse
Affiliation(s)
- Bernardo de Andrada Pereira
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Anna G U Sawa
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jennifer N Lehrman
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Brian P Kelly
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| |
Collapse
|
40
|
Radiographic outcomes and complications after L4 or L5 pedicle subtraction osteotomy for fixed sagittal malalignment in 102 adult spinal deformity patients with a minimum 2-year follow-up. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:104-111. [PMID: 34586505 DOI: 10.1007/s00586-021-07008-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/13/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The objective of this retrospective study was to provide the radiographic outcomes and complications for pedicle subtraction osteotomy (PSO) performed at the low lumbar spine, i.e., L4 or L5 for ASD patients with fixed sagittal malalignment. METHODS ASD patients who underwent L4 or L5 PSO with a minimum 2-year follow-up were included. Preoperative and postoperative radiographs, and complications were collected. Radiographic analysis included lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), thoracic kyphosis (TK), sagittal vertical axis (SVA), spinal lordosis (SL) ratio and global tilt (GT) on standing long-cassette radiographs. RESULTS A total of 102 patients from 2 spinal centers were analyzed. 66 patients underwent PSO at L4 and 36 patients at L5. From preoperatively to the final follow-up, significant improvements occurred in LL (from - 31° to - 52°), SVA (from 13 to 5 cm), and GT (from 44° to 27°) (all, p < 0.05). 12 patients had transient neurological deficits, and 8 patients had persistent neurological deficit. 23 patients underwent revision for PJK (2), pseudarthrosis (10), neurological deficit (2), epidural hematoma (1), or deep surgical site infection (8). No PJK was observed in any of the patients with L5 PSO. CONCLUSIONS PSO at the level of L4 or L5 remains a challenging technique but with an acceptable rate of complications and revisions. It enables correction of fixed sagittal malalignment in ASD patients with a globally satisfactory outcome. In comparison with L4 PSO, L5 PSO patients did not show PJK as a mechanical complication. Distal lumbar PSO at the level of L5 may represent one of the factors that may help preventing the proximal junctional kyphosis complication.
Collapse
|
41
|
Song J, Pan F, Zhu W, Kong C, Lu S. Characteristics of the sagittal spinal balance in the asymptomatic elderly Chinese population. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:233-240. [PMID: 34463863 DOI: 10.1007/s00586-021-06979-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/05/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the normal values of the sagittal spinal parameters and analyze the distribution of the global spinal profiles in a Chinese population with age over 75. METHODS Two hundred and twelve sets of the whole spine lateral radiographs were obtained from a database of an asymptomatic elderly population. Global and regional spinal parameters were measured. Sagittal profiles were determined according to the Roussouly classification compared with previous studies involving different populations. RESULTS A total of 102 elderly subjects (≥ 75 years) were enrolled with an average age of 79.24 ± 3.53 years. The mean values of the spinopelvic parameters were 42.89 ± 11.64° for TK, 13.84 ± 10.78° for TLK, 44.48 ± 12.88° for LL, 44.76 ± 9.84° for PI, 17.19 ± 8.08° for PT, 28.35 ± 7.94° for SS, 3.47 ± 3.56 cm for SVA, 14.75 ± 7.85° for TPA, -0.27 ± 11.95° for PI-LL, respectively. Subjects ≥ 75 years were found to have significantly smaller LL and SS, but greater TLK, PT, SVA, TPA, and PI-LL than those 60-74 years (p < 0.05). Significant age- and sex-dependent differences were found in the Roussouly classification's distribution between the two subgroups. CONCLUSIONS The normal values of the sagittal parameters were presented in the elderly Chinese asymptomatic population (≥ 75 years). Ethnic, age, and sex displayed significant effects on the behaviors of the sagittal spinal balance and profiles. These results could be served as physiological references for the planning of surgical strategies in elderly Chinese patients over 75 years.
Collapse
Affiliation(s)
- Jipeng Song
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fumin Pan
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weiguo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
42
|
Pan C, Wang G, Li Y, Kuang L, Sun J, Lv G. Predictive model of global tilt (GT) determined by individual thoracic kyphosis, lumbar lordosis and pelvic incidence in the human degenerative spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3191-3199. [PMID: 34331586 DOI: 10.1007/s00586-021-06947-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/16/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies only investigated the simple linear relationships of global tilt (GT) with thoracic kyphosis (TK), lumbar lordosis (LL) and pelvic incidence (PI). This study aimed to establish multiple linear regressions of GT based on individual TK, LL and PI in patients with degenerative spines. METHODS Four hundred sixty-nine adult patients aged older than 35 years with various degenerative spinal diseases were enrolled in this two-centre study between January 2017 and December 2020. Full-spine X-rays were performed for all the subjects in a standing position. The following regional and global parameters were measured in the sagittal plane: TK, LL, PI, pelvic tilt (PT), sagittal vertical axis (SVA) and GT. The correlations of the GT, PT and SVA with the TK, LL and PI were analysed, and then multiple linear regressions were constructed. RESULTS GT was statistically correlated with TK, LL and PI. Additionally, TK, LL and PI were significant predictors for the GT, PT and SVA models. The relevant predictive formulae were as follows: GT = -9.60 + 1.09*PI + 0.89*LL + 0.42*TK (R2 = 0.935), PT = -4.49 + 0.81*PI + 0.56*LL + 0.24*TK (R2 = 0.792) and SVA = -25.68 + 2.98*LL + 2.37*PI + 1.67*TK (R2 = 0.416). CONCLUSION The specific sagittal spinopelvic morphology, evaluated by GT parameters, should be determined by individual TK, LL and PI values in the degenerative spine. Surgeons can utilize such predictive models to better understand the degenerative evolution of sagittal alignment and recognize the relationships between regional parameters and global sagittal alignment to customize a precise correction strategy.
Collapse
Affiliation(s)
- Changyu Pan
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Guodong Wang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yunchao Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Lei Kuang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Jianmin Sun
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Guohua Lv
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, People's Republic of China.
| |
Collapse
|
43
|
Kwan KYH, Naresh-Babu J, Jacobs W, de Kleuver M, Polly DW, Yilgor C, Wu Y, Park JB, Ito M, van Hooff ML. Toward the Development of a Comprehensive Clinically Oriented Patient Profile: A Systematic Review of the Purpose, Characteristic, and Methodological Quality of Classification Systems of Adult Spinal Deformity. Neurosurgery 2021; 88:1065-1073. [PMID: 33588440 PMCID: PMC8117436 DOI: 10.1093/neuros/nyab023] [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] [Received: 08/06/2020] [Accepted: 12/14/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Existing adult spinal deformity (ASD) classification systems are based on radiological parameters but management of ASD patients requires a holistic approach. A comprehensive clinically oriented patient profile and classification of ASD that can guide decision-making and correlate with patient outcomes is lacking. OBJECTIVE To perform a systematic review to determine the purpose, characteristic, and methodological quality of classification systems currently used in ASD. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science for literature published between January 2000 and October 2018. From the included studies, list of classification systems, their methodological measurement properties, and correlation with treatment outcomes were analyzed. RESULTS Out of 4470 screened references, 163 were included, and 54 different classification systems for ASD were identified. The most commonly used was the Scoliosis Research Society-Schwab classification system. A total of 35 classifications were based on radiological parameters, and no correlation was found between any classification system levels with patient-related outcomes. Limited evidence of limited quality was available on methodological quality of the classification systems. For studies that reported the data, intraobserver and interobserver reliability were good (kappa = 0.8). CONCLUSION This systematic literature search revealed that current classification systems in clinical use neither include a comprehensive set of dimensions relevant to decision-making nor did they correlate with outcomes. A classification system comprising a core set of patient-related, radiological, and etiological characteristics relevant to the management of ASD is needed.
Collapse
Affiliation(s)
- Kenny Yat Hong Kwan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - J Naresh-Babu
- Department of Spine Surgery, Mallika Spine Centre, Guntur, India
| | - Wilco Jacobs
- The Health Scientist, The Hague, The Netherlands
| | - Marinus de Kleuver
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David W Polly
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Caglar Yilgor
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Yabin Wu
- Research Department, AO Spine International, Davos, Switzerland
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Gyeonggi-do, Korea
| | - Manabu Ito
- Department of Orthopaedics, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Miranda L van Hooff
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| |
Collapse
|
44
|
Optimal Correction of Adult Spinal Deformities Requires Restoration of Distal Lumbar Lordosis. Adv Orthop 2021; 2021:5572181. [PMID: 34040810 PMCID: PMC8121594 DOI: 10.1155/2021/5572181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of this study is to analyze results according to postoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch in the management of adult spine deformity (ASD) patients. Recently, it has been reported that in addition to lumbar lordosis amount, lordosis repartition between its proximal and distal parts was crucial. METHODS We enrolled 77 consecutive ASD patients who underwent posterior spinal fusion and deformity correction between 2015 and 2018. On preoperative and 1-year follow-up radiographs, we analyzed different parameters such as L1-S1 lumbar lordosis, L1-L4 proximal lordosis (PLL), L4-S1 distal lordosis (DLL), pelvic tilt (PT), sagittal vertical axis (SVA), and PI-LL mismatch. Comparisons were performed according to postoperative PI-LL mismatch (defined as "aligned" when PI-LL was <10°). The relationship between lordosis distribution and postoperative alignment status was investigated. RESULTS On the whole series, average lumbar lordosis, SVA, and PI-LL improved (28.2° vs.43.5°, 82 vs. 51 mm, and 26°vs. 14°, all p < 0.001, respectively). On the other hand, PT remained unchanged (30° vs. 28°, p > 0.05). 35 patients were classified as "aligned" and 42 as "not aligned." Patients from the "aligned" group had a significantly lower PI than patients from the "not aligned" group (52° vs. 61°, p=0.009). Postoperative PLL was not different between groups (18° vs. 16° p > 0.05), whereas DLL was significantly higher in the "aligned" group (31° vs. 22°, p=0.003). PI-LL was significantly correlated to DLL (rho = 0.407, p < 0.001) but not with PLL (rho = 0.110, p=0.342). CONCLUSIONS Our results revealed that in ASD patients, postoperative malalignment was associated with a lack of DLL restoration. "Not aligned" patients had also a significantly higher pelvic incidence. Specific attention must be paid to restore optimal distal lumbar lordosis in order to set the amount and the distribution of optimal postoperative lumbar lordosis.
Collapse
|
45
|
Xi Z, Duan PG, Mummaneni PV, Liu J, Guinn JMV, Wang M, Li B, Wu HH, Rivera J, Burch S, Berven SH, Chou D. Posterior Displacement of L1 May be a Risk Factor for Proximal Junctional Kyphosis After Adult Spinal Deformity Correction. Global Spine J 2021; 13:1042-1048. [PMID: 33998302 DOI: 10.1177/21925682211015651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Overcorrection in adult spinal deformity (ASD) surgery may lead to proximal junctional kyphosis (PJK) because of posterior spinal displacement. The aim of this paper is to determine if the L1 position relative to the gravity line (GL) is associated with PJK. METHODS ASD patients fused from the lower thoracic spine to sacrum by 4 spine surgeons at our hospital were retrospectively studied. Lumbar-only and upper thoracic spine fusions were excluded. Spinopelvic parameters, the L1 plumb line (L1PL), L1 distance to the GL (L1-GL), and Roussouly type were measured. RESULTS One hundred fourteen patients met inclusion criteria (63 patients with PJK, 51 without). Mean age and follow up was 65.51 and 3.39 years, respectively. There was no difference between the PJK and the non-PJK groups in baseline demographics, pre-operative and immediate post-operative pelvic incidence-lumbar lordosis mismatch, sagittal vertical axis, or coronal Cobb. The immediate postoperative L1-GL was -7.24 cm in PJK and -3.45 cm in non-PJK (P < 0.001), L1PL was 1.71 cm in PJK and 3.07 cm in non-PJK (P = 0.004), and PT (23.76° vs 18.90°, P = 0.026) and TK (40.56° vs 31.39°, P < 0.001) were larger in PJK than in non-PJK. After univariate and multivariate analyses, immediate postoperative TK and immediate postoperative L1-GL were independent risk factors for PJK without collinearity. CONCLUSIONS A dorsally displaced L1 relative to the GL was associated with an increased risk of PJK after ASD surgery. The postoperative L1-GL distance may be a factor to consider during ASD surgery.
Collapse
Affiliation(s)
- Zhuo Xi
- Department of Neurosurgery, University of California San Francisco, USA.,Department of Neurosurgery, Shengjing Hospital of China Medical University, Liaoning, China
| | - Ping-Guo Duan
- Department of Neurosurgery, University of California San Francisco, USA
| | | | - Jinping Liu
- Department of Neurosurgery, University of California San Francisco, USA
| | - Jeremy M V Guinn
- Department of Neurosurgery, University of California San Francisco, USA
| | - Minghao Wang
- Department of Neurosurgery, University of California San Francisco, USA
| | - Bo Li
- Department of Neurosurgery, University of California San Francisco, USA
| | - Hao-Hua Wu
- Department of Orthopedic Surgery, University of California San Francisco, USA
| | - Joshua Rivera
- Department of Neurosurgery, University of California San Francisco, USA
| | - Shane Burch
- Department of Orthopedic Surgery, University of California San Francisco, USA
| | - Sigurd H Berven
- Department of Orthopedic Surgery, University of California San Francisco, USA
| | - Dean Chou
- Department of Neurosurgery, University of California San Francisco, USA
| |
Collapse
|
46
|
Bari TJ, Hallager DW, Hansen LV, Dahl B, Gehrchen M. Reducing revision rates following Pedicle Subtraction Osteotomy surgery: a single-center experience of trends over 7 years in patients with Adult Spinal Deformity. Spine Deform 2021; 9:803-815. [PMID: 33400231 DOI: 10.1007/s43390-020-00256-5] [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: 08/12/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN This is a single-center, retrospective study. OBJECTIVE To assess if implemented changes to clinical practice have reduced mechanical complications following pedicle subtraction osteotomy (PSO) surgery. Adult spinal deformity (ASD) is increasing in prevalence with concurrent increasing demands for surgical treatment. The most extensive technique, PSO, allows for major correction of rigid deformities. However, surgery-related complications have been reported in rates up to 77% and especially mechanical complications occur at unsatisfactory frequencies. METHODS We retrospectively included all patients undergoing PSO for ASD between 2010 and 2016. Changes to clinical practice were introduced continuously in the study period, including rigorous patient selection; inter-disciplinary conferences; implant-material; number of surgeons; surgeon experience; and perioperative standardized protocols for pain, neuromonitoring and blood-loss management. Postoperative complications were recorded in the 2-year follow-up period. Competing risk survival analysis was used to assess cumulative incidence of revision surgery due to mechanical complications. The Mann-Kendall test was used for analysis of trends. RESULTS We included 185 patients undergoing PSO. The level of PSO changed over the study period (P < 0.01) with L3 being the most common level in 2010 compared to L4 in 2016. Both preoperative and surgical corrections of sagittal vertical axis were larger towards the end of the study period. The 2-year revision rate due to mechanical failure steadily declined over the study period from 52% in 2010 to 14% for patients treated in 2016, although without statistically significant trend (P = 0.072). In addition, rates of mechanical complications steadily declined over the study period and significant decreasing trends were observed in time trend analyses of overall complications, major complications and rod breakage. CONCLUSIONS We observed decreased risks of revision surgery due to mechanical complications following PSO in patients with ASD over a 7-year period. We attribute these improvements to advancements in patient selection, surgical planning and techniques, surgeon experience and more standardized perioperative care. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Tanvir Johanning Bari
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Dennis Winge Hallager
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Valentin Hansen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Benny Dahl
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, 6621 Fannin St, Houston, TX, 77030, USA
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| |
Collapse
|
47
|
Ishihara M, Taniguchi S, Adachi T, Kushida T, Paku M, Ando M, Saito T, Kotani Y, Tani Y. Rod contour and overcorrection are risk factors of proximal junctional kyphosis after adult spinal deformity correction surgery. 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; 30:1208-1214. [PMID: 33646420 DOI: 10.1007/s00586-021-06761-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 01/06/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the risk factors of proximal junctional kyphosis (PJK) after surgery for adult spinal deformity (ASD) focusing on rod contour. METHODS Sixty-three patients with ASD who underwent surgery using lateral lumbar interbody fusion and percutaneous pedicle screws were analyzed. Fixation range was from the lower thoracic spine to the pelvis in all cases. Patients were divided into two groups. The PJK group consisted of 16 patients with PJK. The non-PJK group had 47 patients without PJK. We examined various spinopelvic parameters and parameters related to rod contour. RESULTS Among the various spinal and pelvic parameters, those in the PJK group were significantly larger in terms of preoperative SVA and were significantly smaller in terms of postoperative "PI-LL." For parameters related to rod contour, the rod kyphotic curve at the thoracic spine in the PJK group was significantly less than that in the non-PJK group. The inclination of the pedicle screw at the upper instrumented vertebra (UIV) was significantly more cranial in the PJK group than in the non-PJK group. The kyphotic curve of the rod at the UIV was more parallel in the PJK group than in the non-PJK group. On logistic regression analysis, insufficient kyphotic curve at the thoracic spine along with UIV and overcorrection of the lumbar spine were identified as significant risk factors. CONCLUSIONS Insufficient kyphotic curve of the rod in the thoracic spine along with UIV and overcorrection of the lumbar spine were noted as significant risk factors of PJK.
Collapse
Affiliation(s)
- Masayuki Ishihara
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan.
| | | | - Takashi Adachi
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Taketoshi Kushida
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Masaaki Paku
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Muneharu Ando
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Takanori Saito
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Yoshihisa Kotani
- Department of Orthopedic Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Yoichi Tani
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| |
Collapse
|
48
|
Iwai C, Pizones J, Boissière L, Jakinapally S, Yilgor Ç, Larrieu D, Pellise F, Vital JM, Bourghli A, Obeid I. Static and dynamic sagittal lumbar apex: a new concept for the assessment of lumbar lordosis distribution in spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1155-1163. [PMID: 33606102 DOI: 10.1007/s00586-021-06767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/20/2020] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Sagittal lumbar apex has been demonstrated to be a key parameter in sagittal plane morphology. Our aim was to understand its behavior with postural changes, analyzing two different concepts of lumbar apex. MATERIALS AND METHODS Prospective observational study with a cohort of patients presenting sagittal malalignment identified from a monocenter database of adult spinal deformities (ASD). Inclusion criteria were age > 30 years, SVA > 40 mm, and/or PT > 20. All patients had full-spine EOS radiographs in 2 different positions: (P1: natural position) and position 2 (P2: compensated position). Sagittal alignment, spinopelvic values, and two different methods of assessing lordosis apex location were analyzed in both P1 and P2 positions. Changes between P1 and P2 were compared using a paired t test with a significance level at p < 0.05. RESULTS Twenty-five patients were recruited (21 women and 4 men). The mean age was 64.8 years (range 21-79). The patient's main compensation was based on an increase in the femoral shaft angle, and pelvic retroversion, with a subsequent decrease in sacral slope, and therefore of the lower lumbar arc. When the lumbar apex was calculated as the most anterior point touching the vertical line in a lateral radiograph, postural compensation changes modified its location usually shifting it to a more caudal position. When the lumbar apex was assessed as the most distant point of the global lumbar lordosis, its position remained stable regardless of compensation. CONCLUSIONS Postural changes can modify the location of the lumbar apex when understanding its location as the cornerstone of sagittal plane harmonic distribution. This concept can be useful as an additional sign to assess compensation. However, if the lumbar apex was calculated as the angular point of the global lordosis, its position remained stable regardless of postural changes. This concept can help to mold lumbar lordosis in ASD surgery. LEVEL OF EVIDENCE IV Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
Collapse
Affiliation(s)
- Chizuo Iwai
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France.,Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Louis Boissière
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Sreenath Jakinapally
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Çaglar Yilgor
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Daniel Larrieu
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Ferran Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | - Jean-Marc Vital
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Spine Unit 1, Bordeaux University Hospital, Place Amelie Raba-Leon, 33076, Bordeaux, France.
| |
Collapse
|
49
|
Gao A, Wang Y, Yu M, Liu X. Analysis of sagittal profile and radiographic parameters in symptomatic thoracolumbar disc herniation patients. BMC Musculoskelet Disord 2021; 22:177. [PMID: 33581725 PMCID: PMC7881454 DOI: 10.1186/s12891-021-04033-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies describe thoracolumbar disc herniation (TLDH) as an isolated category, it is frequently classified as the lower thoracic spine or upper lumbar spine. Thus, less is known about the morphology and aetiology of TLDH compared to lumbar disc herniation (LDH). The aim of study is to investigate sagittal alignment in TLDH and analyze sagittal profile with radiographic parameters. METHODS Data from 70 patients diagnosed with TLDH were retrospectively reviewed. The thoracic-lumbar alignment was depicted by description of curvatures (the apex of lumbar curvature, the apex of thoracic curvature, and inflexion point of the two curvatures) and radiographic parameters from complete standing long-cassette spine radiographs. The rank sum test was utilised to compare radiographic parameter values in each subtype. RESULTS We found two subtypes differentiated by the apex of thoracic kyphotic curves. The sagittal profile was similar to that of the normal population in type I, presenting the apex of the thoracic kyphotic curve located in the middle thoracic spine. The well aligned thoracic-lumbar curve was disrupted in type II, presenting the apex of the thoracic kyphotic curve located in the thoracolumbar region in type II patients. Thirty-six patients were classified as type I, and 34 patients were classified as type II. The mean sagittal vertical axis, T1 pelvic angle and L1 pelvic angle were 27.9 ± 24.8°, 8.2 ± 7.3° and 6.2 ± 4.9°, respectively. There was significant difference (p < 0.001) of thoracolumbar angle between type I (14.9 ± 7.9°) and type II patients (29.1 ± 13.7°). CONCLUSIONS We presented two distinctive sagittal profiles in TLDH patients, and a regional kyphotic deformity with a balanced spine was validated in both subtypes. In type I patients, disc degeneration was accelerated by regional kyphosis in the thoracolumbar junction and eventually caused disc herniation. In type II patients, excessive mechanical stress was directly loaded at the top of the curve (thoracolumbar apex region) rather than being diverted by an arc as in a normal population or type I patients. Mismatch between shape and sacral slope value was observed, and better agreement was found in Type II patients.
Collapse
Affiliation(s)
- Ang Gao
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yongqiang Wang
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Miao Yu
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xiaoguang Liu
- Department of Orthopaedics, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
| |
Collapse
|
50
|
Lumbar lordosis morphology correlates to pelvic incidence and erector spinae muscularity. Sci Rep 2021; 11:802. [PMID: 33437009 PMCID: PMC7804424 DOI: 10.1038/s41598-020-80852-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 12/29/2020] [Indexed: 01/09/2023] Open
Abstract
The retrospective study aimed to investigate the relationship between lumbar lordosis morphology, pelvic incidence and paraspinal muscle. It enrolled asymptomatic adult volunteers aged between 18 and 45 years old. Lumbar lordosis morphology, consisting of total lumbar lordosis (LL), proximal lumbar lordosis (PLL), distal lumbar lordosis (DLL), lumbar lordosis apex (LLA) and inflexion point, was evaluated, as well as pelvic incidence (PI) and muscularity of erector spinae (ES) and multifidus. Pearson correlation was performed to analyze the relationship between each other parameter. Cases were stratified according to pelvic incidence (very low < 30°, low 30°–45°, moderate 45°–60°, and high > 60°), comparison between groups was performed by univariance analysis. 87 asymptomatic adult volunteers (33 females and 54 males) were included in the study. PLL revealed a correlation with LLA (r = 0.603, p = 0.002) and inflexion point (r = 0.536, p = 0.004), but did not DLL with LL apex (r = 0.204, p = 0.058) or inflexion point (r = 0.210, p = 0.051). PI revealed a greater correlation with PLL (r = −0.673, p < 0.001) than with DLL (r = −0.237, p = 0.045). Linear stepwise regression analysis also exhibited the correlation between PI and PLL (R2 = 0.452, PLL = 16.2–0.61 * PI, p < 0.001). ES muscularity correlated with LL apex (r = −0.279, p = 0.014) and inflexion point (r = −0.227, p = 0.047). Stratification by PI demonstrated PLL increased across groups (p < 0.001), but DLL was comparable between low and moderate PI group (p = 0.329). Lumbar lordosis morphology appears to accommodate to pelvic incidence and erector spinae muscularity. Proximal lumbar lordosis has a bigger correlation with pelvic incidence than the distal lumbar lordosis. The results are helpful for restoring a rational lumbar lordosis shape in long fusion surgery.
Collapse
|