1
|
Makineni PS, El-Abtah ME, Porto JR, Steinmetz MP, Benzel EC. Pedicle Subtraction Osteotomies for Surgical Correction of Fixed Sagittal Imbalance: A Meta-Analysis and Systematic Review. Neurosurgery 2024:00006123-990000000-01225. [PMID: 38904379 DOI: 10.1227/neu.0000000000003008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/29/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Disruption of the spine's sagittal balance is associated with significant negative impacts on quality of life. Compared with other spinal osteotomies, pedicle subtraction osteotomy (PSO), which can potentially offer greater correction, is considered technically challenging and performed at lower rates. The aim of this study was to review the use of PSO to correct fixed sagittal imbalance and assess its efficacy and associated perioperative complications. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, EBSCO host, MEDLINE, and Google Scholar databases were queried for full-text English manuscripts published from 1961 to 2022, exploring PSO for the management of fixed sagittal imbalance. Studies were included if they reported preoperative and postoperative radiographic measurements. The mean Methodological Index for Nonrandomized Studies (MINORS) for included articles was 9.6 ± 1.1. The outcomes of interest included etiology, operative time, blood loss, complications, radiographic outcomes, and patient-reported outcomes. Statistical analysis was performed using a random-effects, inverse variance-weighted meta-analysis of observational data. Pre and postoperative radiographic and clinical outcomes were compared using a Student t-test. RESULTS Fourteen studies with 595 patients were included. Meta-analysis showed that the mean operative time was 7.2 ± 2.0 hours, and the average blood loss was 2033 ± 629 mL. After PSO, there was a significant improvement in sagittal vertebral axis (12.41-3.92 cm, P = .0003), LL (13.35°-42.60°, P = .000002), PSO angle (5.11° to -26.91°, P = .0001), and Oswestry Disability Index (55.36-27.35, P = .02). Common complications include pseudarthrosis (8.1%), neurological deficits (7.8%), and proximal junctional failure (6.0%). CONCLUSION PSO offers significant correction of sagittal vertebral axis, lumbar lordosis, PSO angle, and Oswestry Disability Index scores despite its reduced utilization in recent years. Blood loss and high complication rates must be considered when evaluating the efficacy of this procedure; however, surgeon experience and operative techniques can be used to reduce morbidity.
Collapse
Affiliation(s)
- Pratheek S Makineni
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mohamed E El-Abtah
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Joshua R Porto
- Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Edward C Benzel
- Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Dharia AA, Guillotte AR, De Stefano FA, Birney MJ, Rouse AG, Ohiorhenuan IE. Coronal Deformity is Associated With Uptake on Single Photon Emission Computed Tomography in Patients With Low Back Pain. Global Spine J 2024:21925682241265302. [PMID: 38896877 DOI: 10.1177/21925682241265302] [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: 06/21/2024] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) is emerging as a valuable imaging test for identifying pain generators within the lumbar spine. The relationship between radiotracer uptake on SPECT/CT and anatomic biomechanical parameters has not been previously studied. METHODS We performed a retrospective review of all patients seen at our institution between 2021-2023 who obtained SPECT/CT scans for workup of thoracolumbar back pain. Patient data including demographic, clinical symptoms, and surgical history were collected. Radiology reports were reviewed for evidence of pathologic degeneration and increased bone metabolism on SPECT/CT. Biomechanical parameters were measured from standing scoliosis plain radiographs. Patients were stratified into two cohorts by either presence or absence of asymmetric coronal uptake on SPECT/CT. RESULTS 160 patients met inclusion criteria. Patients were primarily male (55%) with average age 55 ± 15 years. 87 (54%) patients demonstrated asymmetric uptake on SPECT/CT. These patients were older (P < 0.001), but with similar gender, prior fusion history, sacroiliitis, adjacent segment degeneration, and pseudoarthrosis (P > 0.05). This cohort had more disc disease, facet arthropathy, and greater degree of coronal scoliosis and coronal imbalance (P < 0.001). There were significantly more sites of uptake in the asymmetric cohort, and uptake was preferentially observed in the concavity of the lumbar curve (P < 0.001). There were no significant differences in sagittal balance or spinopelvic mismatch between cohorts (P > 0.05). CONCLUSION Asymmetric uptake on SPECT/CT was associated with coronal deformity in patients with low back pain. Further prospective studies are warranted to assess the effect of coronal deformity on pain generation.
Collapse
Affiliation(s)
- Anand A Dharia
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas, KS, USA
| | - Andrew R Guillotte
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas, KS, USA
| | - Frank A De Stefano
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas, KS, USA
| | - Mia J Birney
- University of Kansas School of Medicine, Kansas, KS, USA
| | - Adam G Rouse
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas, KS, USA
| | - Ifije E Ohiorhenuan
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas, KS, USA
| |
Collapse
|
3
|
Qiao M, Qian BP, Qiu Y, Song CY, Lu JS, Wang KY. Coronal deformity in ankylosing spondylitis with concomitant thoracolumbar kyphosis: patterns, manifestations and surgical strategies. 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 2024:10.1007/s00586-024-08357-9. [PMID: 38869649 DOI: 10.1007/s00586-024-08357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/25/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE To evaluate different patterns of coronal deformity secondary to ankylosing spondylitis (AS), to propose relevant treatment strategies, and to assess efficacy of asymmetrical pedicle subtraction osteotomy (APSO). METHODS Coronal deformity was defined as coronal Cobb angle over 20º or coronal balance distance (CBD) more than 3 cm. 65 consecutive AS patients with concomitant coronal and sagittal deformity who underwent PSO were included. The average follow-up time was 40.4 months. Radiographic evaluation included coronal Cobb angle and CBD. Furthermore, sagittal parameters were used to assess magnitude and maintenance of kyphosis correction. RESULTS Based on curve characteristics, coronal deformity caused by AS included four different radiologic patterns: Pattern I: lumbar scoliosis; Pattern II: C-shaped thoracolumbar curve; Pattern III: trunk shift without major curve; Pattern IV: proximal thoracic scoliosis. APSO was performed for patients in Pattern I to III while conventional PSO was applied for patients in Pattern IV. Significant improvement in all the sagittal parameters were noted in 65 patients without obvious correction loss at the last follow-up. Besides, significant and sustained correction of coronal mal-alignment was identified in 59 APSO-treated patients. Rod fracture occurred in four cases and revision surgery was performed for one case. CONCLUSION According to radiologic manifestations, coronal deformity caused by AS could be categorized into four patterns. APSO proved to be a feasible and effective procedure for correction of Pattern I to III patients. Coronal deformity pattern, apex location, sagittal profile of lumbar spine and preoperative hip function should be considered for osteotomy level selection in APSO.
Collapse
Affiliation(s)
- Mu Qiao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Bang-Ping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Chen-Yu Song
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Jing-Shun Lu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| | - Kai-Yang Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Zhongshan Road 321, Nanjing, 210008, China
| |
Collapse
|
4
|
Sharfman ZT, Clark AJ, Gupta MC, Theologis AA. Coronal Alignment in Adult Spine Surgery. J Am Acad Orthop Surg 2024; 32:417-426. [PMID: 38354413 DOI: 10.5435/jaaos-d-23-00961] [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: 10/13/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024] Open
Abstract
Coronal realignment is an important goal in adult spine surgery that has been overshadowed by emphasis on the sagittal plane. As coronal malalignment drives considerable functional disability, a fundamental understanding of its clinical and radiographic evaluation and surgical techniques to prevent its development is of utmost importance. In this study, we review etiologies of coronal malalignment and their radiographic and clinical assessments, risk factors for and functional implications of postoperative coronal malalignment, and surgical strategies to optimize appropriate coronal realignment in adult spine surgery.
Collapse
Affiliation(s)
- Zachary T Sharfman
- From the Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, CA (Sharfman and Theologis), Department of Neurological Surgery, UCSF, San Francisco, CA (Clark), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Gupta)
| | | | | | | |
Collapse
|
5
|
Shen Y, Sardar ZM, Greisberg G, Katiyar P, Malka M, Hassan F, Reyes J, Zuckerman SL, Marciano G, Lombardi JM, Lehman RA, Lenke LG. Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery: A Comparative Analysis. Spine (Phila Pa 1976) 2024; 49:443-455. [PMID: 38073177 DOI: 10.1097/brs.0000000000004892] [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: 05/11/2023] [Accepted: 11/23/2023] [Indexed: 03/13/2024]
Abstract
STUDY DESIGN Asymptomatic cohort: prospective, cross-sectional, multicenter. Symptomatic: retrospective, multisurgeon, single-center. OBJECTIVE To assess the association between cranial coronal alignment and adult spinal deformity (ASD) surgical risk and outcomes. SUMMARY OF BACKGROUND DATA ASD leads to decreased quality of life. Studies have shown that coronal malignment (CM) is associated with worse surgical outcomes. MATERIALS AND METHODS A total of 468 adult participants were prospectively enrolled in the asymptomatic cohort. Totally, 172 symptomatic ASD patients with 2-year follow-ups were retrospectively enrolled in the symptomatic cohort. Three cranial plumb line parameters: the positions of the plumb lines from the midpoint between the medial orbital rims (ORB-L5), the odontoid (OD-L5), and the C7 centroid (C7-L5) relative to the L5 pedicle, were measured. Each subject had plumb line medial (M), touching (T), or lateral (L) to either pedicle. The association between each group of patients and radiographic parameters, intraoperative variables, patient-reported outcomes, and clinical outcomes were analyzed. RESULTS In the asymptomatic cohort, OD-L5 was medial to or touching the L5 pedicle in 98.3% of volunteers. In the symptomatic patients, preoperative OD-L5-L exhibited higher mean age (56.2±14.0), odontoid-coronal vertical axis (OD-CVA) (5.5±3.3 cm), Oswestry disability index (ODI) score (40.6±18.4), pelvic fixation rate (56/62, 90.3%), OR time (528.4±144.6 min), median estimated blood loss (1300 ml), and durotomy rate (24/62, 38.7%). A similar pattern of higher CVA, preoperative ODI, intraoperative pelvic fixation rate, OR time, estimated blood loss, and durotomy rate was observed in ORB-L5-L and C7-L5-L patients. Final follow-up postoperative OD-L5-L was associated with higher rates of proximal junctional kyphosis (13.0%) and pseudarthrosis (17.4%). CONCLUSION Preoperative OD-L5, ORB-L5, and C7-L5 lateral to pedicles were associated with worse preoperative ODI and higher intraoperative complexity. Postoperative OD-L5-L was associated with higher rates of proximal junctional kyphosis and pseudarthrosis. Postoperative CM, approximated by the cranial plumb line lateral to the L5 pedicles, was associated with sagittal plane complications.
Collapse
Affiliation(s)
- Yong Shen
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Gabriella Greisberg
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Prerana Katiyar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Matan Malka
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Fthimnir Hassan
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Justin Reyes
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Gerard Marciano
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Ronald A Lehman
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| |
Collapse
|
6
|
Colonna S, Casacci F, Borghi C. Scoliosis and Lower Limb Inequality: To Lift or Not to Lift, That Is the Question. Cureus 2024; 16:e58443. [PMID: 38633141 PMCID: PMC11022167 DOI: 10.7759/cureus.58443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 04/19/2024] Open
Abstract
In subjects with scoliotic alterations of the spine, asymmetrical lengths of the lower limbs are frequently observed, a condition commonly referred to as leg length inequality (LLI) or discrepancy (LLD). This asymmetry can induce pelvic misalignments, manifested by an asymmetric height of the iliac crests, and consequently an alteration of the spine's axis. Although correcting this discrepancy might appear to be a straightforward solution, further investigation may reveal other indications. The purpose of this article is to aid clinicians confronted with the decision of whether to compensate for an LLI in individuals with scoliosis, encompassing both adolescents and adults. It presents a literature review on the incidence of LLIs in the general population, distinguishing between structural LLI (sLLI) and functional LLI (fLLI) types of LLIs, and quantifying their magnitude with clinical and instrumental evaluation. Additionally, it links these two types of LLIs to the type of scoliosis (structural or functional). From a clinical perspective, it also examines the compensatory mechanisms employed by the pelvis in the presence of structural or functional LLIs in order to draw useful indications for therapeutic decisions. Moreover, it proposes an additional evaluation parameter in the coronal plane, namely the central sacral vertical line (CSVL), to aid in the decision-making process regarding LLI compensation. Although this parameter has been documented in the literature, it has been little associated with LLIs. The findings indicate that scoliotic discrepancies should be compensated (conservatively or surgically) only when the imbalance of the femoral heads is on the same side as the imbalance of the sacrum and the iliac crests; this corrective action should result in a reduction of the overhang in the coronal plane.
Collapse
Affiliation(s)
- Saverio Colonna
- Rehabilitation Medicine, Spine Center, Bologna, ITA
- Research and Development, Osteopathic Spine Center Education, Bologna, ITA
| | - Fabio Casacci
- Rehabilitation Medicine, Spine Center, Bologna, ITA
- Research and Development, Osteopathic Spine Center Education, Bologna, ITA
| | - Corrado Borghi
- Rehabilitation Medicine, Spine Center, Bologna, ITA
- Research and Development, Osteopathic Spine Center Education, Bologna, ITA
| |
Collapse
|
7
|
Zuckerman SL, Sardar ZM, Marciano G, Cerpa M, Hassan FM, Kerolus MG, Kelly MP, Bourret S, Hasegawa K, Wong HK, Dennis Hey HW, Riahi H, Le Huec JC, Lenke LG. The Importance of Pelvic Obliquity in Assessing Spinal Coronal Alignment: Normative Values, Demographic, and Radiographic Correlations. Clin Spine Surg 2024; 37:E124-E130. [PMID: 38031283 DOI: 10.1097/bsd.0000000000001555] [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: 10/07/2022] [Accepted: 10/03/2023] [Indexed: 12/01/2023]
Abstract
STUDY DESIGN Prospective, cross-sectional study. OBJECTIVE In a geographically diverse population of asymptomatic volunteers, we sought to report the incidence of pelvic obliquity (PO), establish normative values of PO across patient factors, and assess the correlation of PO with radiographic parameters. SUMMARY OF BACKGROUND DATA PO is defined as the misalignment of the pelvis and can be assessed through several anatomic landmarks. Significant PO, whether caused by leg-length discrepancy or not, can lead to coronal malalignment which causes severe pain and disability. Significant emphasis has been placed on achieving appropriate sagittal alignment in recent decades; however, a greater understanding of coronal alignment is needed, and PO is a crucial aspect of evaluating the coronal plane in adult spinal deformity patients. METHODS Asymptomatic adult volunteers, ages 18-80 years, enrolled patients from 5 countries (France, Japan, Singapore, Tunisia, and the United States) in the "multiethnic alignment normative study" cohort (IRB 201812144). The included volunteers had no known spinal disorder(s), no significant neck or back pain (Visual Analog Scale: ≤2; Oswestry Disability Index: ≤20), and no abnormal alignment (Cobb ≤20°). PO was measured in the frontal plane as the distance between the highest points of each acetabulum, calculated along the vertical axis in millimeters (mm). The incidence of PO was defined as PO ≥10 mm. Kruskal-Wallis, Wilcoxon rank-sum, Pearson correlation, and linear regression were used. RESULTS A total of 467 patients were included, and PO values by age, sex, body mass index, and country were provided. The overall incidence of PO ≥10 mm was 4.3%, and a nonsignificant trend toward increased PO with age was seen ( P = 0.077). No significant differences were seen in PO between sex, ethnicity, or body mass index groups. No significant correlation existed between PO and other commonly used coronal radiographic measurements. CONCLUSION PO ≥10 mm occurred in 4.3% of asymptomatic volunteers. Despite the importance of recognizing PO in preventing coronal malalignment, PO did not seem to be associated with other radiographic and demographic information, which underscores the importance of intentionally assessing for any PO before surgery. These results in an asymptomatic population provide a foundation for studying PO in patients with spinal pathology.
Collapse
Affiliation(s)
- Scott L Zuckerman
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Zeeshan M Sardar
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Gerard Marciano
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Meghan Cerpa
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Fthimnir M Hassan
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Mena G Kerolus
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University, St. Louis, MO
| | - Stéphane Bourret
- Department of Orthopedic Surgery, Spine Unit 2, Surgical Research Lab, Bordeaux University Hospital, Bordeaux, France
| | - Kazuhiro Hasegawa
- Department of Orthopedic Surgery, Niigata Spine Surgery Center, Niigata City, Japan
| | - Hee-Kit Wong
- Department of Orthopedic Surgery, National University Hospital (Singapore), Singapore
| | - Hwee Weng Dennis Hey
- Department of Orthopedic Surgery, National University Hospital (Singapore), Singapore
| | - Hend Riahi
- Department of Orthopedic Surgery, Institut Kassab D'orthopédie, Ksar Said La Manouba, Tunis, Tunisia
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery, Spine Unit 2, Surgical Research Lab, Bordeaux University Hospital, Bordeaux, France
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| |
Collapse
|
8
|
Zhang Z, Wang T, Li N, Zheng G, Meng C. Will coronal alignment postoperatively be deteriorating in adult spinal deformity after long-fusion surgery? Eur J Med Res 2024; 29:197. [PMID: 38528614 DOI: 10.1186/s40001-024-01798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/16/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND To investigate whether the coronal alignment (CA) will deteriorate, and identify the risk factors for coronal malalignment (CM) developing in adult spinal deformity (ASD) after long-fusion surgery. METHODS A multi-center retrospective study was performed, which included a total of 161 ASD patients who had undergone the surgical procedure of long-fusion (≥ 5 vertebras) with instrumentations in three medical centers. All of the participants were retrospectively reviewed, and subsequently assigned into the consistency group (C7 plumb line (C7PL) shifting towards the convex side of the main curve), and the opposition group (C7PL shifting towards the concave side). CM was considered if the coronal balance distance (CBD) being over 30 mm. A Kaplan-Meier curve and log-rank test were used to analyze the differences in CM-free survival during follow-up. Multivariate analysis via a Cox proportional hazards test was used to analyze the risk factors. RESULTS Patients showing CM equaled 35 (21.7%) at the pre-operation, and that increased significantly up to 51 (31.7%) at the final follow-up (P = 0.04). In the consistency group, the incidence of CM at the final follow-up was much higher than that preoperatively (35:16, P = 0.002). CM-free survival time decreased significantly in patients with larger CBD correction, pelvic fixation and more instrumented segments, respectively, during follow-up (P < 0.05, log-rank test). Age ≥ 60 years, the consistency CA, pelvic fixation, CBD-correction ≥ 30 mm and fixed-vertebra ≥ 8 were risk factors for CM happening after surgery using multivariate regression analysis (P < 0.05). CONCLUSIONS The coronal alignments in ASD patients underwent long-fusion surgeries may deteriorate during follow-up, for which the risk factors include the consistency CA, age ≥ 60, fixed-vertebra ≥ 8, CBD-correction ≥ 30 mm and pelvic fixation.
Collapse
Affiliation(s)
- Zifang Zhang
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China.
- Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Tianhao Wang
- The Spine Surgery, The Fourth Medical Center of the Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
- Department of Orthopedic Surgery, The fourth Medical Center of the Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Nianhu Li
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guoquan Zheng
- The Spine Surgery, The Fourth Medical Center of the Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
- Department of Orthopedic Surgery, The fourth Medical Center of the Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
| | - Chunyang Meng
- Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China.
- Department of Orthopedic Surgery, Affiliated Hospital of Jining Medical University, Guhuai Road 89, Jining, 272007, China.
- Department of Spine Surgery, Affiliated Hospital of Jining Medical University, Jining Medical University, Guhuai Road 89, Jining, 272007, China.
| |
Collapse
|
9
|
Cummins DD, Clark AJ, Gupta MC, Theologis AA. Anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion for correction of lumbosacral fractional curves in adult (thoraco)lumbar scoliosis: A systematic review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 17:100299. [PMID: 38193108 PMCID: PMC10772279 DOI: 10.1016/j.xnsj.2023.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024]
Abstract
Background Anterior lumbar interbody fusion (ALIF) or transforaminal lumbar interbody fusion (TLIF) may be used to correct the lumbosacral fractional curve (LsFC) in de novo adult (thoraco) lumbar scoliosis. Yet, the relative benefits of ALIF and TLIF for LsFC correction remain largely undetermined. Purpose To compare the currently available data comparing radiographic correction of the LsFC provided by ALIF and TLIF of LsFC in adult (thoraco)lumbar scoliosis. Methods A systematic review was performed on original articles discussing fractional curve correction of lumbosacral spinal deformity (using search criteria: "lumbar" and "fractional curve"). Articles which discussed TLIF or ALIF for LsFC correction were presented and radiographic results for TLIF and ALIF were compared. Results Thirty-one articles were returned in the original search criteria, with 7 articles included in the systematic review criteria. All 7 articles presented radiographic results using TLIF for LsFC correction. Three of these articles also discussed results for patients whose LsFC were treated with ALIFs; 2 articles directly compared TLIF and ALIF for LsFC correction. Level III and level IV evidence indicated ALIF as advantageous for reducing the coronal Cobb angle of the LsFC. There were mixed results on relative efficacy of ALIF and TLIF in the LsFC for restoration of adequate global coronal alignment. Conclusions Limited level III and IV evidence suggests ALIF as advantageous for reducing the coronal Cobb angle of the LsFC in de novo adult (thoraco) lumbar scoliosis. Relative efficacy of ALIF and TLIF in the LsFC for restoration of global coronal alignment may be dictated by several factors, including directionality and magnitude of preoperative coronal deformity. Given the limited and low-quality evidence, additional research is warranted to determine the ideal interbody support strategies to address the LsFC in adult (thoraco) lumbar scoliosis.
Collapse
Affiliation(s)
- Daniel D. Cummins
- Department of Orthopaedic Surgery, University of California — San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143 United States
| | - Aaron J. Clark
- Department of Neurological Surgery, UCSF, 400 Parnassus Ave, Eighth Floor, San Francisco, CA 94143, United States
| | - Munish C. Gupta
- Department of Orthopaedic Surgery, Washington University, Campus Box 8233, 660 Euclid Avenue, Saint Louis, MO 63110, United States
| | - Alekos A. Theologis
- Department of Orthopaedic Surgery, University of California — San Francisco (UCSF), 500 Parnassus Ave, MUW 3rd Floor, San Francisco, CA, 94143 United States
| |
Collapse
|
10
|
Shimizu T, Yagi M, Suzuki S, Takahashi Y, Ozaki M, Tsuji O, Nagoshi N, Yato Y, Matsumoto M, Nakamura M, Watanabe K. How coronal malalignment affects the surgical outcome in corrective spine surgery for adult symptomatic lumbar deformity. Spine Deform 2024; 12:451-462. [PMID: 37979129 DOI: 10.1007/s43390-023-00780-0] [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: 08/16/2023] [Accepted: 10/14/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The importance of coronal alignment is unclear, while the importance of sagittal alignment in the treatment of adult patients with spinal deformities is well described. This study sought to elucidate the impact of global coronal malalignment (GCMA) in surgically treated adult symptomatic lumbar deformity (ASLD) patients. METHODS A multicentre retrospective analysis of a prospective ASD database. GCMA was defined as GCA (C7PL-CSVL) ≥ 3 cm. GCMA is categorized based on the Obeid-Coronal Malalignment Classification (O-CM). Demographic, surgical, radiographic, HRQOL, and complication data were analysed. The risk for postoperative GCMA was analysed by univariate and multivariate analyses. RESULTS Of 230 surgically treated ASLD patients, 96 patients showed GCMA preoperatively and baseline GCA was correlated with the baseline SRS-22 pain domain score (r = - 30). Postoperatively, 62 patients (27%, O-CM type 1: 41[18%], type 2: 21[9%]) developed GCMA. The multivariate risk analysis indicated dementia (OR 20.1[1.2-304.4]), diabetes (OR 5.9[1.3-27.3]), and baseline O-CM type 2 (OR 2.1[1.3-3.4]) as independent risk factors for postoperative GCMA. The 2-year SRS-22 score was not different between the 2 groups, while 4 GCMA patients required revision surgery within 1 year after surgery due to coronal decompensation (GCMA+ vs. GCMA- function: 3.6 ± 0.6 vs. 3.7 ± 0.7, pain: 3.7 ± 0.8 vs. 3.8 ± 0.8, self-image: 3.6 ± 0.8 vs. 3.6 ± 0.8, mental health: 3.7 ± 0.8 vs. 3.8 ± 0.9, satisfaction: 3.9 ± 0.9 vs. 3.9 ± 0.8, total: 3.7 ± 0.7 vs. 3.7 ± 0.7). Additionally, the comparisons of 2-yr SRS-22 between GCMA ± showed no difference in any UIV and LIV level or O-CM type. CONCLUSIONS In ASLD patients with corrective spine surgery, GCMA at 2 years did not affect HRQOL or major complications at any spinal fusion extent or O-CM type of malalignment, whereas GCA correlated with pain intensity before surgery. These findings may warrant further study of the impact of GCMA on HRQOL in the surgical treatment of ASLD patients.
Collapse
Affiliation(s)
- Toshiyuki Shimizu
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- School of Medicine, Department of Orthopedic Surgery, International University of Health and Welfare, 852 Hatakeda Narita, Chiba Prefecture, 286-0124, Japan.
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Takahashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Yato
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
11
|
Kitanaka S, Takatori R, Tonomura H, Shimizu Y, Nagae M, Makinodan A, Takahashi K. Clinical Outcomes of Lateral Lumbar Interbody Fusion with Percutaneous Pedicle Screw for Dialysis-Related Spondyloarthropathy. J Clin Med 2024; 13:1089. [PMID: 38398402 PMCID: PMC10889300 DOI: 10.3390/jcm13041089] [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: 12/30/2023] [Revised: 02/04/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The usefulness and problems with lateral lumbar interbody fusion (LLIF) with a percutaneous pedicle screw (PPS) for dialysis-related spondyloarthropathy are not clear. Therefore, we investigated the usefulness and problems with LLIF with PPS in dialysis-related spondyloarthropathy. Methods: In total, 77 patients who underwent LLIF with PPS were divided into two groups: the dialysis-related spondyloarthropathy group ("Group D") consisted of 15 patients (10 males and 5 females) with a mean age of 70.4 years and a mean duration of hemodialysis of 10.8 years; and the lumbar degenerative disease group ("Group L") included 62 patients (31 males and 31 females) with a mean age of 71.0 years. The mean follow-up period was 4 years in Group D and 3 years 9 months in Group L. We compared surgical invasiveness (operative time, blood loss), perioperative complications, clinical outcomes (Improvement ratio of the JOA score), bone fusion rate, reoperation, sagittal alignment, and coronal imbalance between the two groups. Results: There were no significant differences in operative time, blood loss, or the improvement ratio of the JOA score, but dialysis-related spondyloarthropathy was observed in one patient with superficial infection, three patients with endplate failure, and one patient with restenosis due to cage subsidence. Conclusions: We consider LLIF with PPS for dialysis-related spondyloarthropathy to be an effective treatment option because its surgical invasiveness and clinical outcomes were comparable to those for cases of lumbar degenerative disease. However, as endplate failure due to bone fragility and a reduced bone fusion rate were observed in dialysis spondylolisthesis cases, we advise a careful selection of indications for indirect decompression as well as the application of suitable pre- and postoperative adjuvant therapies.
Collapse
Affiliation(s)
- Shigeyuki Kitanaka
- Department of Orthopedic Surgery, Nishijin Hospital, Kyoto 602-8319, Japan;
| | - Ryota Takatori
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (R.T.); (H.T.); (Y.S.); (M.N.); (K.T.)
| | - Hitoshi Tonomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (R.T.); (H.T.); (Y.S.); (M.N.); (K.T.)
| | - Yuichi Shimizu
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (R.T.); (H.T.); (Y.S.); (M.N.); (K.T.)
| | - Masateru Nagae
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (R.T.); (H.T.); (Y.S.); (M.N.); (K.T.)
| | - Atsushi Makinodan
- Department of Orthopedic Surgery, Nishijin Hospital, Kyoto 602-8319, Japan;
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (R.T.); (H.T.); (Y.S.); (M.N.); (K.T.)
| |
Collapse
|
12
|
Chung NS, Lee HD, Park KH, Sunwoo J, Chung HW. Oblique lateral interbody fusion for lumbosacral fractional curve correction in degenerative lumbar 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 2024; 33:582-589. [PMID: 38227212 DOI: 10.1007/s00586-023-08113-5] [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: 08/23/2023] [Revised: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE In combined anterior-posterior adult spinal deformity surgery, the optimal combination of anterior and posterior procedures remains unclear. We aimed to demonstrate the radiological outcomes and relevant factors in oblique lateral interbody fusion (OLIF) for lumbosacral fractional curve (FC) correction combined with open posterior surgery in degenerative lumbar scoliosis (DLS). METHODS This study involved 42 consecutive patients with DLS who had a major curve (MC) ≥ 20° and an FC (L4 to S1) ≥ 10°, and underwent a combined anterior-posterior surgery Changes in the MC, FC, coronal balance distance, type of coronal imbalance, coronal/sagittal disc angle at L4-5 and L5-S1, L4 and L5 tilt, and sagittal parameters were examined. The associations between FC correction and demographic, surgical, and radiological factors were analysed. RESULTS The FC decreased from 16.9 ± 7.3° preoperatively to 6.6 ± 4.4° at the last follow-up (P < 0.001). The coronal disc angle at L4-5 and L5-S1 were, respectively, 6.8 ± 2.2° and 6.0 ± 4.1° preoperatively and decreased to 2.2 ± 2.1 and 1.2 ± 1.3° at the last follow-up (both P < 0.001). The changes in FC were greater in uppermost instrumented level > T10 (P < 0.001), and associated with the preoperative FC (r = 0.820, P < 0.001), L4 tilt (r = 0.434, P = 0.007), and L5 tilt (r = 0.462, P = 0.003). CONCLUSION OLIF at the FC combined with open posterior surgery is an effective combined anterior-posterior correction strategy in DLS.
Collapse
Affiliation(s)
- Nam-Su Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea
| | - Han-Dong Lee
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea
| | - Ki-Hoon Park
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea
| | - Jung Sunwoo
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea
| | - Hee-Woong Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea.
| |
Collapse
|
13
|
Ding L, Sun Z, Li W, Zeng Y, Chen Z, Qiu W, Hou X, Yuan L. Risk Factors of Postoperative Coronal Balance Transition in Degenerative Lumbar Scoliosis. Spine (Phila Pa 1976) 2024; 49:97-106. [PMID: 37791646 DOI: 10.1097/brs.0000000000004832] [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: 05/01/2023] [Accepted: 08/27/2023] [Indexed: 10/05/2023]
Abstract
STUDY DESIGN Retrospective radiographic study. OBJECTIVE To determine the potential risk factors influencing the transition of postoperative coronal balance in degenerative lumbar scoliosis (DLS) patients. SUMMARY OF BACKGROUND DATA As time passes after surgery, the spinal sequence of DLS patients may dynamically shift from coronal balance to imbalance, causing clinical symptoms. However, the transition of postoperative coronal balance and its risk factors have not been effectively investigated. MATERIALS AND METHODS We included 156 DLS patients. The cohort was divided into immediate postoperative coronal balance with follow-up balance (N=73) and follow-up imbalance (N=21), immediate postoperative coronal imbalance (CIB) with follow-up balance (N=23), and follow-up imbalance (N=39). Parameters included age, sex, classification of coronal balance, coronal balance distance, fusion of L5 or S1, location of apical vertebra, apical vertebral translation (AVT), Cobb angle of the main curve and lumbar-sacral curve, tilt and direction of L4/5, tilt and direction of upper instrumented vertebra (UIV), and Cobb angle of T1-UIV. Statistical testing was performed using chi-square/Fisher exact test, t tests or nonparametric tests, correlation testing, and stepwise logistic regression. RESULTS We identified a significant difference in preoperative AVT, preoperative Cobb angle, and immediate postoperative UIV tilt between patients with and without follow-up balance. Logistic regression analysis demonstrated factors associated with follow-up CIB included preoperative AVT ( P =0.015), preoperative Cobb angle ( P =0.002), and tilt of immediate postoperative UIV ( P =0.018). Factors associated with immediate postoperative CIB in patients with follow-up coronal balance were sex, correction ratio of the main curve, and direction of L4. Logistic regression analysis further identified a correction ratio of main curve ≤0.7 ( P =0.009) as an important predictive factor. CONCLUSION Patients with immediate postoperative coronal balance and higher preoperative AVT, preoperative Cobb angle, and tilt of immediate postoperative UIV were more likely to experience follow-up CIB. A correction ratio of the main curve ≤0.7 was an independent predictor of follow-up CIB. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Linyao Ding
- Key Laboratory of Spinal Disease Research, Bone and Joint Precision Medical Engineering Research Center of the Ministry of Education, Department of Orthopedic Surgery, Peking University Third Hospital, Peking University, Beijing, China
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Liang X, Yang P, Yuan H, Huo Y, Yang D, Wang H, Ding W. Sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis: a cross-sectional study. J Orthop Surg Res 2023; 18:980. [PMID: 38129855 PMCID: PMC10734110 DOI: 10.1186/s13018-023-04357-5] [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: 08/25/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND To evaluate the sex-based differences in clinical and radiological presentation of patients with degenerative lumbar scoliosis (DLS) and to explore whether the difference is helpful in investigating the etiology and progression of DLS. METHOD A retrospective review of 199 patients (41 males, 158 females) with DLS was included. Patient demographics including age, gender, bone mineral density were collected. Back and leg pain was assessed by visual analog scale, and general physical condition was assessed by Oswestry Disability Index. Cobb's angle was measured, and direction of scoliosis, position of the superior, inferior and apex vertebrae, number of vertebrae included in the scoliosis, rotation of apex vertebrae (Nash-Mo index), translation of apex vertebrae were recorded. Sagittal longitudinal axis, thoracolumbar kyphosis, lumbar lordosis (LL), pelvic incidence angle (PI), sacral slope, apex of lumbar lordosis and coronal balance distance were measured by whole spine lateral radiographs, and type of coronal imbalance was evaluated in all patients. Fat infiltration rate (FIR) of the paraspinal muscles at the vertebral apex was measured by MRI. RESULT Compared to female patients, male patients showed more back and leg pain on clinical presentation and smaller Cobb angle, less parietal rotation, larger LL, smaller PI-LL and lower paravertebral muscle FIR on radiologic features. CONCLUSION Gender differences do exist in DLS patients with regard to clinical and radiological presentation, low back pain was more pronounced in male patients, and scoliosis was more severe in female patients based on this cross-sectional study.
Collapse
Affiliation(s)
- Xiao Liang
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Puxin Yang
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Hongru Yuan
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Yachong Huo
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Dalong Yang
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
| | - Hui Wang
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China.
| | - Wenyuan Ding
- Department of Spinal Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China.
| |
Collapse
|
15
|
Lee J, Schupper AJ, Okewunmi J, Bronson WH, Steinberger JM, Lenke LG, Lin JD. The iliac kickstand screw: anatomic CT analysis of screw trajectory and osseous corridor for screw placement. Br J Neurosurg 2023:1-5. [PMID: 38050370 DOI: 10.1080/02688697.2023.2288590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION The 'kickstand screw-rod' technique has been recently described for correction of coronal malalignment. This technique utilizes powerful 'construct-to-ilium' distraction between a fixed multi-screw thoracic construct and the ilium, facilitated by a novel 'iliac kickstand screw'. The 'iliac kickstand screw' traverses a previously undescribed osseous corridor in the ilium. OBJECTIVE Using a radiographic CT study, the objective is to describe a large osseous corridor within the ilium to accommodate the novel iliac kickstand screw. METHODS 50 consecutive patients with pelvic CTs at an academic medical center were queried. Simulated iliac kickstand screw trajectories for the left and right hemipelvis were analyzed with 3D visualization software. Maximal screw lengths and dimensions, and trajectories in the osseous corridor were measured. RESULTS 50 patients' (31 female, 19 male) pelvic CTs were measured with a total of 100 simulated screws. The mean age was 52.4 years and BMI 28.1 ± 7.9. The average length is 119.7 ± 6.6 mm (range 98.7 - 135.3). The narrowest width (maximum potential screw diameter) is 17.8 ± 2.9 mm (coronal) and 20.8 ± 5.3 mm (sagittal). The starting point to the top of the iliac crest is 66.4 mm lateral to midline, and 15.9° caudal in the sagittal and 6.1° lateral in the coronal planes. CONCLUSIONS The novel iliac kickstand screw traverses a consistent and large osseous corridor within the ilium. The average simulated screw length is 119.7 mm and maximum potential diameter of 17.8 mm. Starting points relative to the iliac crest are identified.
Collapse
Affiliation(s)
- Jonathan Lee
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | | | - Jeffrey Okewunmi
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Wesley H Bronson
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| | | | - Lawrence G Lenke
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - James D Lin
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, NY, USA
| |
Collapse
|
16
|
Boissiere L, Bourghli A, Kieser D, Larrieu D, Alanay A, Pellisé F, Kleinstück F, Loibl M, Pizones J, Obeid I. Fixed coronal malalignment (CM) in the lumbar spine independently impacts disability in adult spinal deformity (ASD) patients when considering the obeid-CM (O-CM) classification. Spine J 2023; 23:1900-1907. [PMID: 37633521 DOI: 10.1016/j.spinee.2023.08.004] [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: 04/14/2023] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Postoperative flatback has been described in detail for sagittal plane considerations over the past 2 decades, and its correlations with disability are now accepted. Fixed Coronal Malalignment (CM) has been less described, and some authors report no significant association with the clinical outcome. The O-CM classification analyses CM and incorporates specific modifiers for each curve type. PURPOSE This study evaluates the O-CM classification modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs). Our hypothesis is that fixed CM correlates with PROMs independently from sagittal alignment and age. STUDY DESIGN Retrospective analysis of a large adult spinal deformity (ASD) database prospectively collected. PATIENT SAMPLE We included 747 patients from the database with long lumbar fusion (more than 3 levels), with at least two years of follow-up. Three categories of patients met the inclusion criteria (prior surgery at baseline and no revision surgery afterward, prior surgery at baseline and revision afterward, no prior surgery at baseline but fusion>3 levels and 2 years follow-up). OUTCOME MEASURES All patients completed the Oswestry Disability Index (ODI), Short Form 36 (SF36), and Scoliosis Research Society 22 scores. METHODS The patients were classified according to the six modifiers of the O-CM classification. Central Sacral Vertical Line (CSVL) above 2, 3, and 4 cm's impact on PROMs was analyzed. Multivariate analysis was performed on the relationship between PROMS and age, global tilt (GT), and CM modifiers. RESULTS After multivariate analysis using age and GT as confounding factors, we found that CM independently affects PROMs starting at 2 cm offset. Disability increases linearly with CSVL. Patients classified with 2B modifiers have the worst SRS-22 total score, social life, and self-image. CONCLUSION In a fused spine, CM independently affects disability in ASD patients. Disability increases linearly with CSVL. Despite previous reports that failed to find correlations of CM with PROMs, our study showed that fixed postoperative CM, according to O-CM classification, correlates independently from sagittal malalignment with worse PROMs. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Louis Boissiere
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, Bruges, France.
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Hospital, Al Mathar Ash Shamali, Riyadh 11564, Saudi Arabia
| | - David Kieser
- School of Medicine, University of Otago, PO Box 4345, Christchurch 8140, New Zealand
| | - Daniel Larrieu
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, Bruges, France
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Kayışdağı Cd., 34750 Ataşehir/ Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron 119, 08035 Barcelona, Spain
| | - Frank Kleinstück
- Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - Markus Loibl
- Research and Development, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, P.º de la Castellana, 261, Madrid, Spain
| | - Ibrahim Obeid
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, Bruges, France
| |
Collapse
|
17
|
Baroncini A, Frechon P, Bourghli A, Smith JS, Larrieu D, Pellisé F, Pizones J, Kleinstueck F, Alanay A, Kieser D, Cawley DT, Boissiere L, Obeid I. Adherence to the Obeid coronal malalignment classification and a residual malalignment below 20 mm can improve surgical outcomes in adult spine deformity 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 2023; 32:3673-3680. [PMID: 37393421 DOI: 10.1007/s00586-023-07831-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/17/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Coronal balance is a major factor impacting the surgical outcomes in adult spinal deformity (ASD). The Obeid coronal malalignment (O-CM) classification has been proposed to improve the coronal alignment in ASD surgery. Aim of this study was to investigate whether a postoperative CM < 20 mm and adherence to the O-CM classification could improve surgical outcomes and decrease the rate of mechanical failure in a cohort of ASD patients. METHODS Multicenter retrospective analysis of prospectively collected data on all ASD patients who underwent surgical management and had a preoperative CM > 20 mm and a 2-year follow-up. Patients were divided in two groups according to whether or not surgery had been performed in adherence to the guidelines of the O-CM classification and according to whether or not the residual CM was < 20 mm. The outcomes of interest were radiographic data, rate of mechanical complications and Patient-Reported Outcome Measures. RESULTS At 2 years, adherence to the O-CM classification led to a lower rate of mechanical complications (40 vs. 60%). A coronal correction of the CM < 20 mm allowed for a significant improvement in SRS-22 and SF-36 scores and was associated with a 3.5 times greater odd of achieving the minimal clinical important difference for the SRS-22. CONCLUSION Adherence to the O-CM classification could reduce the risk of mechanic complications 2 years after ASD surgery. Patients with a residual CM < 20 mm showed better functional outcomes and a 3.5 times greater odd of achieving the MCID for the SRS-22 score.
Collapse
Affiliation(s)
- Alice Baroncini
- Department of Orthopaedics and Trauma Surgery, RWTH Uniklinik Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Paul Frechon
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- Department of Neurosurgery, Caen University Hospital, Caen, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Justin S Smith
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Daniel Larrieu
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - Ahmet Alanay
- Spine Center, Acibadem University School of Medicine, Istanbul, Turkey
| | - David Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | - Derek T Cawley
- Department of Spine Surgery, Mater Private Hospital, Dublin, Ireland
| | - Louis Boissiere
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
| | - Ibrahim Obeid
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Brugge Cedex, France
| |
Collapse
|
18
|
Dalton J, Mohamed A, Akioyamen N, Schwab FJ, Lafage V. PreOperative Planning for Adult Spinal Deformity Goals: Level Selection and Alignment Goals. Neurosurg Clin N Am 2023; 34:527-536. [PMID: 37718099 DOI: 10.1016/j.nec.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Adult Spinal Deformity (ASD) is a complex pathologic condition with significant impact on quality of life, including pain, loss of function, and fatigue. Achieving realignment goals is crucial for long-term results. Reliable preoperative planning strategies, including nomograms, measurement tools, and level selection, are key to maximizing the likelihood of achieving a good outcome following ASD corrective surgery. This review covers recent literature on such strategies, including review of the different targets for realignment and their association with outcomes (both patients-reported outcomes and complications), selection of upper and lower instrumented vertebrae, and the latest innovation in preoperative planning for deformity surgery.
Collapse
Affiliation(s)
- Jay Dalton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Ayman Mohamed
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10075, USA
| | - Noel Akioyamen
- Department of Orthopaedic Surgery, Monteriore Medical Center, 1250 Waters Place, Tower 1, 11th Floor, Bronx, NY 10461, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10075, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY 10075, USA.
| |
Collapse
|
19
|
Mundis GM, Eastlack RK, LaMae Price A. Anterior Column Realignment: Adult Sagittal Deformity Treatment Through Minimally Invasive Surgery. Neurosurg Clin N Am 2023; 34:633-642. [PMID: 37718109 DOI: 10.1016/j.nec.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
This article focuses on the treatment of sagittal spinal deformity using a minimally invasive technique, anterior column realignment. Traditional methods to address sagittal spine deformity have been associated with high morbidity, long operative times, and excessive blood loss. This technique uses a minimally invasive lateral retroperitoneal approach to release the anterior longitudinal ligament and apply a hyperlordotic implant for interbody fusion to restore lumbar lordosis and sagittal alignment.
Collapse
Affiliation(s)
- Gregory M Mundis
- Scripps Clinic, Department of Spine Surgery, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA; San Diego Spine Foundation, Suite 212, 6190 Cornerstone Ct. East, San Diego, CA 92121, USA
| | - Robert Kenneth Eastlack
- Scripps Clinic, Department of Spine Surgery, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA; San Diego Spine Foundation, Suite 212, 6190 Cornerstone Ct. East, San Diego, CA 92121, USA
| | - Amber LaMae Price
- Scripps Clinic, Department of Spine Surgery, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA; San Diego Spine Foundation, Suite 212, 6190 Cornerstone Ct. East, San Diego, CA 92121, USA.
| |
Collapse
|
20
|
Lovecchio F, Shahi P, Patel A, Qureshi S. Single-position Minimally Invasive Surgery for Correction of Adult Spinal Deformity. J Am Acad Orthop Surg 2023; 31:e590-e600. [PMID: 37162446 DOI: 10.5435/jaaos-d-22-01037] [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: 11/11/2022] [Accepted: 03/27/2023] [Indexed: 05/11/2023] Open
Abstract
Minimally invasive adult spinal deformity (MIS ASD) surgery may offer benefits over conventional techniques in select circumstances. The success of the procedure is based on proper patient selection, restoring adequate alignment, and optimizing fusion. In the past, MIS techniques were limited because of the need to reposition the patient-a source of increased surgical time and potentially patient risk. New developments now allow for single-position, MIS correction of adult deformity. Additional research will be needed to determine the ideal patient for minimally invasive adult spinal deformity surgery and whether prone or lateral single-position confers the best outcomes.
Collapse
Affiliation(s)
- Francis Lovecchio
- From the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Lovecchio, Shahi, and Qureshi) and the Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL (Patel)
| | | | | | | |
Collapse
|
21
|
Takeuchi T, Takamizawa Y, Konishi K, Sano H, Takahashi M, Nakamichi K, Kono H, Hosogane N. Evaluation of intraoperative coronal alignment using a computer-assisted rod bending system (CARBS) without intraoperative radiation exposure in adult spinal deformity surgery: a technical note and preliminary results. Spine Deform 2023; 11:1199-1208. [PMID: 37204756 DOI: 10.1007/s43390-023-00698-7] [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: 01/10/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Intraoperative radiographs and fluoroscopy are used in adult spinal deformity (ASD) surgery to prevent postoperative coronal malalignment but with limited accuracy. Therefore, we applied a computer-assisted rod bending system (CARBS: Bendini®) for an intraoperative coronal alignment evaluation. The purpose of this study is to introduce this novel technique and validate its accuracy. METHODS Fifteen ASD patients were included in the study. The heads of the bilateral S1 pedicle screws (S1), the S1 spinous process, and the bilateral greater trochanter (GT) and the C7 spinous process were recorded with CARBS for an intraoperative coronal alignment evaluation. The lines which connect the bilateral S1 and GT were used as references. The C7-center sacral vertical line (C7-CSVL) on the CARBS monitor was checked, and the C7-CSVL from the intraoperative CARBS recording and postoperative standing whole spine radiograph were compared. RESULTS Intraoperative C7-CSVL with CARBS was 35.1 ± 31.6 mm when the S1 pedicle screws were used as the reference line and was 16.6 ± 17.8 mm when the GTs were used. Postoperative C7-CSVL by radiograph was 15.1 ± 16.5 mm. In addition, the intraoperative C7-CSVL with CARBS and the postoperative C7-CSVL showed a strong positive correlation in both GT (R = 0.86, p < 0.01) and in S1(R = 0.79, p < 0.01), with a better correlation found in GT than in S1. CONCLUSION Intraoperative C7-CSVL with CARBS was found to be highly accurate in ASD surgery. Our results suggest that this novel technique can be useful as an alternative to intraoperative radiography and fluoroscopy and may reduce radiation exposure.
Collapse
Affiliation(s)
- Takumi Takeuchi
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Yuhei Takamizawa
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Kazumasa Konishi
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Hideto Sano
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Masahito Takahashi
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Kiyohiro Nakamichi
- Keiyu Orthopaedic Hospital, 2267-1, Akouda-Cho, Tatebayashi, Gunma-Ken, 374-0013, Japan
| | - Hitoshi Kono
- Keiyu Orthopaedic Hospital, 2267-1, Akouda-Cho, Tatebayashi, Gunma-Ken, 374-0013, Japan
| | - Naobumi Hosogane
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan.
| |
Collapse
|
22
|
Ishihara M, Taniguchi S, Ono N, Adachi T, Tani Y, Paku M, Kawashima K, Ando M, Saito T. New Effective Intraoperative Techniques for the Prevention of Coronal Imbalance after Circumferential Minimally Invasive Correction Surgery for Adult Spinal Deformity. J Clin Med 2023; 12:5670. [PMID: 37685737 PMCID: PMC10488895 DOI: 10.3390/jcm12175670] [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: 07/03/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
This study aimed to devise measures and investigate their effect on coronal imbalance (CI) after circumferential minimally invasive correction surgery (CMIS) with lateral lumbar interbody fusion and percutaneous pedicle screw for adult spinal deformity (ASD). A total of 115 patients with ASD who underwent CMIS from the lower thoracic spine to the ilium were included. Patients were stratified based on the distance between the spinous process of the upper instrumented vertebra and central sacrum vertical line (UIV-CSVL) after the first intraoperative rod application into groups P (UIV-CSVL > 10 mm, n = 50) and G (UIV-CSVL < 10 mm, n = 65). Measures to correct postoperative CI introduced during surgery, preoperative and postoperative UIV-CSVL, and changes in UIV-CSVL after various measures (ΔUIV-CSVL) were investigated in group P. Rod rotation (RR), S2 alar-iliac screw distraction (SD), and kickstand-rod (KR) technique were performed in group P. Group P was further divided into group RR (n = 38), group SD (RR and SD) (n = 7), and group KR (RR and KR) (n = 5); the ΔUIV-CSVLs were 13.9 mm, 20.1 mm, and 24.4 mm in these three groups, respectively. Postoperative C7-CSVL < 10 mm was achieved in all three correction groups. In conclusion, our measures enabled sufficient correction of the UIV-CSVL and are useful for preventing CI after CMIS for ASD.
Collapse
Affiliation(s)
- Masayuki Ishihara
- Department of Orthopedic Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata City 573-1191, Japan; (S.T.); (N.O.); (T.A.); (Y.T.); (M.P.); (K.K.); (M.A.); (T.S.)
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Naresh-Babu J, Kwan KYH, Wu Y, Yilgor C, Alanay A, Cheung KMC, Polly DW, Park JB, Ito M, Lenke LG, van Hooff ML, de Kleuver M. AO Spine Adult Spinal Deformity Patient Profile: A Paradigm Shift in Comprehensive Patient Evaluation in Order to Optimize Treatment and Improve Patient Care. Global Spine J 2023; 13:1490-1501. [PMID: 34402318 PMCID: PMC10448102 DOI: 10.1177/21925682211037935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Modified Delphi study. OBJECTIVE Adult spinal deformity (ASD) is an increasingly recognized condition, comprising a spectrum of pathologies considerably impacting patients' health and functional status. Patients present with a combination of pain, disability, comorbidities and radiological deformity. The study aims to propose a systematic approach of gathering information on the factors that drive decision-making by developing a patient profile. METHODS The present study comprises of 3 parts. Part 1: Development of prototype of patient profile: The data from the Core Outcome Study on SCOlisis (COSSCO) by Scoliosis Research Society (SRS) was categorized into a conceptual framework. Part 2: Modified Delphi study: Items reaching >70% agreement were included in a 4 round iterative process with 51 panellists across the globe. Part 3: Pilot testing-feasibility: Content validity and usability were evaluated quantitatively. RESULTS The profile consisted of 4 domains. 1. General health with demographics and comorbidities, 2.Spine-specific health with spine related health and neurological status, 3. Imaging with radiographic and MRI parameters and 4. Deformity type. Each domain consisted of 1 or 2 components with various factors and their measuring instruments. Profile was found to have an excellent content validity (I-CVIr 0.78-1.00; Ave-CVI 0.92) appropriateness, relevance and usefulness. CONCLUSIONS The present study, is first to provide a universally applicable multimodal ASD patient profile to methodically describe patients. Physicians are encouraged to assess ASD patients holistically using this profile and not just based on radiographic findings.
Collapse
Affiliation(s)
- J Naresh-Babu
- Department of Spine Surgery, Mallika Spine Centre, Guntur, Andhra Pradesh, India
| | - Kenny Yat Hong Kwan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yabin Wu
- Research Department, AO Spine International, Davos, Switzerland
| | - Caglar Yilgor
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Kenneth M. C. Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - David W. Polly
- Department of Orthopaedic Surgery, University of Minnesota, MN, USA
| | - 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
| | - Lawrence G. Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Miranda L. van Hooff
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Research, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Marinus de Kleuver
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | |
Collapse
|
24
|
Pan A, Hai Y, Lenke LG, Zheng Z, Yang J. Apical Vertebras Distribution Modifier for Coronal Balance Classification in Adult Idiopathic Scoliosis. J Pers Med 2023; 13:897. [PMID: 37373886 DOI: 10.3390/jpm13060897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Background: We aimed to propose the apical vertebras distribution modifier to supplement the coronal balance (CB) classification for adult idiopathic scoliosis (AdIS). An algorithm to predict postoperative coronal compensation and avoid postoperative coronal imbalance (CIB) was proposed. Methods: Patients were categorized into CB and CIB groups according to the preoperative coronal balance distance (CBD). The apical vertebras distribution modifier was defined as negative (-) if the centers of the apical vertebras (CoAVs) were on either side of the central sacral vertical line (CSVL) and positive (+) if the CoAVs were on the same side of the CSVL. Results: A total of 80 AdIS patients, with an average age of 25.97 ± 9.20 years, who underwent posterior spinal fusion (PSF) were prospectively recruited. The mean Cobb angle of the main curve was 107.25 ± 21.11 degrees at preoperation. The mean follow-up time was 3.76 ± 1.38 (2-8) years. At postoperation and follow-up, CIB occurred in 7 (70%) and 4 (40%) CB- patients, 23 (50%) and 13 (28.26%) CB+ patients, 6 (60%) and 6 (60%) CIB- patients, and 9 (64.29%) and 10 (71.43%) CIB+ patients. Health-related quality of life (HRQoL) was significantly better in the CIB- group compared with that of the CIB+ group in the dimension of back pain. To avoid postoperative CIB, the correction rate of the main curve (CRMC) should match the compensatory curve for CB-/+ patients; the CRMC should be greater than the compensatory curve for CIB- patients; and the CRMC should be less than the compensatory curve for CIB+ patients, and the inclination of the LIV needs to be reduced. Conclusions: CB+ patients have the least postoperative CIB rate and the best coronal compensatory ability. CIB+ patients are at a high risk of postoperative CIB and have the poorest coronal compensatory capacity in the event of postoperative CIB. The proposed surgical algorithm facilitates the handling of each type of coronal alignment.
Collapse
Affiliation(s)
- Aixing Pan
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yong Hai
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Lawrence G Lenke
- New York-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Zhaomin Zheng
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510062, China
| | - Jincai Yang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| |
Collapse
|
25
|
Lu S, Zhu W, Diwan AD, Wang JC, Zhao G, Buser Z, Wang D, Cui P, Wang Y, Kong C, Wang W, Chen X. Global Coronal Malalignment in Degenerative Lumbar Scoliosis and Priority-Matching Correction Technique to Prevent Postoperative Coronal Decompensation. Global Spine J 2023:21925682231178202. [PMID: 37217200 DOI: 10.1177/21925682231178202] [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: 05/24/2023] Open
Abstract
STUDY DESIGN A prospective case-control study. OBJECTIVE To analyze global coronal malalignment (GCM) in degenerative lumbar scoliosis (DLS) and to prospectively investigate the performance of priority-matching correction technique on preventing postoperative coronal imbalance. METHODS A total of 444 DLS inpatients and outpatients were recruited. GCMs were classified into 2 types: Type 1, GCM with thoracolumbar (TL/L) curve as the main contribution on coronal imbalance; Type 2, GCM with lumbosacral (LS) curve as the main contribution on coronal imbalance. Patients receiving priority-matching correction were assigned to Group P-M and receiving traditional correction were assigned to Group T form August 2020. The fundamental principle of priority-matching technique was to first correct the key curve contributing to coronal imbalance rather than the curve with greater magnitude. RESULTS Type 1 GCM accounted for 45% and Type 2 GCM accounted for 55% of patients. Type 2 GCM was detected to have greater LS Cobb angle and L4 tilt. At 1-year follow-up, 29.8% of patients with Type 2 GCM, whereas 11.7% of patients with Type 1 GCM were observed to have postoperative coronal decompensation. Patients with postoperative imbalance were revealed to have greater preoperative LS Cobb angle and L4 tilt and smaller correction extent of LS curve and L4 tilt. 6.25% of patients developed postoperative coronal imbalance in Group P-M, whereas 40.5% developed in Group T. CONCLUSION Highlighting priority and aggressive correction of the key curve to coronal imbalance, priority-matching technique was proved to be able to limit the development of postoperative coronal decompensation.
Collapse
Affiliation(s)
- Shibao Lu
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Weiguo Zhu
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Ashish D Diwan
- Department of Orthopaedic Surgery, St George Hospital Campus, Kogarah, NSW, AU
| | | | - Guoguang Zhao
- National Geriatric Disease Research Center, Beijing, China
- Department of Neurology, Beijing Xuanwu Hospital, Beijing, China
- Department of Neurosurgery, Beijing Xuanwu Hospital, Beijing, China
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA
| | - Dongfan Wang
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Peng Cui
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Yu Wang
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Chao Kong
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Wei Wang
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| | - Xiaolong Chen
- Department of Orthopaedic Surgery, Beijing Xuanwu Hospital, Beijing, China
- National Geriatric Disease Research Center, Beijing, China
| |
Collapse
|
26
|
Ruffilli A, Barile F, Paolucci A, Manzetti M, Viroli G, Ialuna M, Vita F, Cerasoli T, Faldini C. Independent Risk Factors of Postoperative Coronal Imbalance after Adult Spinal Deformity Surgery. J Clin Med 2023; 12:jcm12103559. [PMID: 37240665 DOI: 10.3390/jcm12103559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of the present study is to elucidate preoperative risk factors for inadequate correction of coronal imbalance and/or creation of new postoperative coronal imbalance (iatrogenic CIB) in patients who undergo surgery for Adult Spinal Deformity (ASD). A retrospective review of adults who underwent posterior spinal fusion (>5 levels) for ASD was performed. Patients were divided into groups according to the Nanjing classification: type A (CSVL < 3 cm), type B (CSVL > 3 cm and C7 plumb line shifted to major curve concavity), and type C (CSVL > 3 cm and C7 plumb line shifted to major curve convexity). They were also divided according to postoperative coronal balance in balanced (CB) vs. imbalanced (CIB) and according to iatrogenic coronal imbalance (iCIB). Preoperative, postoperative, and last follow-up radiographical parameters and intraoperative data were recorded. A multivariate analysis was performed to identify independent risk factors for CIB. A total of 127 patients were included (85 type A, 30 type B, 12 type C). They all underwent long (average levels fused 13.3 ± 2.7) all-posterior fusion. Type C patients were more at risk of developing postoperative CIB (p = 0.04). Multivariate regression analysis indicated L5 tilt angle as a preoperative risk factor for CIB (p = 0.007) and indicated L5 tilt angle and age as a preoperative independent risk factors for iatrogenic CIB (p = 0.01 and p = 0.008). Patients with a preoperative trunk shift towards the convexity of the main curve (type C) are more prone to postoperative CIB and leveling the L4 and L5 vertebrae is the key to achieve coronal alignment preventing the "takeoff phenomenon".
Collapse
Affiliation(s)
- Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca Barile
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Azzurra Paolucci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Ialuna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Tosca Cerasoli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| |
Collapse
|
27
|
Lazennec JY, Pour AE. Patient perception of leg length after total hip arthroplasty does not correlate with sagittal lumbar spine stiffness, history of spinal pathology or fusion. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05810-0. [PMID: 37071149 DOI: 10.1007/s00264-023-05810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/09/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Although spinal pathology or fusion can change patients' posture and pelvic orientation, their correlation with perception of limb length discrepancy (LLD) after total hip arthroplasty (THA) is not well understood. We hypothesised that LLD perception after THA would not correlate with a history of spinal pathology, fusion or sagittal lumbar spine stiffness among patients who underwent THA. METHODS Four hundred consecutive patients who underwent THA and had a complete set of anteroposterior and lateral EOS® imaging in standing and sitting positions were included in this retrospective case-control study. All patients underwent THA between 2011 and 2020. Sagittal lumbar spine stiffness was measured by changes in lumbar lordosis and sacral slope from the standing to the sitting position (lumbar spine stiffness: standing sacral slope-sitting sacral slope < 10°). Anatomical and functional lower extremity length, change in the centre of hip rotation, coronal and sagittal knee alignment, and hindfoot height were measured. Multiple logistic regression was used to investigate the correlation between patient perceptions of LLD, and the variables found to be significant in the univariate analysis. RESULTS There was a substantial difference between the patients with and without LLD perceptions regarding axial pelvic rotation (p = 0.001), knee flexum-recurvatum (p = 0.007) and hindfoot height (p = 0.004). There was no significant difference between patients with and without LLD perceptions regarding differences in femoral length (p = 0.06), history of spine pathology or fusion (p = 0.128) and lumbar spine stiffness (p = 0.955). CONCLUSIONS Our study found no significant correlation between perceptions of LLD after THA and spinal fusion or lumbar spine stiffness. Changes in the position of the centre of hip rotation can affect the functional leg length. Surgeons should consult patients regarding other factors, such as knee alignment or hind-/midfoot pathologies, as well as compensatory mechanisms, such as axial pelvic rotation, that could affect perceptions of LLD.
Collapse
Affiliation(s)
- Jean Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpétrière Hospital Assistance Publique-Hopitaux de Paris, Sorbonne Medecine Universite, Paris, France
| | - Aidin Eslam Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, 06510, USA.
| |
Collapse
|
28
|
Zuckerman SL, Chanbour H, Hassan FM, Lai CS, Shen Y, Kerolus MG, Ha A, Buchanan I, Lee NJ, Leung E, Cerpa M, Lehman RA, Lenke LG. The Lumbosacral Fractional Curve vs Maximum Coronal Cobb Angle in Adult Spinal Deformity Patients with Coronal Malalignment: Which Matters More? Global Spine J 2023:21925682231161564. [PMID: 36987946 DOI: 10.1177/21925682231161564] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES In patients undergoing adult spinal deformity (ASD) surgery we sought to: 1) report preoperative and postoperative lumbosacral fractional (LSF) curve and maximum coronal Cobb angles and 2) determine their impact on radiographic, clinical, and patient-reported outcomes (PROs). METHODS A single-institution cohort study was undertaken. The LSF curve was the cobb angle between the sacrum and most tilted lower lumbar vertebra. Coronal/sagittal vertical axis (CVA/SVA) were collected. Patients were compared between 4 groups: 1) Neutral Alignment (NA); 2) coronal malalignment only (CM); 3) Sagittal malalignment only (SM); and 4) Combined-Coronal-Sagittal-Malalignment (CCSM). Outcomes including postoperative CM, postoperative coronal vertical axis, complications, readmissions, reoperation, and PROs. RESULTS A total of 243 patients underwent ASD surgery with mean total instrumented levels of 13.5. Mean LSF curve was 12.1±9.9°(0.2-62.3) and mean max Cobb angle was 43.0±26.5° (0.0-134.3). The largest mean LSF curves were seen in patients with CM (14.6°) and CCSM (13.1°) compared to NA (12.1°) and SM (9.5°) (p=0.100). A higher LSF curve was seen in patients with fusion to the sacrum and instrumentation to the pelvis (p=0.009), and a higher LSF curve was associated with more TLIFs (p=0.031). Postoperatively, more TLIFs were associated with greater amount of LSF curve correction (p<0.001). Comparing the LSF and the max Cob angle among Qiu types, the highest mean max Cobb angle was in Qiu Type B patients (p=0.025), whereas the highest mean LSF curve was in Qiu Type C patients (p=0.037). Moreover, 82.7% of patients had a LSF curve opposite the max Cobb angle. The LSF curve was larger than the max Cobb angle in 22/243 (9.1%) patients, and most of these 22 patients were Qiu Type A (59.1%). Regarding correction, the max Cobb angle achieved more correction than the LSF curve, judged by the percent improved from preop (54.5% Cobb vs. 46.5% LSF, p=0.025) in patients with max cobb>20° and LSF curve >5°. The LSF curve underwent greater correction in Qiu Type C patients (9.2°) compared to Type A (5.7°) and Type B (5.1°) (p=0.023); however, the max Cobb angle was similarly corrected among Qiu Types: Type A 21.8°, Type B 24.6°, and Type C 25.4° (p=0.602). Minimal differences were seen comparing the preop/postop/change in LSF curve and max Cobb angle regarding postop CM, postop CVA, complications, readmissions, reoperation, and PROs. CONCLUSIONS The LSF curve was highest in patients with CM, CCSM, and Qiu Type C curves. Most patients had a LSF curve opposite the max Cobb angle. The max Cobb angle was more often corrected than the LSF curve. The LSF curve underwent greater correction among Qiu Type C patients, whereas the max Cobb angle was similarly corrected among all Qiu Types. No clear trend was seen regarding postoperative complications and PROs between the LSF curve and max Cobb angle.
Collapse
Affiliation(s)
- Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fthimnir M Hassan
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Christopher S Lai
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yong Shen
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Mena G Kerolus
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Alex Ha
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Ian Buchanan
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Nathan J Lee
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Eric Leung
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Meghan Cerpa
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
29
|
Hiyama A, Sakai D, Katoh H, Sato M, Watanabe M. Postoperative Radiological Improvement after Staged Surgery Using Lateral Lumbar Interbody Fusion for Preoperative Coronal Malalignment in Patients with Adult Spinal Deformity. J Clin Med 2023; 12:jcm12062389. [PMID: 36983389 PMCID: PMC10052673 DOI: 10.3390/jcm12062389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
This retrospective observational study evaluated improvement in coronal malalignment (CM) after anteroposterior staged surgery using lateral lumbar interbody fusion (LLIF) in patients with coronal lumbar curve adult spinal deformity (ASD). Sixty patients with ASD underwent surgery; 34 had SRS-Schwab type L lumbar curve. Patients with a coronal balance distance (CBD) ≥20 mm were diagnosed with CM. Using the Obeid CM classification, we classified the preoperative coronal pattern as concave CM (type 1) or convex CM (type 2). Demographic, surgical, and radiological parameters were compared. Whole-spine standing radiographs were assessed preoperatively and postoperatively. Twenty-three patients had type 1A, six had type 2A, five had no CM, and none had type 1B or 2B according to the Obeid CM classification. Compared with patients with Obeid type 1A, those with Obeid type 2A had significantly higher preoperative and postoperative coronal L4 tilts and a smaller change in corrected CBD (Δ|CBD|) (76.6 mm vs. 24.1 mm, p < 0.001). At the final follow-up, 58.6% (17/29 patients) of patients with SRS-Schwab type L CM showed improvement after corrective fusion using LLIF. Although the difference was not statistically significant, CM improved in 69.6% (16/23 patients) of patients with Obeid type 1A type but only 16.7% (1/6 patients) of those with Obeid type 2A type (p = 0.056). CM was more likely to remain after anteroposterior staged surgery using LLIF in patients with preoperative Obeid type 2A ASD.
Collapse
Affiliation(s)
- Akihiko Hiyama
- Department Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Daisuke Sakai
- Department Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Hiroyuki Katoh
- Department Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Masato Sato
- Department Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan
| | - Masahiko Watanabe
- Department Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan
| |
Collapse
|
30
|
Zhu W, Wang Y, Kong C, Sun X, Pan F, Wang W, Lu S. A Comprehensive Analysis of the Behavior of Pelvic Incidence After Different Posterior Spinal Procedures in Elderly Patients With Spinal Deformity. Global Spine J 2023; 13:368-377. [PMID: 33648378 PMCID: PMC9972256 DOI: 10.1177/2192568221996683] [Citation(s) in RCA: 1] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A retrospective case-control study. OBJECTIVE To evaluate the behavior of pelvic incidence (PI) after different posterior spinal procedures in elderly patients with adult spinal deformity (ASD), to determine the potential associated factors with the variability in PI after spinal surgery and to comprehensively analyze its mechanisms. METHODS Elderly patients underwent long fusion to sacrum with and without pelvic fixation were assigned to Group L+P and Group L-P, respectively. In Group L-P, those with severe sagittal deformity were selected as Group A. 20 elderly patients with severe sagittal deformity underwent short lumbar fusion were included as Group B. The following radiographic parameters were evaluated: thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), PI-LL, sagittal vertical axis (SVA), T1 pelvic angle (TPA), and pelvic parameters. PI changing more than 5° (△PI > 5°) was considered as substantially changed. RESULTS For the whole cohort and in Group L+P, PI were not substantially changed (△PI ≤ 5°) after surgery. Besides the severer sagittal malalignment in patients with △PI > 5° in Group L-P, relatively larger mean age, greater proportion of female and lower preoperative PI were found than those in patients with △PI ≤ 5°. 70.8% of patients had substantial increase of PI in Group A, while only 10% of patients had in Group B (P < 0.001). CONCLUSION PI behaves differently under different conditions in elderly ASD patients. Besides severe sagittal deformity, aging, female and low preoperative PI are also the potential risk factors of PI increasing after long fusion to sacrum.
Collapse
Affiliation(s)
- Weiguo Zhu
- Department of Orthopaedic Surgery,
Capital Medical University Xuanwu Hospital, Beijing, China
- National Clinical Research Center for
Geriatric Diseases, Beijing, China
| | - Yu Wang
- Department of Orthopaedic Surgery,
Capital Medical University Xuanwu Hospital, Beijing, China
- National Clinical Research Center for
Geriatric Diseases, Beijing, China
| | - Chao Kong
- Department of Orthopaedic Surgery,
Capital Medical University Xuanwu Hospital, Beijing, China
- National Clinical Research Center for
Geriatric Diseases, Beijing, China
| | - Xiangyao Sun
- Department of Orthopaedic Surgery,
Capital Medical University Xuanwu Hospital, Beijing, China
- National Clinical Research Center for
Geriatric Diseases, Beijing, China
| | - Fumin Pan
- Department of Orthopaedic Surgery,
Capital Medical University Xuanwu Hospital, Beijing, China
- National Clinical Research Center for
Geriatric Diseases, Beijing, China
| | - Wei Wang
- Department of Orthopaedic Surgery,
Capital Medical University Xuanwu Hospital, Beijing, China
- National Clinical Research Center for
Geriatric Diseases, Beijing, China
| | - Shibao Lu
- Department of Orthopaedic Surgery,
Capital Medical University Xuanwu Hospital, Beijing, China
- National Clinical Research Center for
Geriatric Diseases, Beijing, China
- Shibao Lu, Department of Orthopaedic
Surgery, Capital Medical University Xuanwu Hospital, Beijing, 100053, China.
| |
Collapse
|
31
|
Short-Segment versus Long-Segment Spinal Fusion Constructs for the Treatment of Adult Degenerative Scoliosis: A Comparison of Clinical Outcomes. World Neurosurg 2023; 171:e611-e619. [PMID: 36529425 DOI: 10.1016/j.wneu.2022.12.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare clinical outcomes of patients diagnosed with degenerative scoliosis undergoing short-segment versus long-segment spinal fusion. METHODS A retrospective cohort study was conducted of patients with degenerative thoracolumbar scoliosis undergoing elective spinal fusion at a single academic medical center. Cohorts were divided into short-segment (<3) or long-segment (≥3) groups. RESULTS A total of 197 patients (122 short, 75 long) were included. Patients undergoing short-segment fusion more frequently presented with radiculopathy (P < 0.001) and had greater baseline visual analog scale (VAS) leg scores (P < 0.001). Patients with long-segment fusions had longer hospital length of stay (short, 3.82 ± 2.98 vs. long, 7.40 ± 6.85 days; P < 0.001), lower home discharge rates (short, 80.3% vs. long, 51.8; P = 0.003), higher revision surgery rates (short, 10.77% vs. long, 25.3%; P = 0.012), and greater percentage curve correction (short, 37.3% ± 25.9% vs. long, 45.1% ± 23.9%; P = 0.048). No significant differences were noted in postoperative complication rates (short, 1.64% vs. long, 5.33%; P = 0.143). At 1 year, patients with long fusions had worse ΔOswestry Disability Index (ODI) (P = 0.024), ΔVAS leg score (P = 0.002), and VAS leg minimum clinically important difference % (P = 0.003). Multivariate regression found that short-segment fusions were associated with greater improvements in ODI (P = 0.029), Physical Component Summary-12 (P = 0.024), and VAS leg score at 1 year (P = 0.002). CONCLUSIONS Patients undergoing short-segment fusions more frequently presented with radiculopathy and had higher preoperative VAS leg scores compared with those receiving long constructs. Short-construct fusions in appropriately selected patients may provide satisfactory improvements in patient-reported outcome measures, particularly ΔODI and ΔVAS leg score, and mitigate hospital length of stay, revision surgery rates, and nonhome discharge.
Collapse
|
32
|
Bourghli A, Boissière L, Obeid I. The Obeid-coronal malalignment classification is reliable and helps guiding decision-making and surgical management of adult spinal deformities: letter to the editor of BMC Musculoskeletal Disorders. BMC Musculoskelet Disord 2023; 24:145. [PMID: 36823582 PMCID: PMC9948463 DOI: 10.1186/s12891-023-06257-5] [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] [Received: 07/14/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
A recently published article by Zhang et al. in BMC Musculoskeletal Disorders reported that the classification of coronal deformity based on preoperative global coronal malalignment for adult spinal deformity is questionable. The aim of the paper was to specifically discredit the Obeid-Coronal Malalignment (O-CM) classification. In this correspondence, we thought it judicious to clarify misunderstood concepts by the authors. We highlight several limitations of their study, and explain the deep interest of the classification from our perspective in order to avoid misleading the readers. Overarching, we aim to help the colleagues through a constructive rather than destructive approach to better understand the foundations of a coronal malalignment classification.
Collapse
Affiliation(s)
- Anouar Bourghli
- Spine surgery department, King Faisal Special Hospital and Research Center, P.O.Box 3354, 11211, Riyadh, Saudi Arabia.
| | - Louis Boissière
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
| |
Collapse
|
33
|
Zuckerman SL, Chanbour H, Hassan FM, Lai C, Kerolus M, Ha A, Buchannan I, Cerpa M, Lehman RA, Lenke LG. Patients With Coronal Malalignment Undergoing Adult Spinal Deformity Surgery: Does Coronal Alignment Change From Immediately Postoperative to 2-years? Clin Spine Surg 2023; 36:E14-E21. [PMID: 35858210 DOI: 10.1097/bsd.0000000000001359] [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: 03/28/2022] [Accepted: 05/18/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The objectives were to: (1) characterize the changes in coronal vertical axis (CVA) after adult spinal deformity (ASD) surgery from immediate postoperative to 2-years postoperative, and (2) assess for predictors of CVA change from immediate postoperative to 2-years postoperative. SUMMARY OF BACKGROUND DATA It is unknown whether coronal correction obtained immediately postoperative accurately reflects long-term coronal alignment. MATERIALS AND METHODS A retrospective, single-institution registry was queried for patients undergoing ASD surgery from 2015-2019, including patients undergoing ≥6-level fusions with preoperative coronal malalignment (CM), defined as CVA≥3 cm. A clinically significant change in CVA was defined a priori as ≥1 cm. Radiographic variables were obtained preoperatively, immediately postoperative, and at 2-years postoperative. RESULTS Of 368 patients undergoing ASD surgery, 124 (33.7%) had preoperative CM, and 64 (17.0%) completed 2-years follow-up. Among 64 patients, mean age was 53.6±15.4 years. Preoperatively, absolute mean CVA was 5.4±3.1 cm, which improved to 2.3±2.0 cm ( P <0.001) immediately postoperative and 2.2±1.6 cm ( P <0.001) at 2-years. The mean change in CVA from preoperative to immediately postoperative was 2.2±1.9 cm (0.3-14.4). During the immediate postoperative to 2-years interval, 29/64 (45.3%) patients experienced a significant change of CVA by ≥1 cm, of which 22/29 (76%) improved by a mean of 1.7 cm and 7/29 (24%) worsened by a mean of 3.5 cm. No preoperative or surgical factors were associated with changed CVA from immediately postoperative to 2-years. CONCLUSION Among 64 patients undergoing ASD surgery with preoperative CM, 45.3% experienced a significant (≥1 cm) change in their CVA from immediately postoperative to 2-years postoperative. Of these 29 patients, 22/29 (76%) improved, whereas 7/29 (24%) worsened. Although no factors were associated with undergoing a change in CVA, this information is useful in understanding the evolution and spontaneous coronal alignment changes that take place after major ASD coronal plane correction.
Collapse
Affiliation(s)
- Scott L Zuckerman
- Departments of Neurological Surgery
- Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Fthimnir M Hassan
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Christopher Lai
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Mena Kerolus
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Alex Ha
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Ian Buchannan
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Meghan Cerpa
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| |
Collapse
|
34
|
Puvanesarajah V, Raad M, Hassan FM, Lombardi JM, Sardar ZM, Lehman RA, Lenke LG. The "kickstand rod" technique for correction of coronal malalignment: two-year clinical and radiographic outcomes. Spine Deform 2023; 11:153-161. [PMID: 35939259 DOI: 10.1007/s43390-022-00564-y] [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] [Received: 04/04/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Restoring coronal alignment in spine deformity patients has been shown to play an important role in improving patient reported outcomes (PRO). Recently, the "kickstand rod" (KSR) technique was developed as a novel coronal correction method in complex spine deformity cases. The goal of the present study was to assess outcomes of this technique at two years of follow-up. METHODS Consecutive, unique adult patients who underwent KSR constructs for coronal spinal malalignment between 2015 and 2019 with a minimum 2 year clinical and radiographic follow-up were identified. A KSR construct includes a more laterally placed iliac screw and additional rod that effectively depresses the ipsilateral ilium/pelvis for coronal correction, while serving as a buttress to prevent future loss of correction. Outcomes included revision for instrumentation-related complications, radiographic alignment, and PROs. RESULTS Twenty patients were included with a mean age of 54 years [range: 20-73 years]. Mean follow-up time was 2.5 years [range: 2.0-5.0]. Mean number of levels fused was 17.3 [range: 10-24]. There were significant improvements in coronal alignment (CVA: 5.8 cm ± 2.6 cm vs. 1.7 cm ± 1.5 cm), sagittal alignment (SVA: 5.6 cm ± 5.9 cm vs. 1.6 cm ± 2.5 cm) and major Cobb angle (55º ± 32 vs. 26º ± 21) maintained at 2 years (p < 0.05). One patient experienced an asymptomatic fracture at the shank of the KSR iliac screw. There were significant improvements in Oswestry Disability Index and SRS-22 domains (p < 0.05). CONCLUSION The KSR technique is a safe and effective method for correcting coronal malalignment in complex spinal deformity patients with no revisions specific for the KSR or iliac screw and significantly improved PROs at a minimum two-year follow-up.
Collapse
Affiliation(s)
- Varun Puvanesarajah
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, NY, NY, 10034, USA.
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fthimnir M Hassan
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, NY, NY, 10034, USA
| | - Joseph M Lombardi
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, NY, NY, 10034, USA
| | - Zeeshan M Sardar
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, NY, NY, 10034, USA
| | - Ronald A Lehman
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, NY, NY, 10034, USA
| | - Lawrence G Lenke
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Medical Center, 5141 Broadway, NY, NY, 10034, USA
| |
Collapse
|
35
|
Banno T, Yamato Y, Oba H, Ohba T, Hasegawa T, Yoshida G, Arima H, Oe S, Ide K, Yamada T, Takahashi J, Haro H, Matsuyama Y. Risk factors and clinical impact of persistent coronal imbalance after posterior spinal fusion in thoracolumbar/lumbar idiopathic scoliosis. J Neurosurg Spine 2022; 37:883-892. [PMID: 35901689 DOI: 10.3171/2022.5.spine22385] [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: 04/08/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Persistent coronal imbalance (PCI) can develop postoperatively. In this study, the authors aimed to clarify the risk factors and clinical impact of PCI after posterior spinal fusion (PSF) in idiopathic scoliosis (IS) patients with a major thoracolumbar/lumbar (TL/L) curve. METHODS Data on 108 patients with Lenke type 5C or 6C IS who underwent PSF with a minimum of 2 years of follow-up were retrospectively analyzed. PCI was defined as coronal imbalance persisting 2 years after surgery. Radiographic parameters and clinical outcomes were compared between the PCI (+) and PCI (-) groups. Multivariate regression analyses of associated factors were performed to determine the risk factors for PCI. RESULTS Of the 108 patients, 48 (44%) had immediate postoperative coronal imbalance, and 10 of these patients (9%) had coronal imbalance persisting 2 years after surgery. The PCI (+) group had significantly worse postoperative subtotal and satisfaction scores than the PCI (-) group. Preoperative apical vertebral translation (AVT) of the TL/L curve (AVT-TL/L) and postoperative coronal balance (CB) were identified as independent risk factors for PCI. The cutoff values of preoperative AVT-TL/L at 49.5 mm (area under the curve [AUC] 0.835, p = 0.001, 95% CI 0.728-0.941, sensitivity 70.0%, specificity 72.4%) and those of postoperative CB at -27.5 mm (AUC 0.837, p < 0.001, 95% CI 0.729-0.945, sensitivity 78.6%, specificity 70.0%) were used to predict PCI. In selective fusion cases, older age (OR 2.110, 95% CI 1.159-3.842, p = 0.015), greater preoperative AVT-TL/L (OR 1.199, 95% CI 1.029-1.398, p = 0.020), and less postoperative CB (OR 0.855, 95% CI 0.743-0.983, p = 0.027) were independent risk factors for PCI. CONCLUSIONS Preoperative AVT-TL/L and postoperative CB are important parameters for predicting PCI. PCI adversely affects postoperative clinical outcomes. In selective fusion surgery, PCI tends to occur in older patients due to reduced flexibility and compensatory abilities.
Collapse
Affiliation(s)
- Tomohiro Banno
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Yu Yamato
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hiroki Oba
- 2Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Nagano
| | - Tetsuro Ohba
- 3Department of Orthopaedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Tomohiko Hasegawa
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Go Yoshida
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Hideyuki Arima
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Shin Oe
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Koichiro Ide
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Tomohiro Yamada
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Jun Takahashi
- 2Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Nagano
| | - Hirotaka Haro
- 3Department of Orthopaedic Surgery, Yamanashi University, Chuo, Yamanashi, Japan
| | - Yukihiro Matsuyama
- 1Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| |
Collapse
|
36
|
Zhao J, Meng Y, Ma J, Zhou X, Jiang H. Sectional Correction Technique in Dystrophic Scoliosis Secondary to Neurofibromatosis Type 1: A Comparison with Traditional 2-Rod Correction Technique. World Neurosurg 2022; 167:e507-e514. [PMID: 35977683 DOI: 10.1016/j.wneu.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the traditional 2-rod correction technique with the sectional correction technique in terms of radiographic results and clinical outcomes for patients with dystrophic scoliosis caused by neurofibromatosis type 1 (NF1). METHODS From May 2015 to April 2018, 53 patients with dystrophic scoliosis caused by NF1 underwent 1-stage posterior corrective surgery. Patients were separated into 2 groups based on technique: the sectional correction technique (SC group) and the traditional 2-rod technique (TT group). Before surgery and at the final follow-up, the demographic information, radiographic parameters, and clinical outcomes were compared between the groups using independent-sample t tests. RESULTS The SC group consisted of 24 patients, while the TT group consisted of 29 patients. Patients in the SC group showed a higher coronal balance distance after the operation (8.3 ± 8.2 mm vs. 16.2 ± 8.8 mm, P = 0.002) and at the final follow-up (9.5 ± 9.3 mm vs. 19.3 ± 10.1 mm, P < 0.0001). At the last follow-up, the loss of correction in the SC group was 2.2 ± 0.9 and 2.1 ± 0.7 in the coronal and sagittal planes, respectively, and these values were significantly lower than those in the TT group (5.3 ± 1.6 in the coronal plane and 4.5 ± 1.9 in the sagittal plane, both P < 0.05). The SC group had better improvement based on appearance and satisfaction score at the final follow-up. CONCLUSIONS The sectional correction technique using a concave domino connector can restore coronal imbalance and reduce the risk of implant failure.
Collapse
Affiliation(s)
- Jianquan Zhao
- Department of Orthopedics, Changzheng hospital, Naval Medical University, Shanghai, P.R.China
| | - Yichen Meng
- Department of Orthopedics, Changzheng hospital, Naval Medical University, Shanghai, P.R.China
| | - Jun Ma
- Department of Orthopedics, Changzheng hospital, Naval Medical University, Shanghai, P.R.China
| | - Xuhui Zhou
- Department of Orthopedics, Changzheng hospital, Naval Medical University, Shanghai, P.R.China
| | - Heng Jiang
- Department of Orthopedics, Changzheng hospital, Naval Medical University, Shanghai, P.R.China.
| |
Collapse
|
37
|
Zuckerman SL, Chanbour H, Hassan FM, Lai CS, Shen Y, Lee NJ, Kerolus MG, Ha AS, Buchanan IA, Leung E, Cerpa M, Lehman RA, Lenke LG. Evaluation of coronal alignment from the skull using the novel orbital-coronal vertical axis line. J Neurosurg Spine 2022; 37:410-419. [PMID: 35364571 DOI: 10.3171/2022.1.spine211527] [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: 12/10/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE When treating patients with adult spinal deformity (ASD), radiographic measurements evaluating coronal alignment above C7 are lacking. The current objectives were to: 1) describe the new orbital-coronal vertical axis (ORB-CVA) line that evaluates coronal alignment from cranium to sacrum, 2) assess correlation with other radiographic variables, 3) evaluate correlations with patient-reported outcomes (PROs), and 4) compare the ORB-CVA with the standard C7-CVA. METHODS A retrospective cohort study of patients with ASD from a single institution was undertaken. Traditional C7-CVA measurements were obtained. The ORB-CVA was defined as the distance between the central sacral vertical line and the vertical line from the midpoint between the medial orbital walls. The ORB-CVA was correlated using traditional coronal measurements, including C7-CVA, maximum coronal Cobb angle, pelvic obliquity, leg length discrepancy (LLD), and coronal malalignment (CM), defined as a C7-CVA > 3 cm. Clinical improvement was analyzed as: 1) group means, 2) minimal clinically important difference (MCID), and 3) minimal symptom scale (MSS) (Oswestry Disability Index < 20 or Scoliosis Research Society-22r Instrument [SRS-22r] pain + function domains > 8). RESULTS A total of 243 patients underwent ASD surgery, and 175 had a 2-year follow-up. Of the 243 patients, 90 (37%) had preoperative CM. The mean (range) ORB-CVA at each time point was as follows: preoperatively, 2.9 ± 3.1 cm (-14.2 to 25.6 cm); 1 year postoperatively, 2.0 ± 1.6 cm (-12.4 to 6.7 cm); and 2 years postoperatively, 1.8 ± 1.7 cm (-6.0 to 11.1 cm) (p < 0.001 from preoperatively to 1 and 2 years). Preoperative ORB-CVA correlated best with C7-CVA (r = 0.842, p < 0.001), maximum coronal Cobb angle (r = 0.166, p = 0.010), pelvic obliquity (r = 0.293, p < 0.001), and LLD (r = 0.158, p = 0.006). Postoperatively, the ORB-CVA correlated only with C7-CVA (r = 0.629, p < 0.001) and LLD (r = 0.153, p = 0.017). Overall, 155 patients (63.8%) had an ORB-CVA that was ≥ 5 mm different from C7-CVA. The ORB-CVA correlated as well and sometimes better than C7-CVA with SRS-22r subdomains. After multivariate logistic regression, a greater ORB-CVA was associated with increased odds of complication, whereas C7-CVA was not associated with any of the three clinical outcomes (complication, readmission, reoperation). A larger difference between the ORB-CVA and C7-CVA was significantly associated with readmission and reoperation after univariate and multivariate logistic regression analyses. A threshold of ≥ 1.5-cm difference between the preoperative ORB-CVA and C7-CVA was found to be predictive of poorer outcomes. CONCLUSIONS The ORB-CVA correlated well with known coronal measurements and PROs. ORB-CVA was independently associated with increased odds of complication, whereas C7-CVA was not associated with any outcomes. A ≥ 1.5-cm difference between the preoperative ORB-CVA and C7-CVA was found to be predictive of poorer outcomes.
Collapse
Affiliation(s)
- Scott L Zuckerman
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- 2Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Hani Chanbour
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fthimnir M Hassan
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Christopher S Lai
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Yong Shen
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Nathan J Lee
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Mena G Kerolus
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Alex S Ha
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Ian A Buchanan
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Eric Leung
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Meghan Cerpa
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Ronald A Lehman
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Lawrence G Lenke
- 3Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at NewYork-Presbyterian, New York, New York
| |
Collapse
|
38
|
Li S, Mao S, Ma Y, Zhu Z, Liu Z, Qian B, Sun X, Qiu Y. Scoliosis: an unusual clinical presentation of paraspinal ganglioneuroma. Spine Deform 2022; 10:1185-1195. [PMID: 35486319 DOI: 10.1007/s43390-022-00511-x] [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: 10/07/2021] [Accepted: 04/09/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To comprehensively present the clinical characteristics and treatment strategies in patients with scoliosis secondary to ganglioneuroma (S-GN). METHODS Six patients with S-GN treated surgically at a median age of 12 years were retrospectively reviewed and the median follow-up period was 6 years (4-14 years). The radiological features of GN and the associated scoliosis were evaluated. The surgical strategies and the corresponding outcomes were investigated. RESULTS All patients had a delayed diagnosis age of GN than scoliosis (12 vs. 9 years). GN was located at the posterior mediastinum in four patients (66.7%) and at retroperitoneum in two, respectively. Tumor occupancies were frequently detected on the X-ray films for four patients (66.7%), being uniformly on the convexity of the main curve. All patients complained of rapid progressive deformities during the growth period. Five patients (83.3%) received total tumor resections, one accepted partial resection. Deformity correction was implemented for all patients with an average rate of 66.4% on the main curve. No recurrence of the GN was detected for all totally tumor-resected patients at the latest follow-up. CONCLUSION S-GN is often misdiagnosed clinically. Paravertebral mass neighboring the apex of scoliosis can be meticulously detected from the X-ray films. Total tumor resection should be aggressively performed if possible. The deformity correction could be satisfactorily obtained and the risk of recurrence of the GN was relatively low.
Collapse
Affiliation(s)
- Song Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Saihu Mao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China.
| | - Yanyu Ma
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Bangping Qian
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu Province, China
| |
Collapse
|
39
|
Zhang Z, Liu T, Wang Y, Wang Z, Zheng G. Factors Related to Preoperative Coronal Malalignment in Degenerative Lumbar Scoliosis: An Analysis on Coronal Parameters. Orthop Surg 2022; 14:1846-1852. [PMID: 35795967 PMCID: PMC9363746 DOI: 10.1111/os.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/29/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Recently the effects of coronal malalignment (CM) in degenerative lumbar scoliosis (DLS) have been reported, however, there was few studies on the correlated parameters of coronal alignments at pre‐operation. The aims of this current study were to investigate the associations of coronal parameters with scoliosis and coronal alignment, and to explore the relationships between the coronal pelvic tilt and coronal alignment in DLS. Methods One hundred and sixty‐one DLS patients in our hospital from May 2016 to December 2020 were reviewed and documented. The coronal balance distance (CBD, the offset between the center of C7 and the plumb line drawn from the center of S1), major Cobb (MC), fractional Cobb (FC), L4 coronal tilt, L5 coronal tilt, coronal pelvic tilt, apical rotation, and the vertebras in major curve were measured and documented. CM was considered if the CBD ≥ 30mm. All of those participants were assigned into group A (CBD ≥ 30 mm) and group B (CBD < 30 mm). Comparisons of demographic and radiographic data were performed between groups A and B. Pearson correlation and further multiple regression with stepwise method analysis were used to investigate those coronal parameters correlated to MC and CBD, respectively. Results Thirty‐one patients suffering from CM were assigned into group A, and the rest of 130 patients were assigned to group B accordingly. Then the incidence of CM was about 19.3% (31/161). Patients in group A had less vertebras in the main curve (P = 0.009), however, the apical rotation (P < 0.001) and the L4 coronal tilt (P = 0.007) were much larger. Although the MC (P = 0.426) and FC (P = 0.06) had no difference between the two groups, the match between MC and FC was much smaller (p = 0.021) in group A. The coronal pelvic tilt correlated significantly with FC (r = 0.552, p < 0.001), but mildly with MC (r = −0.366, p < 0.001), L4 coronal tilt (r = 0.348, p < 0.001), and L5 coronal tilt (r = 0.351, p < 0.001), respectively. The CBD correlated strongly with L4 coronal tilt (r = −0.471, p < 0.001) and L5 coronal tilt (r = −0.468, p < 0.001), respectively, but mildly with FC (r = −0.255, p = 0.016). Further multiple regression analysis revealed that only L4 coronal tilt was the independent factor for MC (r2 = 0.549, p < 0.001) and CBD (r2 = 0.221, p < 0.001), respectively. Conclusions The prevalence of CM in DLS patients is about 19% at pre‐operation. With similar major Cobb, the less the vertebras in the major curve, the larger the CBD. L4 coronal tilt may correlate significantly to scoliosis and CBD. Coronal pelvic tilt may be just one of the compensations for the scoliosis deformity but effects CBD directly.
Collapse
Affiliation(s)
- Zifang Zhang
- The Spinal Surgery Department of the Affiliated Hospital of Jining Medical University, Jining, China.,The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Tao Liu
- The Department of Orthopaedics, Yanzhou Branch of Affiliated Hospital of Jining Medial University, Jining, China
| | - Yan Wang
- The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Zheng Wang
- The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Guoquan Zheng
- The Department of Orthopaedics, The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
40
|
Zuckerman SL, Lai CS, Shen Y, Cerpa M, Lee NJ, Kerolus MG, Ha AS, Buchanan IA, Leung E, Lehman RA, Lenke LG. Understanding the role of pelvic obliquity and leg length discrepancy in adult spinal deformity patients with coronal malalignment: unlocking the black box. J Neurosurg Spine 2022; 37:64-72. [PMID: 35171835 DOI: 10.3171/2021.10.spine21800] [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: 06/09/2021] [Accepted: 10/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study had 3 objectives: 1) to describe pelvic obliquity (PO) and leg-length discrepancy (LLD) and their relationship with coronal malalignment (CM); 2) to report rates of isolated PO and PO secondary to LLD; and 3) to assess the importance of preoperative PO and LLD in postoperative complications, readmission, reoperation, and patient-reported outcomes. METHODS Patients undergoing surgery (≥ 6-level fusions) for adult spinal deformity at a single institution were reviewed. Variables evaluated were as follows: 1) PO, angle between the horizontal plane and a line touching bilateral iliac crests; and 2) LLD, distance from the head to the tibial plafond. Coronal vertical axis (CVA) and sagittal vertical axis measurements were collected, both from C7. The cutoff for CM was CVA > 3 cm. The Oswestry Disability Index (ODI) was collected preoperatively and at 2 years. RESULTS Of 242 patients undergoing surgery for adult spinal deformity, 90 (37.0%) had preoperative CM. Patients with preoperative CM had a higher PO (2.8° ± 3.2° vs 2.0° ± 1.7°, p = 0.013), a higher percentage of patients with PO > 3° (35.6% vs 23.5%, p = 0.044), and higher a percentage of patients with LLD > 1 cm (21.1% vs 9.8%, p = 0.014). Whereas preoperative PO was significantly positively correlated with CVA (r = 0.26, p < 0.001) and maximum Cobb angle (r = 0.30, p < 0.001), preoperative LLD was only significantly correlated with CVA (r = 0.14, p = 0.035). A total of 12.2% of patients with CM had significant PO and LLD, defined as follows: PO ≥ 3°; LLD ≥ 1 cm. Postoperatively, preoperative PO was significantly associated with both postoperative CM (OR 1.22, 95% CI 1.05-1.40, p = 0.008) and postoperative CVA (β = 0.14, 95% CI 0.06-0.22, p < 0.001). A higher preoperative PO was independently associated with postoperative complications after multivariate logistic regression (OR 1.24, 95% CI 1.05-1.45, p = 0.010); however, 2-year ODI scores were not. Preoperative LLD had no significant relationship with postoperative CM, CVA, ODI, or complications. CONCLUSIONS A PO ≥ 3° or LLD ≥ 1 cm was seen in 44.1% of patients with preoperative CM and in 23.5% of patients with normal coronal alignment. Preoperative PO was significantly associated with preoperative CVA and maximum Cobb angle, whereas preoperative LLD was only associated with preoperative CVA. The direction of PO and LLD showed no consistent pattern with CVA. Preoperative PO was independently associated with complications but not with 2-year ODI scores.
Collapse
Affiliation(s)
- Scott L Zuckerman
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
- 2The Och Spine Hospital at NewYork-Presbyterian, New York, New York
| | - Christopher S Lai
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Yong Shen
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Meghan Cerpa
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Nathan J Lee
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Mena G Kerolus
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Alex S Ha
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Ian A Buchanan
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Eric Leung
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Ronald A Lehman
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| | - Lawrence G Lenke
- 1Department of Orthopedic Surgery, Columbia University Medical Center; and
| |
Collapse
|
41
|
Zhang T, Shu S, Jing W, Gu Q, Liu Z, Sun X, Wang B, Qiu Y, Zhu Z, Bao H. Sacral Agenesis: A Neglected Deformity That Increases the Incidence of Postoperative Coronal Imbalance in Congenital Lumbosacral Deformities. Global Spine J 2022; 12:916-921. [PMID: 33203259 PMCID: PMC9344515 DOI: 10.1177/2192568220970509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To identify if there is a link between sacral agenesis (SA) and post-operative coronal imbalance in patients with congenital lumbosacral deformities. METHODS This study reviewed a consecutive series of patients with congenital lumbosacral deformities. They had a minimum follow-up of 2 years. According to different diagnosis, they were divided into SA and non-SA group. Comparison analysis was performed between patients with and without post-operative coronal imbalance and risk factors were identified. RESULTS A total of 45 patients (18 in SA group and 27 in non-SA group) were recruited into this study, among whom 33 patients maintained coronal balance while 12 demonstrated postoperative coronal imbalance at last follow-up (14.32 ± 7.67 mm vs 35.53 ± 3.91 mm, P < 0.001). Univariate analysis showed that preoperative lumbar Cobb angle, immediate postoperative coronal balance distance and diagnosis of SA were significantly different between patients with and without post-operative coronal imbalance (P < 0.05). Binary logistic regression analysis showed that SA was an independent risk factor for postoperative coronal imbalance. CONCLUSIONS As an independent risk factor for postoperative coronal imbalance, high level of suspicion of SA should be aware in children with congenital lumbosacral deformities. Sufficient bone grafts at sacroiliac joint are recommended for SA patients to prevent postoperative coronal imbalance.
Collapse
Affiliation(s)
- Tianyuan Zhang
- Department of Spine Surgery, Nanjing
Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shibin Shu
- Department of Spine Surgery, Nanjing
Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wenting Jing
- Department of Spine Surgery, Nanjing
Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qi Gu
- Department of Spine Surgery, Nanjing
Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing,
China
| | - Zhen Liu
- Department of Spine Surgery, Nanjing
Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xu Sun
- Department of Spine Surgery, Nanjing
Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bin Wang
- Department of Spine Surgery, Nanjing
Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, Nanjing
Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, Nanjing
Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongda Bao
- Department of Spine Surgery, Nanjing
Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China,Hongda Bao, Department of Spine Surgery,
Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing
210008, China.
| |
Collapse
|
42
|
Zuckerman SL, Cerpa M, Lai CS, Lenke LG. Coronal Alignment in Adult Spinal Deformity Surgery: Definitions, Measurements, Treatment Algorithms, and Impact on Clinical Outcomes. Clin Spine Surg 2022; 35:196-203. [PMID: 33843764 DOI: 10.1097/bsd.0000000000001175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
The major focus of realignment in adult spinal deformity (ASD) surgery has been on the sagittal plane, and less emphasis has been given to the coronal plane. In light of this overlooked area within ASD surgery, we aimed to refocus the narrative on coronal alignment in ASD surgery. The objectives of the current narrative review were to (1) define coronal alignment and discuss existing measurements; (2) report the incidence and prevalence of coronal malalignment (CM); (3) discuss the impact of CM on clinical outcomes; and (4) describe our preferred treatment algorithm of surgical correction of CM in ASD.
Collapse
Affiliation(s)
- Scott L Zuckerman
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY
| | | | | | | |
Collapse
|
43
|
Risk factors for coronal oblique take-off following adult spinal deformity surgery using lateral lumbar interbody fusion and open posterior corrective fusion. Spine Deform 2022; 10:647-656. [PMID: 34773630 DOI: 10.1007/s43390-021-00438-9] [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] [Received: 06/10/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate risk factors associated with oblique take-off (OT) following lateral lumbar interbody fusion (LLIF) for adult spinal deformity. METHODS Thirty-nine consecutive patients (mean age 67.9 years) with scoliosis of the lumbar curve (> 30°) were evaluated. Multilevel LLIF, followed by open thoraco-pelvic posterior corrective fusion after 1 week, was performed. We defined OT as a distance of > 25 mm between the C7 plumb line and the central sacral vertical line and examined risk factors by dividing the patients into the OT and non-OT groups. RESULTS OT occurred in 11 patients (28%), all showing a tilt to the convex side. The correction rate of the lumbar curve was approximately 70% range for both groups, which indicated good correction. Preoperative radiographs showed a high L1-central sacral vertical line in the standing position; high L5 tilt in the supine position; high L3, L4, and L5 tilts to the convex side in the supine-bending position; and a high L4 vertebral wedge on the convex side in OT cases. Multiple logistic regression analysis showed that an L4 tilt to the concave side in the bending position was the most effective predictor of OT (odds ratio = 1.104, P = 0.047). For a cutoff value of 16°, the sensitivity and specificity were 73% and 61%, respectively, according to the receiver operating characteristic curve analysis (area under the curve = 0.73). CONCLUSION OT occurred in 28% of adult scoliosis patients following LLIF. An L4 tilt > 16° to the concave side in the bending position was the most valuable risk factor. LEVEL OF EVIDENCE IV.
Collapse
|
44
|
Mundis GM, Walker CT, Smith JS, Buell TJ, Lafage R, Shaffrey CI, Eastlack RK, Okonkwo DO, Bess S, Lafage V, Uribe JS, Lenke LG, Ames CP. Kickstand rods and correction of coronal malalignment in patients with adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1197-1205. [PMID: 35292847 DOI: 10.1007/s00586-022-07161-7] [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: 09/22/2021] [Revised: 01/20/2022] [Accepted: 02/23/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Coronal malalignment (CM) is a challenging spinal deformity to treat. The kickstand rod (KR) technique is powerful for correcting truncal shift. This study tested the hypothesis that the KR technique provides superior coronal alignment correction in adult deformity compared with traditional rod techniques. METHODS A retrospective evaluation of a prospectively collected multicenter database was performed. A 2:1 matched cohort of non-KR accessory rod and KR patients was planned based on preoperative coronal balance distance (CBD) and a vector of global shift. Patients were subgrouped according to CM classification with a 30-mm CBD threshold defining CM, and comparisons of surgical and clinical outcomes among groups was performed. RESULTS Twenty-one patients with preoperative CM treated with a KR were matched to 36 controls. KR-treated patients had improved CBD compared with controls (18 vs. 35 mm, P < 0.01). The postoperative CBD did not result in clinical differences between groups in patient-reported outcomes (P ≥ 0.09). Eight (38%) of 21 KR patients and 12 (33%) of 36 control patients with preoperative CM had persistent postoperative CM (P = 0.72). CM class did not significantly affect the likelihood of treatment failure (postoperative CBD > 30 mm) in the KR cohort (P = 0.70), the control cohort (P = 0.35), or the overall population (P = 0.31). CONCLUSIONS Application of the KR technique to coronal spinal deformity in adults allows for successful treatment of CM. Compared to traditional rod techniques, the use of KRs did not improve clinical outcome measures 1 year after spinal deformity surgery but was associated with better postoperative coronal alignment.
Collapse
Affiliation(s)
- Gregory M Mundis
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Thomas J Buell
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
| | | | | | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine Center, Denver, CO, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University, The Spine Hospital, New York, NY, USA
| | - Christopher P Ames
- Department of Neurosurgery, University of California, San Francisco Medical Center, San Francisco, CA, USA
| |
Collapse
|
45
|
Mao S, Li S, Ma Y, Shi BL, Liu Z, Zhu ZZ, Qiao J, Qiu Y. How to rectify the convex coronal imbalance in patients with unstable dystrophic scoliosis secondary to type I neurofibromatosis: experience from a case series. BMC Musculoskelet Disord 2022; 23:368. [PMID: 35443648 PMCID: PMC9020035 DOI: 10.1186/s12891-022-05321-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There was a paucity of valid information on how to rectify the convex coronal imbalance effectively in dystrophic scoliosis secondary to Type I neurofibromatosis (DS-NF1), while postoperative inadvertent aggravation of CCI occurred regularly resulting in poor patient satisfaction. We aimed to identify the risk factors for persistent postoperative CCI in DS-NF1, and to optimize the coronal rebalancing strategies based on the lessons learned from this rare case series. METHODS NF1-related scoliosis database was reviewed and those with significant CCI (> 3 cm) were identified, sorted and the outcomes of surgical coronal rebalance were analyzed to identify the factors being responsible for failure of CCI correction. RESULTS CCI with dystrophic thoracolumbar/lumbar apex was prone to remain uncorrected (7 failure cases in 11) when compared to those with thoracic apex (0 failure cases in 4) (63.6% vs. 0.0%, p = 0.077). Further comparison between those with and without post-op CCI showed a higher correction of main curve Cobb angle (65.9 ± 9.1% vs. 51.5 ± 37.3%, p = 0.040), more tilted instrumentation (10.3 ± 3.6° vs. 3.2 ± 3.1°, p = 0.001) and reverse tilt and translation of upper instrumented vertebra (UIV) to convex side (8.0 ± 2.3° vs. -3.4 ± 5.9°, p < 0.001; 35.4 ± 6.9 mm vs. 12.3 ± 13.1 mm, p = 0.001) in the uncorrected imbalanced group. Multiple linear regression analysis revealed that △UIV translation (pre- to post-operation) (β = 0.832; p = 0.030) was significantly correlated with the correction of CBD. CONCLUSION Thoracolumbar/lumbar CCI in dystrophic scoliosis was prone to suffer high risk of persistent post-op CCI. Satisfying coronal rebalance should avoid UIV tilt and translation to the convex side, tilted morphology of instrumentation and over correction maneuvers for main curve, the upper hemi-curve region in particular.
Collapse
Affiliation(s)
- Saihu Mao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
| | - Song Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Yanyu Ma
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Ben-Long Shi
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Zhen Liu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Ze-Zhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Jun Qiao
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China
| |
Collapse
|
46
|
Safaee MM, Maloney PR, Deviren V, Ames CP. Kickstand Rod With Asymmetric Pedicle Subtraction Osteotomy for Treatment of Adult Kyphoscoliosis With Severe Coronal Imbalance. Oper Neurosurg (Hagerstown) 2022; 22:e245-e250. [PMID: 35383725 DOI: 10.1227/ons.0000000000000148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The kickstand rod has been described for the treatment of severe coronal imbalance. We present a modified description that combines an asymmetric pedicle subtraction osteotomy (PSO) for correction of severe kyphoscoliosis. OBJECTIVE To describe the use of a temporary kickstand rod. METHODS Type 1 osteotomies were performed across the main and fractional curves. An asymmetric PSO was performed at the apex of the main curve, and a kickstand rod placed on the concavity anchored from the ilium to a temporary connector above the main curve. Distraction was applied across the kickstand rod because the PSO was closed on the convexity. A permanent rod was placed contralateral to the kickstand, followed by replacement of the kickstand with a permanent rod and bilateral accessory rods. RESULTS A 66-year-old man presented with kyphoscoliosis causing severe coronal and sagittal imbalance. He underwent L4-S1 anterior lumbar interbody fusion followed by T4-pelvis instrumented fusion the following day. Type 1 osteotomies were performed from T6-T12 to L3-S1 and an asymmetric PSO at L2. A temporary kickstand rod was used to distract across the concavity because the PSO was closed on the convexity. The patient achieved excellent clinical and radiographical results. CONCLUSION When used in conjunction with appropriate osteotomies, the kickstand rod can aid in correction of severe coronal imbalance. Use of a temporary kickstand rod is technically easier and allows for correction of the main and fractional curves when used with an asymmetric PSO.
Collapse
Affiliation(s)
- Michael M Safaee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Patrick R Maloney
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
47
|
Zhang J, Yu Y, Gao S, Hai Y, Wu B, Su X, Wang Z. The classification of coronal deformity based on preoperative global coronal malalignment for adult spinal deformity is questionable. BMC Musculoskelet Disord 2022; 23:300. [PMID: 35351065 PMCID: PMC8962466 DOI: 10.1186/s12891-022-05246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 03/09/2022] [Indexed: 12/03/2022] Open
Abstract
Study design Retrospective case–control radiographic study. Objective To identify main effects of preoperative pattern and global coronal malalignment (GCM) on postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients and evaluate the rationality of the classification of coronal deformity based on preoperative GCM. Summary of background data A classification of coronal deformity based on preoperative GCM (20 mm set as the threshold of coronal imbalance) has been proposed recently, but whether it is practical is unclear. Methods One hundred twelve DLS patients treated with posterior instrumented fusion were reviewed. Coronal measurements included GCM and major Cobb angle. Based on relationship between C7 PL and major curve, preoperative patterns were classified into: Pattern 1(concave pattern), C7 PL shifted to the concave side of major curve; Pattern 2(convex pattern), C7 PL shifted to the convex side of major curve. Patients were separated into 4 groups (3 types): Type 0–1: GCM < 20 mm plus Pattern 1; Type 0–2: GCM < 20 mm plus Pattern 2; Type 1: GCM > 20 mm plus Pattern 1; Type 2: GCM > 20 mm plus Pattern 2. After comparison within patterns or among 4 groups, further factorial analysis was performed. Results Significant differences regarding postoperative GCM or coronal imbalance/balance ratio existed among 4 groups (F = 6.219, p = 0.001; x2 = 22.506, p < 0.001, respectively), despite no significant difference in intra-pattern 1(concave pattern) or intra-pattern 2(convex pattern) groups. Two-way analysis of variance showed preoperative pattern exhibited significant effect on postoperative GCM or imbalance/balance ratio (F(1,108) = 14.286, p < 0.001; F(1,108) = 30.514, p < 0.001, respectively) while neither preoperative GCM alone nor interaction of preoperative GCM with pattern did. Conclusion In DLS patients, it’s the preoperative pattern other than GCM that had main effects on postoperative coronal imbalance. Classification of coronal deformity based on preoperative GCM is questionable. Level of evidence 3
Collapse
|
48
|
Shi B, Liu D, Zhu Z, Wang Y, Li Y, Liu Z, Sun X, Qiu Y. Sequential correction technique in degenerative scoliosis with type C coronal imbalance: a comparison with traditional 2-rod technique. J Neurosurg Spine 2021:1-7. [PMID: 34952513 DOI: 10.3171/2021.10.spine21768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to compare the radiographic and clinical outcomes in patients with degenerative scoliosis (DS) with type C coronal imbalance who underwent either a sequential correction technique or a traditional 2-rod technique with a minimum of 2 years of follow-up. METHODS DS patients with type C coronal imbalance undergoing posterior correction surgery from February 2014 to January 2018 were divided into groups by technique: the sequential correction technique (SC group) and the traditional 2-rod technique (TT group). Radiographic parameters, including Cobb angle, coronal balance distance (CBD), global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope, were assessed pre- and postoperatively. The SF-36 questionnaire was used to assess quality of life. RESULTS A total of 34 patients were included. Significant postoperative improvement in the Cobb angle of the main curve, CBD, GK, TK, LL, SVA, and PT was found in both groups (p < 0.05). Postoperatively, the coronal balance was type A in 13 patients (92.9%) in the SC group and in 16 patients (80.0%) in the TT group (p = 0.298). In the TT group, 1 patient had deteriorative coronal imbalance immediately postoperatively, and coronal imbalance deteriorated from type A to type C in 2 patients during follow-up. The scores of Physical Functioning, Role-Physical, Bodily Pain, Vitality, Social Functioning, Role-Emotional, and Mental Health were statistically improved postoperatively (p < 0.05) in both groups. Type C coronal imbalance at the last follow-up was associated with a relatively worse quality of life. There were no implant failures during follow-up in the SC group, whereas rod fracture was observed in 3 patients in the TT group. CONCLUSIONS Compared with the traditional 2-rod technique, the sequential correction technique can simplify rod installation procedure, enhance internal instrumentation, and reduce risk of implant failures. The sequential correction technique could be routinely recommended for DS patients with type C coronal imbalance.
Collapse
|
49
|
Kieser DC, Boissiere L, Bourghli A, Hayashi K, Cawley D, Yilgor C, Alanay A, Acaroglu E, Kleinstueck F, Pizones J, Pellise F, Perez-Grueso FJS, Obeid I. Obeid-Coronal Malalignment Classification Is Age Related and Independently Associated to Personal Reported Outcome Measurement Scores in the Nonfused Spine. Neurospine 2021; 18:475-480. [PMID: 34610677 PMCID: PMC8497236 DOI: 10.14245/ns.2142458.229] [Citation(s) in RCA: 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: 05/08/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023] Open
Abstract
Objective To evaluate Obeid-coronal malalignment (O-CM) modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs), in the mobile spine.
Methods Retrospective review of a prospective multicenter adult spinal deformity (ASD) database with 1,243 (402 nonoperative, 841 operative) patients with no prior fusion surgery. Patients were included if they were aged over 18 years and were affected by spinal deformity defined by one of: Cobb angle ≥ 20°, pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°. Patients were classified according to the O-CM classification and compared to coronally aligned patients. Multivariate analysis was performed on the relationship between PROMs and age, global tilt (GT) and coronal malalignment (CM).
Results Four hundred forty-three patients had CM of more than 2 cm compared to 800 who did not. The distribution of these modifiers was correlated to age. After multivariate analysis, using age and GT as confounding factors, we found that before the age of 50 years, 2A1 patients had worse sex life and greater satisfaction than patients without CM. After 50 years of age, patients with CM (1A1, 1A2) had worse self-image and those with 2A2, 2B had worse self-image, satisfaction, and 36-item Short Form Health Survey physical function. Self-image was the consistent determinant of patients opting for surgery for all ages.
Conclusion CM distribution according to O-CM modifiers is age dependent. A clear correlation between the coronal malalignment and PROMs exists when using the O-CM classification and in the mobile spine, this typically affects self-image and satisfaction. Thus, CM classified according to O-CM modifiers is correlated to PROMs and should be considered in ASD.
Collapse
Affiliation(s)
- David Christopher Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Louis Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Kazunori Hayashi
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Derek Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Caglar Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Emre Acaroglu
- Spine Surgery Unit, Ankara Acibadem ARTES Spine Center, Ankara, Turkey
| | | | | | - Ferran Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | | |
Collapse
|
50
|
Zuckerman SL, Lai CS, Shen Y, Kerolus MG, Ha AS, Buchanan IA, Lee NJ, Leung E, Cerpa M, Lehman RA, Lenke LG. Be Prepared: Preoperative Coronal Malalignment Often Leads to More Extensive Surgery Than Sagittal Malalignment During Adult Spinal Deformity Surgery. Neurospine 2021; 18:570-579. [PMID: 34610688 PMCID: PMC8497231 DOI: 10.14245/ns.2142384.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the effect of coronal alignment on: (1) surgical invasiveness and operative complexity and (2) postoperative complications.
Methods A retrospective, cohort study of adult spinal deformity patients was conducted. Alignment groups were: (1) neutral alignment (NA): coronal vertical axis (CVA) ≤ 3 cm and sagittal vertical axis (SVA) ≤ 5 cm; (2) coronal malalignment (CM) only: CVA > 3 cm; (3) Sagittal malalignment (SM) only: SVA > 5 cm; and (4) coronal and sagittal malalignment (CCSM): CVA > 3 cm and SVA > 5 cm.
Results Of 243 patients, alignment groups were: NA 115 (47.3%), CM 48 (19.8%), SM 38 (15.6%), and CCSM 42 (17.3%). Total instrumented levels (TILs) were highest in CM (14.5±3.7) and CCSM groups (14±4.0) (p<0.001). More 3-column osteotomies (3COs) were performed in SM (21.1%) and CCSM (28.9%) groups than CM (10.4%) (p=0.003). CM patients had more levels instrumented (p=0.029), posterior column osteotomies (PCOs) (p<0.001), and TLIFs (p=0.002) than SM patients. CCSM patients had more TLIFs (p=0.012) and higher estimated blood loss (EBL) (p=0.003) than SM patients. CVA displayed a stronger relationship with TIL (p=0.002), EBL (p<0.001), and operative time (p<0.001) than SVA, which had only one significant association with EBL (p=0.010). Both SM/CCSM patients had higher readmissions (p=0.003) and reoperations (p<0.001) than CM patients.
Conclusion Amount of preoperative CM was a better predictor of surgical invasiveness than the amount of SM, despite 3COs more commonly performed in SM patients. CM patients had more instrumented levels, PCOs, and TLIFs than SM patients.
Collapse
Affiliation(s)
- Scott L Zuckerman
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Christopher S Lai
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Yong Shen
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Mena G Kerolus
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Alex S Ha
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Ian A Buchanan
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Nathan J Lee
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Eric Leung
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Meghan Cerpa
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Ronald A Lehman
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY, USA
| |
Collapse
|