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Homer CJ, Haselhuhn JJ, Ellingson AM, Bechtold JE, Polly DW. Development of a sacral fracture model to demonstrate effects on sagittal alignment. Spine Deform 2023; 11:1325-1333. [PMID: 37382877 DOI: 10.1007/s43390-023-00721-x] [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: 02/21/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To develop a modeling framework to predict the secondary consequences on spinal alignment following correction and to demonstrate the impact of pedicle subtraction osteotomy (PSO) location on sagittal alignment. METHODS Six patients were included, and pelvic incidence (PI) was measured. Full-length standing radiographs were uploaded into PowerPoint and manipulated to model S1-S2 joint line sacral fractures at 15°, 20°, 25°, and 30°. PSO corrections with hinge points at the anterior superior corner and vertical midpoint of the L3-5 vertebral bodies were modeled. Anterior translation (AT) and vertical shortening (VS) were calculated for the six PSO locations in the four fracture angle (FA) models. RESULTS PI had a strong effect in the mixed AT and VS models (P < 0.001). Both AT and VS were significantly different from zero at all FA (p < 0.001), and pairwise comparisons revealed all FA were different from each other with respect to both AT and VS after adjusting for PSO location (p < 0.001), increasing as FA increased. Varying PSO location resulted in significant differences in AT when comparing all locations (p < 0.001). AT was greatest for all FA in all patients when the PSO correction was performed at the L3-AS (p < 0.001). There were significant differences in VS when comparing the L5-Mid PSO location to the L3-AS, L3-Mid, L4-AS, and L4-Mid PSO locations (p < 0.034). CONCLUSION PSO correction superior to a sacral fracture resulted in AT and VS of the spine. It is crucial that these changes in spinal measures be predicted and accounted for to optimize patient sagittal alignment and outcomes.
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Affiliation(s)
- Cole J Homer
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
| | - Jason J Haselhuhn
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
| | - Arin M Ellingson
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
- The Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joan E Bechtold
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA
- The Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - David W Polly
- The Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA.
- The Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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The Reliability of Computer-Assisted Three-Dimensional Surgical Simulation of Posterior Osteotomies in Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis Patients. Mediators Inflamm 2022; 2022:8134242. [PMID: 36072573 PMCID: PMC9444461 DOI: 10.1155/2022/8134242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives. The study was aimed at investigating the reliability of computer-assisted three-dimensional surgical simulation (CA3DSS) of posterior osteotomies in thoracolumbar kyphosis secondary to ankylosing spondylitis (TLKAS) patients. Methods. Eligible TLKAS patients who underwent posterior correction surgery with posterior osteotomies were consecutively included. Simulated posterior osteotomies were performed in Mimics and 3-Matic Medical software. Coronal and sagittal angle and alignment parameters were measured in preoperative full-length X-ray, preoperative original 3D spine (Pre-OS), simulated 3D spine (SS), and postoperative original 3D spine (Post-OS). Reliability was tested by both intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Results. A total of 30 TLKAS patients were included. Excellent consistency of radiological parameters was shown between preoperative X-ray and Pre-OS model. In SS and Post-OS models, excellent reliabilities were shown in global kyphosis (ICC 0.832, 95% CI 0.677-0.916), thoracic kyphosis (ICC 0.773, 95% CI 0.577-0.885), and lumbar lordosis (ICC 0.896, 95% CI 0.794-0.949) and good reliabilities were exhibited in the main curve (ICC 0.680, 95% CI 0.428-0.834) and sagittal vertical axis (ICC 0.619, 95% CI 0.338-0.798). ICCs of correction angle achieved by pedicle subtraction osteotomy (PSO) was 0.754 (95% CI 0.487-0.892), and that of posterior column osteotomies (PCO) was 0.703 (95% CI 0.511-0.829). Bland-Altman analysis also showed good agreement for both Cobb angle and distance measurements in Pre-OS and SS models, and good reliabilities were shown in PCO and PSO in real spine and SS models. Conclusions. CA3DSS can provide an accurate measurement, and it is a reliable and effective method to conduct proper simulation for correction surgery with posterior osteotomies in TLKAS patients. This trial is registered with Chinese Clinical Trial Registry ChiCTR2100053808.
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Luo J, Yang K, Yang Z, Chen J, Huang Z, Luo Z, Tao H, Duan C, Wu T. Preoperative prediction of sagittal imbalance in kyphosis secondary to ankylosing spondylitis after one-level three-column osteotomy. BMC Musculoskelet Disord 2022; 23:790. [PMID: 35982428 PMCID: PMC9386921 DOI: 10.1186/s12891-022-05740-9] [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: 02/03/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to determine preoperative predictors for sagittal imbalance in kyphosis secondary to ankylosing spondylitis (AS) after one-level three-column osteotomy. Methods A total of 55 patients with AS who underwent one-level three-column osteotomy were enrolled. The patients were divided into two groups according to sagittal vertical axis (SVA) value at the final follow-up (group A: SVA > 5 cm; group B: SVA ≤ 5 cm). The radiographic measures included global kyphosis, lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), sacral slope, T1 pelvic angle (TPA), SVA, osteotomized vertebral angle and PI and LL mismatch (PI − LL). Postoperative clinical outcomes were evaluated using Scoliosis Research Society-22 questionnaire (SRS-22) and Oswestry Disability Index (ODI). Results Fifty-five AS patients had an average follow-up of 30.6 ± 10.2 months (range 24–84 months). Group A had larger preoperative and postoperative LL, PT, PI − LL, TPA and SVA values compared with group B (P < 0.05), and no significant differences were found in ODI and SRS-22 scores between the two groups (P > 0.05). Preoperative LL, PT, PI − LL, TPA, and SVA values were positively correlated with the follow-up SVA value (P < 0.05). Among them, TPA > 40.9°, PI − LL > 32.5° and SVA > 13.7 cm were the top three predictors with the best accuracy to predict sagittal imbalance. Immediate postoperative SVA value of ≤ 7.4 cm was a key factor in reducing the risk of sagittal imbalance during follow-up. Conclusions Preoperative TPA > 40.9°, PI − LL > 32.5° and SVA > 13.7 cm could predict sagittal imbalance in AS kyphosis after one-level three-column osteotomy, and additional osteotomies were recommended for this condition. Immediate postoperative SVA ≤ 7.4 cm was an optimal indicator for preventing sagittal imbalance. Level of evidence IV.
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Affiliation(s)
- Jianzhou Luo
- Shenzhen University Health Science Center, Shenzhen, Guangdong, 518000, People's Republic of China.,Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, 518000, People's Republic of China
| | - Kai Yang
- Department of Orthopedics, Xi'an Red Cross Hospital, Xi'an, Shaanxi, 710000, People's Republic of China
| | - Zili Yang
- Shenzhen University Health Science Center, Shenzhen, Guangdong, 518000, People's Republic of China.,Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, 518000, People's Republic of China
| | - Jiayi Chen
- Department of Neurology, the Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Zhengji Huang
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, 518000, People's Republic of China
| | - Zhenjuan Luo
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, 518000, People's Republic of China
| | - Huiren Tao
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, 518000, People's Republic of China
| | - Chunguang Duan
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, 518000, People's Republic of China
| | - Tailin Wu
- Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, 518000, People's Republic of China.
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Zhao SZ, Qian BP, Huang JC, Qiao M, Wang B, Qiu Y. Failure patterns and related risk factors of sagittal reconstruction following pedicle subtraction osteotomy in patients with ankylosing spondylitis and thoracolumbar kyphosis. Neurosurg Focus 2021; 51:E7. [PMID: 34598148 DOI: 10.3171/2021.7.focus21146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the specific patterns and risk factors of sagittal reconstruction failure in ankylosing spondylitis (AS)-related thoracolumbar kyphosis after pedicle subtraction osteotomy (PSO). METHODS A retrospective study was performed in patients with AS and thoracolumbar kyphosis after lumbar PSO with a minimum follow-up of 2 years. Patients were classified as having successful realignment (group A), inadequate correction immediately postoperatively (group B), and sagittal decompensation during follow-up (group C) according to the immediately postoperative and latest follow-up sagittal vertical axis (SVA). Radiographic parameters and clinical outcomes were collected. Pelvic tilt (PT) was used to assess the magnitude of pelvic backward rotation. Hip structural damage and ossification of the anterior longitudinal ligament (ALL) at the proximal junction, PSO level, and distal junction were also evaluated on radiographs. RESULTS Overall, 109 patients with a mean age of 35.3 years were included. Patients in both group B (n = 16) and group C (n = 13) were older than those in group A (n = 80) (mean ages 43.6 vs 32.9 years, p < 0.011; and 39.2 vs 32.9 years, p = 0.018; respectively). Age (OR 1.102, p = 0.011), and preoperative PT (OR 1.171, p = 0.041) and SVA (OR 1.041, p = 0.016) were identified as independent risk factors of inadequate correction. Additionally, a higher distribution of patients with adequate ALL ossification at the PSO level was found in group B than in group A (37.5% vs 22.5%, p = 0.003). Age (OR 1.101, p = 0.011) and preoperative SVA (OR 1.013, p = 0.020) were identified as independent risk factors of sagittal decompensation. Furthermore, compared with group A, group C showed a higher distribution of patients with severe hip structural damage (15.4% vs 0, p = 0.018) and higher incidences of rod fracture (RF) (38.5% vs 8.8%, p = 0.011) and pseudarthrosis (15.4% vs 0, p = 0.018). Additionally, the incidence of RF (19.6% vs 6.9%, p = 0.045) and changes in the proximal junctional angle (0.5° vs 2.2°, p = 0.027) and the distal junctional angle (0.3° vs 2.2°, p = 0.019) were lower during follow-up in patients with adequate ALL ossification than in those without adequate ossification. CONCLUSIONS Sagittal reconstruction failure in patients with AS could be attributed to inadequate correction immediately after surgery (14.7%) and sagittal decompensation during follow-up (11.9%). Adequate ALL ossification was a risk factor of inadequate correction. However, adequate ALL ossification could decrease the development of RF and relieve the junctional kyphotic change during follow-up. Older age and greater baseline SVA were independent risk factors for both inadequate correction and sagittal decompensation.
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Affiliation(s)
- Shi-Zhou Zhao
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing; and.,2Medical School of Nanjing University, Nanjing, China
| | - Bang-Ping Qian
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing; and
| | - Ji-Chen Huang
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing; and.,2Medical School of Nanjing University, Nanjing, China
| | - Mu Qiao
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing; and
| | - Bin Wang
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing; and
| | - Yong Qiu
- 1Spine Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing; and
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