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Solla F, Ilharreborde B, Blondel B, Prost S, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Lamas V, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Kerckhove MV, Lebhar J, Giorgi H, Faure A, Sauleau EA, Pesenti S, Charles YP. Can Lumbopelvic Parameters Be Used to Predict Thoracic Kyphosis at all Ages? A National Cross-Sectional Study. Global Spine J 2024; 14:1116-1124. [PMID: 36282728 DOI: 10.1177/21925682221134039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN National cross-sectional study. OBJECTIVE Thoracic kyphosis (TK) is related to sagittal parameters as pelvic tilt (PT), lumbar lordosis (LL) and pelvic incidence (PI). The equation TK = 2 (PT+LL-PI) was validated for adolescents. The purpose of this study was to investigate if this equation correctly predicts TK regardless of age. METHODS Sagittal alignment parameters were assessed on full spine radiographs of 2599 individuals without spine pathology (1488 females, 1111 males). Calculated TK (CTK) = 2 (PT+LL-PI) and measured TK (MTK) were compared by calculating the gap and using a linear regression between both parameters. Subgroup analyses were performed for gender, age, TK groups (≤20°, 21°-40°, 41°-60°, >60°), and PI groups (<45°, 45°-60°, >60°). RESULTS Average values in the total population were: MTK 45.0°, CTK 36.9°. Average TK gap was 8.1°, 5.2° in females (intercept 11.7, slope .61) and 11.9° in males (intercept 7.1, slope .58). The mean gap was 3.6° for 15-34 years, 5.7° under 15 years and it increased progressively after 35 years with a maximum of 19.9° over 80 years. The gap also increased with the amount of MTK: -3.5° for TK<20° up to 17.3° for TK >60°. Differences in gaps were minor between PI groups. The intercept was smallest and slopes >.6 for PI <45° and TK ≤20°. CONCLUSION The formula TK=2 (PT+LL-PI) yielded moderate accuracy for adolescents and young adults, but did not fit for over 35 years and under 15. The amount and variance in TK increased in elderly subjects, which made the formula less accurate.
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Affiliation(s)
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Île-de-France, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Vincent Lamas
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Unité du Rachis, Centre Orthopédique Santy, Hôpital privé Jean Mermoz Ramsay Santé, Lyon, France
| | - Michiel Vande Kerckhove
- Unité du Rachis, Centre Orthopédique Santy, Hôpital privé Jean Mermoz Ramsay Santé, Lyon, France
| | - Jonathan Lebhar
- Institut Locomoteur de l'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, France
| | | | | | - Erik A Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, France
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
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Gomez-Rice A, Capdevila-Bayo M, Núñez-Pereira S, Haddad S, Pérez-Grueso F, Kleinstück F, Obeid I, Alanay A, Pellise F, Pizones J. Influence of smoking on patient-reported outcome measures (PROMs) in patients undergoing surgery for adult spinal deformity: a propensity score-matched analysis. Spine Deform 2024; 12:819-827. [PMID: 38329602 DOI: 10.1007/s43390-024-00821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/31/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE The purpose of this study was to determine the isolated influence of smoking in patient-reported outcome measures (PROMs) for adult spinal deformity (ASD) surgery excluding known tobacco-related complications. METHODS Retrospective analysis of a prospective multicenter ASD database. Patients operated on ASD with 2 year post-operative follow-up were included. Former smokers (non-active smokers) and patients developing mechanical or infectious complications were excluded. Changes of PROMs over time were analyzed using mixed models for repeated measures (MMRM). Propensity score matching (PSM) (1:1 ratio, caliper 0.10) was performed without replacement using optimum algorithm, tolerance ≤ 0.001, and estimated with 95% confidence interval (CI). PROMS in both groups were compared by paired t test or Wilcoxon signed-rank test. RESULTS 692 out of 1246 surgical patients met our inclusion criteria. 153 smokers were matched with 153 non-smokers according to age, BMI, number of fused levels, and global tilt. After PSM both groups were homogeneous regarding baseline parameters, surgical data, and complications (mechanical complications and infection excluded). Smokers had worse baseline results for SRS-total, SRS-pain COMI-back, and ODI; smokers also showed worse 2-year outcomes for SRS-total, SRS-function, SRS-pain, SRS-self-image, and ODI. However, no differences between the two groups were found in the improvement from baseline to 2-year follow-up or in the timing of this improvement (MMRM). The proportion of patients reaching the minimal clinically important difference (MCID) after surgery was similar in the two groups, but the proportion of patients reaching patient acceptable symptom state (PASS) was significantly lower in smokers for SRS-Subtotal, SRS-function, and SRS-image. CONCLUSION Even in the absence of smoking-related complications, smokers had worse PROMs at baseline and 2 years after surgery with less patients achieving PASS, but similar degrees on improvement compared to non-smokers. The proportion achieving MCID was also similar between the two cohorts.
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Affiliation(s)
- Alejandro Gomez-Rice
- Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo Km 9, 100, 28034, Madrid, Spain.
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Pellisé F, Bayo MC, Ruiz de Villa A, Núñez-Pereira S, Haddad S, Barcheni M, Pizones J, Valencia MR, Obeid I, Alanay A, Kleinstueck FS, Mannion AF. The Impact of Unplanned Reoperation Following Adult Spinal Deformity Surgery: A Prospective Longitudinal Cohort Study with 5-Year Follow-up. J Bone Joint Surg Am 2024; 106:681-689. [PMID: 38630053 DOI: 10.2106/jbjs.23.00242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND The long-term impact of reoperations following adult spinal deformity (ASD) surgery is still poorly understood. Our aim was to identify the relationship between unplanned reoperation and health-related quality of life (HRQoL) gain at 2 and 5 years of follow-up. METHODS We included patients enrolled in a prospective ASD database who underwent surgery ≥5 years prior to the start of the study and who had 2 years of follow-up data. Adverse events (AEs) leading to an unplanned reoperation, the time of reoperation occurrence, invasiveness (blood loss, surgical time, hospital stay), and AE resolution were assessed. HRQoL was measured with use of the Oswestry Disability Index, Scoliosis Research Society-22, and Short Form-36. Linear models controlling for baseline data and index surgery characteristics were utilized to assess the relationships between HRQoL gain at 2 and 5-year follow-up and the number and invasiveness of reoperations. The association between 5-year HRQoL gain and the time of occurrence of the unplanned reoperation and that between 5-year HRQoL gain and AE resolution were also investigated. RESULTS Of 361 eligible patients, 316 (87.5%) with 2-year follow-up data met the inclusion criteria and 258 (71.5%) had 5-year follow-up data. At the 2-year follow-up, 96 patients (30.4%) had a total of 165 unplanned reoperations (1.72 per patient). At the 5-year follow-up, 73 patients (28.3%) had a total of 117 unplanned reoperations (1.60 per patient). The most common cause of reoperations was mechanical complications (64.9%), followed by surgical site infections (15.7%). At the 5-year follow-up, the AE that led to reoperation was resolved in 67 patients (91.8%). Reoperation invasiveness was not associated with 5-year HRQoL scores. The number of reoperations was associated with lesser HRQoL gain at 5 years for all HRQoL measures. The mean associated reduction in HRQoL gain per unplanned reoperation was 41% (range, 19% to 66%). Reoperations resulting in no resolution of the AE or resolution with sequelae had a greater impact on 5-year follow-up HRQoL scores than reoperations resulting in resolution of the AE. CONCLUSIONS A postoperative, unplanned reoperation following ASD surgery was associated with lesser gain in HRQoL at 5 years of follow-up. The association did not diminish over time and was affected by the number, but not the magnitude, of reoperations. Resolution of the associated AE reduced the impact of the unplanned reoperation. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ferran Pellisé
- Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Sleiman Haddad
- Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maggie Barcheni
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
| | | | | | | | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Anne F Mannion
- Spine Center Division, Schulthess Klinik, Zurich, Switzerland
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Pizones J, Hills J, Kelly M, Yilgor C, Moreno-Manzanaro L, Perez-Grueso FJS, Kleinstück F, Obeid I, Alanay A, Pellisé F. Which sagittal plane assessment method is most predictive of complications after adult spinal deformity surgery? Spine Deform 2024:10.1007/s43390-024-00864-5. [PMID: 38607513 DOI: 10.1007/s43390-024-00864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Different methods of sagittal alignment assessment compete for predicting adverse events after adult spinal deformity (ASD) surgery. We wanted to study which method provides greater benefit. METHODS Retrospective study of 391 patients operated for ASD, with > 6 instrumented levels, fused to the pelvis, and 2 years of follow-up. Three alignment methods were analyzed 6-week postoperatively: (1) Roussouly mismatch; (2) GAP score/GAP categories; (3) T4-L1-Hip axis. Binary logistic regression generated models that best predict the following adverse events: mechanical complications (MC): in general and isolated (PJK, PJF, rod breakage); reinterventions (in general and after MC); and readmissions. ROC/AUC analysis was also implemented. In a second regression round, we added different variables that were selected on univariate analysis-demographic, surgical, and radiographic-to complete the models. RESULTS The best predictor parameters in most models were T4-L1PA mismatch and GAP score; we could not prove a predictive ability of the Roussouly mismatch. The T4-L1PA mismatch best predicted general MC, PJK, PJK + PJF, and readmission, while the GAP score best predicted PJF and reinterventions (for MC and for any complication). However, the variance explained by these models was limited (Nagelkerke's R2 = 0.031-0.113), with odds ratios ranging from 1.070 to 1.456. ROC curves plotted an AUC between 0.57 and 0.70. Introducing additional variables (demographic, surgical, and radiographic) improved prediction in all the models (Nagelkerke's R2 = 0.082-0.329) and allowed predicting rod breakage. CONCLUSION The T4-L1-Hip axis and GAP score show potential in predicting adverse events, surpassing the Roussouly method. Despite partial efficacy in complication anticipation, recognizing postoperative sagittal alignment as a key modifiable risk factor, the crucial need arises to integrate diverse variables, both modifiable and non-modifiable, for enhanced predictive accuracy. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | | | - Michael Kelly
- Rady Children Hospital San Diego, University of California, San Diego, CA, USA
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Raganato R, Gómez-Rice A, Moreno-Manzanaro L, Escámez F, Talavera G, Aguilar A, Sánchez-Márquez JM, Fernández-Baíllo N, Perez-Grueso FJS, Kleinstück F, Alanay A, Obeid I, Pellisé F, Pizones J. What factors are associated with a better restoration of pelvic version after adult spinal deformity surgery? Spine Deform 2024:10.1007/s43390-024-00863-6. [PMID: 38589595 DOI: 10.1007/s43390-024-00863-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Poor restoration of pelvic version after adult spinal deformity (ASD) surgery is associated with an increased risk of mechanical complications and worse quality of life. We studied the factors linked to the improvement of postoperative pelvic version. MATERIALS AND METHODS This is a retrospective analysis of a prospective multicenter ASD database. Selection criteria were: operated patients having preoperative severe pelvic retroversion as per GAP score (Relative Pelvic Version-RPV < - 15°); panlumbar fusions to the pelvis; 2-year follow-up. Group A comprised patients with any postoperative improvement of RPV score, and group B had no improvement. Groups were compared regarding baseline characteristics, surgical factors, and postoperative sagittal parameters. Parametric and non-parametric analyses were employed. RESULTS 177 patients were studied, median age 67 years (61; 72.5), 83.6% female. Groups were homogeneous in baseline demographics, comorbidities, and preoperative sagittal parameters (p > 0.05). The difference in RPV improvement was 11.56º. Group A (137 patients) underwent a higher percentage of ALIF procedures (OR = 6.66; p = 0.049), and posterior osteotomies (OR = 4.96; p < 0.001) especially tricolumnar (OR = 2.31; p = 0.041). It also showed a lower percentage of TLIF procedures (OR = 0.45; p = 0.028), and posterior decompression (OR = 0.44; p = 0.024). Group A displayed better postoperative L4-S1 angle and relative lumbar lordosis (RLL), leading to improved sacral slope (and RPV), and global alignment (RSA). Group A patients had longer instrumentations (11.45 vs 10; p = 0.047) and hospitalization time (13 vs 11; p = 0.045). All postoperative sagittal parameters remained significantly better in group A through follow-up. However, differences between the groups narrowed over time. CONCLUSIONS ALIF procedures and posterior column osteotomies improved pelvic version postoperatively, and associated better L4-S1 and lumbar lordosis restoration, indirectly improving all other sagittal parameters. However, these improvements seemed to fade during the 2-year follow-up.
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Affiliation(s)
- Riccardo Raganato
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Alejandro Gómez-Rice
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Fernando Escámez
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Gloria Talavera
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Antonio Aguilar
- Department of Orthopedic Surgery, Hospital Virgen de las Nieves, Granada, Spain
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - José Miguel Sánchez-Márquez
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Nicomedes Fernández-Baíllo
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Francisco Javier Sánchez Perez-Grueso
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain.
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Pizones J, Moreno-Manzanaro L, Pupak A, Núñez-Pereira S, Larrieu D, Boissiere L, Richner-Wunderlin S, Loibl M, Zulemyan T, Yücekul A, Zgheib S, Charles YP, Chang DG, Kleinstueck F, Obeid I, Alanay A, Sánchez Pérez-Grueso FJ, Pellisé F. Reliability of a New Digital Tool for Photographic Analysis in Quantifying Body Asymmetry in Scoliosis. J Clin Med 2024; 13:2114. [PMID: 38610880 PMCID: PMC11012662 DOI: 10.3390/jcm13072114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Advancements in non-ionizing methods for quantifying spinal deformities are crucial for assessing and monitoring scoliosis. In this study, we analyzed the observer variability of a newly developed digital tool for quantifying body asymmetry from clinical photographs. Methods: Prospective observational multicenter study. Initially, a digital tool was developed using image analysis software, calculating quantitative measures of body asymmetry. This tool was integrated into an online platform that exports data to a database. The tool calculated 10 parameters, including angles (shoulder height, axilla height, waist height, right and left waistline angles, and their difference) and surfaces of the left and right hemitrunks (shoulders, waists, pelvises, and total). Subsequently, an online training course on the tool was conducted for twelve observers not involved in its development (six research coordinators and six spine surgeons). Finally, 15 standardized back photographs of adolescent idiopathic scoliosis patients were selected from a multicenter image bank, representing various clinical scenarios (different age, gender, curve type, BMI, and pre- and postoperative images). The 12 observers measured the photographs at two different times with a three-week interval. For the second round, the images were randomly mixed. Inter- and intra-observer variabilities of the measurements were analyzed using intraclass correlation coefficients (ICCs), and reliability was measured by the standard error of measurement (SEM). Group comparisons were made using Student's t-test. Results: The mean inter-observer ICC for the ten measurements was 0.981, the mean intra-observer ICC was 0.937, and SEM was 0.3-1.3°. The parameter with the strongest inter- and intra-observer validity was the difference in waistline angles 0.994 and 0.974, respectively, while the highest variability was found with the waist height angle 0.963 and 0.845, respectively. No test-retest differences (p > 0.05) were observed between researchers (0.948 ± 0.04) and surgeons (0.925 ± 0.05). Conclusion: We developed a new digital tool integrated into an online platform demonstrating excellent reliability and inter- and intra-observer variabilities for quantifying body asymmetry in scoliosis patients from a simple clinical photograph. The method could be used for assessing and monitoring scoliosis and body asymmetry without radiation.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.M.-M.); (F.J.S.P.-G.)
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.M.-M.); (F.J.S.P.-G.)
| | - Anika Pupak
- Spine Research Unit, Vall d’Hebron Institute of Research, 08035 Barcelona, Spain;
| | - Susana Núñez-Pereira
- Spine Surgery Unit, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain (F.P.)
| | - Daniel Larrieu
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | - Louis Boissiere
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | | | - Markus Loibl
- Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland (M.L.); (F.K.)
| | - Tais Zulemyan
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | - Altug Yücekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | - Sara Zgheib
- Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France; (S.Z.); (Y.P.C.)
| | - Yann Philippe Charles
- Spine Surgery Unit, University Hospital Strasbourg, 67000 Strasbourg, France; (S.Z.); (Y.P.C.)
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 01757 Seoul, Republic of Korea;
| | - Frank Kleinstueck
- Department of Orthopedics, Schulthess Klinik, 8008 Zurich, Switzerland (M.L.); (F.K.)
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, 33076 Bordeaux, France; (D.L.); (I.O.)
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, 34752 Istanbul, Turkey; (T.Z.); (A.Y.); (A.A.)
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain (F.P.)
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Baroncini A, Boissiere L, Yilgor C, Larrieu D, Alanay A, Pellisé F, Kleinstueck F, Pizones J, Charles YP, Roscop C, Bourghli A, Obeid I. Primary Pelvic Anteversion: Definition, Relevance And History After Surgery for Adult Spine Deformity. Spine (Phila Pa 1976) 2024:00007632-990000000-00604. [PMID: 38407226 DOI: 10.1097/brs.0000000000004971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVE To identify the best definition of primary anteverted pelvis in the setting of adult spine deformity (ASD), and to investigate whether this is a pathologic setting that requires surgical correction. SUMMARY OF BACKGROUND DATA While pelvic retroversion has been thoroughly investigated, pelvic anteversion (AP) is a far lesser discussed topic. Four different AP definitions have been proposed, and AP has been described as a normal or pathologic entity by different authors. METHODS All patients consulting for ASD at the five participating sites were included. Firstly, the four definitions of AP were compared with descriptive statistics (anatomic method - Pelvic Tilt <0°; Relative Pelvic Version method - RPV >5°; Roussouly method - Pelvic Incidence (PI)<50° and Sacral Slope (SS)>35°); low PT method - PT/PI <25th percentile). Secondly a subgroup analysis among operated AP patients with a two-year follow-up was performed. Complication rate, radiographic parameters and clinical scores (ODI, SF-36) were compared in a multivariate analysis between patients who did and did not maintain an AP at the 2-year follow-up. RESULTS 1163 patients were available for the first analysis. The RPV method appeared to be the most appropriate to define AP in ASD patient. For the second analysis, data on 410 subjects were available, and most of them were young adults with idiopathic scoliosis that did not require pelvic fixation. AP patients who maintained an AP after ASD surgery presented comparable radiographic and clinical outcomes to the patients who presented a normo/retroverted pelvis after surgery. CONCLUSIONS According to the results of the presented study, the RPV method is the most appropriate to define primary AP, which is not a pathologic condition and is most often observed in young adults with idiopathic scoliosis. Anteverted pelvis does not require direct surgical correction in this patient group.
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Affiliation(s)
- Alice Baroncini
- Department of Orthopaedics and Trauma Surgery, RWTH Uniklinik Aachen, Germany
| | - Louis Boissiere
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Bruges Cedex, France
| | - Caglar Yilgor
- Spine Center, Acibadem University School of Medicine, Istanbul, Turkey
| | - Daniel Larrieu
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Ahmet Alanay
- Spine Center, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | | | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | - Cecile Roscop
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
| | - Anouar Bourghli
- Spine surgery department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Bordeaux, France
- ELSAN, Polyclinique Jean Villar, Bruges Cedex, France
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Pan C, Anouar B, Yang Y, Li L, Kuang L, Wang B, Lv G, Obeid I. Relationships between lumbar lordosis correction and the change in global tilt (GT) in adult spinal deformity. Eur Spine J 2024; 33:610-619. [PMID: 38104044 DOI: 10.1007/s00586-023-08066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 07/24/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE This study aimed to explore the relationships between lumbar lordosis (LL) correction and improvement of postoperative global sagittal alignment and to establish corresponding linear regressions to predict the change in global tilt (GT) based on the corrected LL following adult spinal deformity (ASD) surgery. METHODS A total of 240 ASD patients who underwent lumbar correction were enrolled in this multicentre study. The following sagittal parameters were measured pre- and postoperatively: thoracic kyphosis (TK), LL, upper and lower LL (ULL and LLL), pelvic tilt (PT), sagittal vertical axis (SVA) and GT. The correlations among the changes in GT (△GT), SVA (△SVA), PT (△PT), TK (△TK), LL (△LL), ULL (△ULL) and LLL (△LLL) were assessed, and linear regressions were conducted to predict △GT, △SVA, △PT and △TK from △LL, △ULL and △LLL. RESULTS △LL was statistically correlated with △GT (r = 0.798, P < 0.001), △SVA (r = 0.678, P < 0.001), △PT (r = 0.662, P < 0.001) and △TK (r = - 0.545, P < 0.001), and the outcomes of the linear regressions are: △GT = 3.18 + 0.69 × △LL (R2 = 0.636), △SVA = 4.78 + 2.57 × △LL (R2 = 0.459), △PT = 2.57 + 0.34 × △LL (R2 = 0.439), △TK = 7.06-0.43 × △LL (R2 = 0.297). In addition, △LLL had more correlations with △GT, △SVA and △PT, while △ULL had more correlations with △TK. CONCLUSION Surgical correction of LL could contribute to the restoration of global sagittal morphology following ASD surgery. These models were established to predict the changes in sagittal parameters, in particular △GT, determined by △LL, which has not been previously done and may help to customize a more precise correction plan for ASD patients.
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Affiliation(s)
- Changyu Pan
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Bourghli Anouar
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yue Yang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Lei Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Lei Kuang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Guohua Lv
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France.
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Pan C, Bourghli A, Larrieu D, Boissiere L, Pizones J, Alanay A, PelIise F, Kleinstück F, Obeid I. Sagittal alignment of diverse mechanical complications following adult spinal deformity surgery. Eur Spine J 2024:10.1007/s00586-023-08126-0. [PMID: 38270602 DOI: 10.1007/s00586-023-08126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE To compare the sagittal alignment of patients with diverse mechanical complications (MCs) following adult spinal deformity (ASD) surgery with that of patients without MCs. METHODS A total of 371 patients who underwent ASD surgery were enrolled. The sagittal spinopelvic parameters were measured preoperatively and at the 6-month and last follow-up, and the global alignment and proportion (GAP) score was calculated. The subjects were divided into non-MC and MCs groups, and the MCs group was further divided into rod fracture (RF), screw breakage (SB), screw dislodgement (SD) and proximal junctional kyphosis (PJK) subgroups. RESULTS Preoperatively, the RF group had greater thoracolumbar kyphosis (TLK) and relative upper lumbar lordosis (RULL); the SB group had the largest pelvic incidence (PI) and lumbar lordosis (LL); the SD group had the least global sagittal imbalance; and the PJK group had the highest thoracic kyphosis (TK), TLK and RULL. At the last follow-up, the RF and SB groups featured a large PI minus LL (PI-LL), while the PJK group featured a prominent TK; all the MCs subgroups had sagittal malalignment and a higher GAP score, and the SB group had the most severe cases. Logistic regressions showed that the relative spinopelvic alignment (RSA) score was correlated with RF, SB and SD, while the RSA and age scores were associated with PJK. CONCLUSION Each patient with MCs had individual characteristics in the sagittal plane following ASD surgery, which may be helpful to understand the pathophysiology of poor sagittal alignment with its subsequent MCs and guide an eventual revision strategy.
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Affiliation(s)
- Changyu Pan
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Digital Spine Research Institute, Changsha, 410011, Hunan, China.
| | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, 11671, Riyadh, Saudi Arabia
| | - Daniel Larrieu
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ferran PelIise
- Spine Surgery Unit, Hospital Universitario Vall Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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Haddad S, Yasuda T, Vila-Casademunt A, Yilgor Ç, Nuñez-Pereira S, Ramirez M, Pizones J, Alanay A, Kleinstuck F, Obeid I, Pérez-Grueso FJS, Matsuyama Y, Pellisé F. Correction: Revision surgery following long lumbopelvic constructs for adult spinal deformity: prospective experience from two dedicated databases. Eur Spine J 2024; 33:365. [PMID: 37906292 DOI: 10.1007/s00586-023-07988-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Sleiman Haddad
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain.
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
| | - Tatsuya Yasuda
- Department of Orthopedic Surgery, Iwata City Hospital, Iwata-City, Shizuoka, Japan
| | | | - Çaglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey
| | - Susana Nuñez-Pereira
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - Manuel Ramirez
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - Javier Pizones
- Spine Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey
| | | | - Ibrahim Obeid
- Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | | | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-City, Shizuoka, Japan
| | - Ferran Pellisé
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
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Boissiere L, Bourghli A, Guevara-Villazon F, Pellisé F, Alanay A, Kleinstück F, Pizones J, Roscop C, Larrieu D, Obeid I. Rod Angulation Relationship with Thoracic Kyphosis after Adolescent Idiopathic Scoliosis Posterior Instrumentation. Children (Basel) 2023; 11:29. [PMID: 38255344 PMCID: PMC10813855 DOI: 10.3390/children11010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Surgery to correct spinal deformities in scoliosis involves the use of contoured rods to reshape the spine and correct its curvatures. It is crucial to bend these rods appropriately to achieve the best possible correction. However, there is limited research on how the rod bending process relates to spinal shape in adolescent idiopathic scoliosis surgery. METHODS A retrospective study was conducted using a prospective multicenter scoliosis database. This study included adolescent idiopathic scoliosis patients from the database who underwent surgery with posterior instrumentation covering the T4 to T12 segments. Standing global spine X-rays were used in the analysis. The sagittal Cobb angles between T5 and T11 were measured on the spine. Additionally, the curvature of the rods between T5 and T11 was measured using the tangent method. To assess the relationship between these measurements, the difference between the dorsal kyphosis (TK) and the rod kyphosis (RK) was calculated (ΔK = TK - RK). This study aimed to analyze the correlation between ΔK and various patient characteristics. Both descriptive and statistical analyses were performed to achieve this goal. RESULTS This study encompassed a cohort of 99 patients, resulting in a total of 198 ΔK measurements for analysis. A linear regression analysis was conducted, revealing a statistically significant positive correlation between the kyphosis of the rods and that of the spine (r = 0.77, p = 0.0001). On average, the disparity between spinal and rod kyphosis averaged 5.5°. However, it is noteworthy that despite this modest mean difference, there was considerable variability among the patients. In particular, in 84% of cases, the concave rod exhibited less kyphosis than the spine, whereas the convex rod displayed greater kyphosis than the spine in 64% of cases. It was determined that the primary factor contributing to the flattening of the left rod was the magnitude of the coronal Cobb angle, both before and after the surgical procedure. These findings emphasize the importance of considering individual patient characteristics when performing rod bending procedures, aiming to achieve the most favorable outcomes in corrective surgery. CONCLUSIONS Although there is a notable and consistent correlation between the curvature of the spine and the curvature of the rods, it is important to acknowledge the substantial heterogeneity observed in this study. This heterogeneity suggests that individual patient factors play a significant role in shaping the outcome of spinal corrective surgery. Furthermore, this study highlights that more severe spinal curvatures in the frontal plane have an adverse impact on the shape of the rods in the sagittal plane. In other words, when the scoliosis curve is more pronounced in the frontal plane, it tends to influence the way the rods are shaped in the sagittal plane. This underscores the complexity of spinal deformities and the need for a tailored approach in surgical interventions to account for these variations among patients.
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Affiliation(s)
- Louis Boissiere
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, 08035 Barcelona, Spain
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul 34750, Turkey
| | - Frank Kleinstück
- Research and Development, Schulthess Klinik, 8008 Zurich, Switzerland
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Cécile Roscop
- Spine Surgery Unit, CHU Pellegrin, 33076 Bordeaux, France
| | - Daniel Larrieu
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
| | - Ibrahim Obeid
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
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12
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Passias PG, Williamson TK, Kummer NA, Pellisé F, Lafage V, Lafage R, Serra-Burriel M, Smith JS, Line B, Vira S, Gum JL, Haddad S, Sánchez Pérez-Grueso FJ, Schoenfeld AJ, Daniels AH, Chou D, Klineberg EO, Gupta MC, Kebaish KM, Kelly MP, Hart RA, Burton DC, Kleinstück F, Obeid I, Shaffrey CI, Alanay A, Ames CP, Schwab FJ, Hostin RA, Bess S. Cost Benefit of Implementation of Risk Stratification Models for Adult Spinal Deformity Surgery. Global Spine J 2023:21925682231212966. [PMID: 38081300 DOI: 10.1177/21925682231212966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
STUDY DESIGN/SETTING Retrospective cohort study. OBJECTIVE Assess the extent to which defined risk factors of adverse events are drivers of cost-utility in spinal deformity (ASD) surgery. METHODS ASD patients with 2-year (2Y) data were included. Tertiles were used to define high degrees of frailty, sagittal deformity, blood loss, and surgical time. Cost was calculated using the Pearl Diver registry and cost-utility at 2Y was compared between cohorts based on the number of risk factors present. Statistically significant differences in cost-utility by number of baseline risk factors were determined using ANOVA, followed by a generalized linear model, adjusting for clinical site and surgeon, to assess the effects of increasing risk score on overall cost-utility. RESULTS By 2 years, 31% experienced a major complication and 23% underwent reoperation. Patients with ≤2 risk factors had significantly less major complications. Patients with 2 risk factors improved the most from baseline to 2Y in ODI. Average cost increased by $8234 per risk factor (R2 = .981). Cost-per-QALY at 2Y increased by $122,650 per risk factor (R2 = .794). Adjusted generalized linear model demonstrated a significant trend between increasing risk score and increasing cost-utility (r2 = .408, P < .001). CONCLUSIONS The number of defined patient-specific and surgical risk factors, especially those with greater than two, were associated with increased index surgical costs and diminished cost-utility. Efforts to optimize patient physiology and minimize surgical risk would likely reduce healthcare expenditures and improve the overall cost-utility profile for ASD interventions.Level of evidence: III.
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Affiliation(s)
- Peter G Passias
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, NY, NY, USA
| | - Tyler K Williamson
- Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Nicholas A Kummer
- Departments of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, NY, NY, USA
| | - Ferran Pellisé
- Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Miguel Serra-Burriel
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Breton Line
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Shaleen Vira
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Sleiman Haddad
- Spine Surgery Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Dean Chou
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, Missouri, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, CA, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Frank Kleinstück
- Spine Center Division, Department of Orthopedics and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
| | - Ibrahim Obeid
- Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Christopher I Shaffrey
- Spine Division, Departments of Neurosurgery and Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acıbadem University, Istanbul, Turkey
| | - Christopher P Ames
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Frank J Schwab
- Department of Orthopaedics, Lenox Hill Hospital, New York, NY, USA
| | - Richard A Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, TX, USA
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Pan C, Anouar B, Li Y, Li L, Kuang L, Wang B, Sun J, Lv G, Obeid I. Predicting thoracic kyphosis morphology and the thoracolumbar inflection point determined by individual lumbar lordosis in asymptomatic adults. Eur Spine J 2023:10.1007/s00586-023-07983-z. [PMID: 37851162 DOI: 10.1007/s00586-023-07983-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/31/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE The aims of this study were to explore the correlations between thoracic kyphosis (TK) and lumbar lordosis (LL) parameters and to build corresponding linear regressions to predict TK morphology and the thoracolumbar inflection point (IP) determined by individual LL parameters in asymptomatic adults. METHODS A total of 280 adult healthy volunteers were recruited, and full-spine X-rays were performed for each subject in a standing posture. The following sagittal parameters were measured: cumulative TK, LL, proximal LL (PLL), the apices of TK (TKA) and LL (LLA), the IP and the distance from the plumb line of the thoracic apex (TAPL) and the lumbar apex (LAPL) to the gravity line. The correlations between TK and LL parameters were analyzed, and the corresponding linear regressions were conducted. RESULTS Extensive variations existed in TK alignment, including angular and morphological parameters. In addition, there were statistical correlations of all cumulative TK angles with LL (r values from - 0.173 to - 0.708) and PLL (r values from - 0.206 to - 0.803), TKA and IP with LLA (rs = 0.359 and 0.582, respectively) and TAPL with LAPL (rs = 0.335). The common predictive formulas employed in ASD surgery could include T10-L1 = - 3.6-0.2*LL (R2 = 0.201), T4-L1 = 3.4-0.5*LL (R2 = 0.457), TKA = - 10.3 + 1.1*LLA (R2 = 0.180) and IP = - 12.7 + 1.6*LLA (R2 = 0.330). CONCLUSION There were intimate associations between TK and LL parameters in asymptomatic adults. Moreover, predictive models for thoracic alignment, particularly cumulative TK, based on LL parameters were proposed, which could better delineate anatomical relationships, guide thoracic construction during adult spinal deformity surgery and may help preventing proximal junctional failure.
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Affiliation(s)
- Changyu Pan
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
| | - Bourghli Anouar
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yunchao Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Lei Li
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Lei Kuang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jianmin Sun
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China
| | - Guohua Lv
- Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
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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. Eur Spine J 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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16
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Boissiere L, Guevara-Villazón F, Bourghli A, Abdallah R, Pellise F, Pizones J, Alanay A, Kleinstueck F, Larrieu D, Obeid I. Rod angulation does not reflect sagittal curvature in adult spinal deformity surgery: comparison of lumbar lordosis and rod contouring. Eur Spine J 2023; 32:3666-3672. [PMID: 37278877 DOI: 10.1007/s00586-023-07791-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/26/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE Relationship between rod and spinal shape in the sagittal plane in adult spinal deformity (ASD) surgery. BACKGROUND Corrective surgery for adult spinal deformity (ASD) involves the use of contoured rods to correct and modify the spinal curvatures. Adequate rod bending is crucial for achieving optimal correction. The correlation between rods and spinal shape in long constructs has not been reported previously. METHODS We conducted a retrospective analysis of a prospective, multicenter database of patients who underwent surgery for ASD. The inclusion criteria were patients who underwent pelvic fixation and had an upper instrumented vertebra at or above T12. Pre- and post-operative standing radiographs were used to assess lumbar lordosis at the L4S1 and L1S1 levels. The angle between the tangents to the rod at the L1, L4, and S1 pedicles was calculated to determine the L4S1 and L1S1 rod lordosis. The difference between the lumbar lordosis (LL) and the rod lordosis (RL) was calculated as ΔL = LL-RL. The correlation between this difference (ΔL) and various characteristics was analyzed using descriptive and statistical methods. RESULTS Eighty-three patients were included in the study, resulting in 166 analyzed differences (ΔL) between the rod and spinal lordosis. The values for rod lordosis were found to be both greater and lesser than those of the spine but were mostly lower. The range for total ΔL was -24 °-30.9 °, with a mean absolute ΔL of 7.8 ° for L1S1 (standard deviation (SD) = 6.0) and 9.1 ° for L4S1 (SD = 6.8). In 46% of patients, both rods had a ΔL of over 5 °, and over 60% had at least one rod with a ΔL difference of over 5 °. Factors found to be related to a higher ΔL included postoperative higher lumbar lordosis, presence of osteotomies, higher corrected degrees, older age, and thinner rods. Multivariate analysis correlated only higher postoperative L1S1 lordosis with higher ΔL. No correlation was found between a higher ΔL and sagittal imbalance. CONCLUSIONS Variations between spinal and rod curvatures were observed despite the linear regression correlation. The shape of the rod does not seem to be predictive of the shape of the spine in the sagittal plane in ASD long-construct surgeries. Several factors, other than rod contouring, are involved in explaining the postoperative shape of the spine. The observed variation calls into question the fundamentals of the ideal rod concept.
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Affiliation(s)
- Louis Boissiere
- Elsan, Polylinique Jean Villar Bruges, Bruges-Bordeaux, France
| | | | - Anouar Bourghli
- Spine Surgey Department King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ralph Abdallah
- Elsan, Polylinique Jean Villar Bruges, Bruges-Bordeaux, France
| | - Ferran Pellise
- Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem University, Istanbul, Turkey
| | - Frank Kleinstueck
- Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
| | - Daniel Larrieu
- Elsan, Polylinique Jean Villar Bruges, Bruges-Bordeaux, France
| | - Ibrahim Obeid
- Elsan, Polylinique Jean Villar Bruges, Bruges-Bordeaux, France.
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17
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Prost S, Blondel B, Bauduin E, Pesenti S, Ilharreborde B, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Charles YP. Do Age-Related Variations Of Sagittal Alignment Rely On SpinoPelvic Organization? An Observational Study Of 1540 Subjects. Global Spine J 2023; 13:2144-2154. [PMID: 35191731 PMCID: PMC10538341 DOI: 10.1177/21925682221074660] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Descriptive radiographic analysis of a prospective multi-center database. OBJECTIVE This study aims to provide normative values of spinopelvic parameters and their correlations according to age and pelvic incidence (PI) of subjects without spinal deformity. METHODS After Institutional Review Board (IRB) approval, 1540 full spine radiographs were analyzed. Subjects were divided into 3 groups of PI: low PI < 45°, intermediate PI 45-60°, high PI > 60°, and then stratified by age (20-34, 35-49, 50-64, > 65 Y.O). Pelvic and spinal parameters were measured. Statistical analysis between parameters was performed using Bayesian inference and correlation. RESULTS Mean age was 53.5 years (845 females, 695 males, range 20-93 years).In low PI group, lumbar lordosis (LL) decrease was mainly observed in the 2 younger age groups.In medium and high PI groups, loss of lordosis was linear during aging and occurred mainly on the distal arch of lordosis. Moderate PI group had a stable lordosis apex and thoracolumbar inflection point. High PI group had a stable thoracolumbar inflection point and a more distal lordosis apex in elderly subjects.For all subjects, kyphosis and pelvic tilt (PT) increased with age.There was a constant chain of correlation between PI and age groups. Proximal lumbar lordosis (PLL) was correlated with kyphosis and sagittal vertical axis (SVA C7), while the distal lumbar lordosis (DLL) was correlated with PI and PT. CONCLUSION This study provides a detailed repository of sagittal spinopelvic parameters normative values with detailed analysis of segmental kyphosis and lordosis distribution according to gender, age, and PI.
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Affiliation(s)
- Solène Prost
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, France
| | - Benjamin Blondel
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, France
| | - Sébastien Pesenti
- Service d’Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, France
| | - Federico Solla
- Service d’Orthopédie Pédiatrique, Fondation Lenval, Nice, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Unité du Rachis, Centre Orthopédique Santy, Lyon, France
| | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, France
| | - Jonathan Lebhar
- Institut Locomoteur de l’Ouest Rachis,Centre Hospitalier Privé Saint-Grégoire, France
| | | | | | - Erik A. Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - The French Spine Surgery Society (SFCR)
- Aix-Marseille Université, APHM, CNRS, ISM, CHU Timone, Unité de chirurgie rachidienne, France
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, France
- Service d’Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, France
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, France
- Hôpital Privé de l’Est Lyonnais, Saint-Priest, France
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
- Hôpital Privé du Dos Francheville, Périgueux, France
- Clinique du Dos Jean Villar, Bruges, France
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, France
- Service d’Orthopédie Pédiatrique, Fondation Lenval, Nice, France
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, France
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
- Unité du Rachis, Centre Orthopédique Santy, Lyon, France
- Institut Locomoteur de l’Ouest Rachis,Centre Hospitalier Privé Saint-Grégoire, France
- Institut Méditerranéen du Dos, Marseille, France
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, France
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
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Yucekul A, Ozpinar A, Kilickan FDB, Dalla M, Muthiah N, Zulemyan T, Yavuz Y, Pizones J, Obeid I, Kleinstück F, Pérez-Grueso FJS, Pellisé F, Yilgor C, Alanay A. Relationship between pelvic incidence-adjusted relative spinopelvic parameters, global sagittal alignment and lower extremity compensations. Eur Spine J 2023; 32:3599-3607. [PMID: 37041394 DOI: 10.1007/s00586-023-07677-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/12/2022] [Accepted: 03/22/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE In response to sagittal malalignment, compensatory spinal and lower extremity mechanisms are recruited. Thoracolumbar realignment surgery has been shown to yield reciprocal changes in these compensations. Thus, whole-body radiographic assessment has come to the fore. This study aimed to evaluate the relationship between spinopelvic parameters and lower extremity compensation angles and to examine their coupled change with deformity correction. METHODS This was a multicenter retrospective analysis of patients who had ≥ 4 levels posterior fusion, whole-body radiographs, and ≥ 2 years follow-up. Relative Pelvic Version (RPV), Relative Lumbar Lordosis (RLL), Relative Spinopelvic Alignment (RSA), Femoral Obliquity Angle (FOA), Knee Flexion Angle (KFA) and Global Sagittal Axis (GSA) were measured preoperatively and 6 week postoperatively. Kruskal-Wallis tests were performed to assess the relation of relative spinopelvic parameters to global sagittal alignment and lower extremity compensation angles. Spearman's correlations were performed to assess correlations of pre-to-postoperative changes. RESULTS 193 patients (156F, 37 M) were included. The mean age was 57.2 ± 16.6 years. The mean follow-up duration was 50.6 (24-90) months. On average, 10.3 ± 3.8 levels were fused. Among the cohort, 124 (64.2%) had a sacral or sacroiliac fixation, and 43 (22.3%) had 3-column osteotomies. Preoperative FOA, KFA and GSA significantly differed between RPV, RLL and RSA categories. Significant weak-to-strong correlations were observed between spinopelvic parameters, global sagittal alignment and lower extremity compensation angles (rho range: - 0.351 to 0.767). CONCLUSIONS PI-adjusted relative spinopelvic parameters significantly correlated with measurements of the lower extremity compensation. Postoperative changes in RPV, RLL and RSA reflected changes in FOA, KFA and GSA. These measurements may serve as a valuable proxy for surgical planning when whole-body imaging is not available.
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Affiliation(s)
- Altug Yucekul
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Alp Ozpinar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Mohammed Dalla
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Nallammai Muthiah
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Istanbul, Turkey
| | - Yasemin Yavuz
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Javier Pizones
- Spine Unit, Orthopaedic Surgery Department, Hospital Universitario La Paz, Madrid, Spain
| | - Ibrahim Obeid
- Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Frank Kleinstück
- Spine Center Division, Department of Orthopedics and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Istanbul, Turkey.
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Tkatschenko D, Hansen S, Koch J, Ames C, Fehlings MG, Berven S, Sekhon L, Shaffrey C, Smith JS, Hart R, Kim HJ, Wang J, Ha Y, Kwan K, Hai Y, Valacco M, Falavigna A, Taboada N, Guiroy A, Emmerich J, Meyer B, Kandziora F, Thomé C, Loibl M, Peul W, Gasbarrini A, Obeid I, Gehrchen M, Trampuz A, Vajkoczy P, Onken J. Prevention of Surgical Site Infections in Spine Surgery: An International Survey of Clinical Practices Among Expert Spine Surgeons. Global Spine J 2023; 13:2007-2015. [PMID: 35216540 PMCID: PMC10556889 DOI: 10.1177/21925682211068414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
STUDY DESIGN Questionnaire-based survey. OBJECTIVES Surgical site infection (SSI) is a common complication in spine surgery but universal guidelines for SSI prevention are lacking. The objectives of this study are to depict a global status quo on implemented prevention strategies in spine surgery, common themes of practice and determine key areas for future research. METHODS An 80-item survey was distributed among spine surgeons worldwide via email. The questionnaire was designed and approved by an International Consensus Group on spine SSI. Consensus was defined as more than 60% of participants agreeing to a specific prevention strategy. RESULTS Four hundred seventy-two surgeons participated in the survey. Screening for Staphylococcus aureus (SA) is not common, whereas preoperative decolonization is performed in almost half of all hospitals. Body mass index (BMI) was not important for surgery planning. In contrast, elevated HbA1c level and hypoalbuminemia were often considered as reasons to postpone surgery. Cefazoline is the common drug for antimicrobial prophylaxis. Alcohol-based chlorhexidine is mainly used for skin disinfection. Double-gloving, wound irrigation, and tissue-conserving surgical techniques are routine in the operating room (OR). Local antibiotic administration is not common. Wound closure techniques and postoperative wound dressing routines vary greatly between the participating institutions. CONCLUSIONS With this study we provide an international overview on the heterogeneity of SSI prevention strategies in spine surgery. We demonstrated a large heterogeneity for pre-, peri- and postoperative measures to prevent SSI. Our data illustrated the need for developing universal guidelines and for testing areas of controversy in prospective clinical trials.
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Affiliation(s)
- Dimitri Tkatschenko
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sonja Hansen
- Department of Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Koch
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Michael G. Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sigurd Berven
- Orthopedic Surgery, UCSF Spine Center, San Francisco, CA, USA
| | | | - Christopher Shaffrey
- Departments of Neurosurgery and Orthopaedic Surgery, Duke Medical Center, Durham, NC, USA
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Robert Hart
- Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, USA
| | | | - Yoon Ha
- Department of Neurosurgery, Spine, and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kenny Kwan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Marcelo Valacco
- Department of Orthopaedics, Churruca Hospital de Buenos Aires, Buenos Aires, Argentina
| | - Asdrubal Falavigna
- Department of Neurosurgery, University of Caxias do Sul, Caxias do Sul, Brazil
| | | | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español, Mendoza, Argentina
| | - Juan Emmerich
- Department of Neurological Surgery, Children’s Hospital, La Plata, Argentina
| | - Bernhard Meyer
- Department of Neurosurgery, Technische Universität München, Munich, Germany
| | - Frank Kandziora
- Centre for Spinal Surgery and Neurotraumatology, BG Unfallklinik, Frankfurt am Main, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Tyrol, Austria
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Klinik Zürich Switzerland and Department of Trauma Surgery, University Medical Center, Regensburg, Germany
| | - Wilco Peul
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center & Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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20
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Raganato R, Pizones J, Yilgor C, Moreno-Manzanaro L, Vila-Casademunt A, Sánchez-Márquez JM, Fernández-Baíllo N, Sánchez Pérez-Grueso FJ, Kleinstück F, Alanay A, Obeid I, Pellisé F. Sagittal realignment: surgical restoration of the global alignment and proportion score parameters: a subgroup analysis. What are the consequences of failing to realign? Eur Spine J 2023; 32:2238-2247. [PMID: 37000217 DOI: 10.1007/s00586-023-07649-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/18/2023] [Accepted: 03/09/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION The Global Alignment and Proportion (GAP) score incorporates three domains directly modified with surgery (relative pelvic version-RPV, relative lumbar lordosis-RLL, lumbar distribution index-LDI) and one indirectly restored (relative spinopelvic alignment-RSA). We analyzed our surgical realignment performance and the consequences of domain-specific realignment failure on mechanical complications and PROMs. MATERIALS AND METHODS From an adult spinal deformity prospective multicenter database, we selected patients: fused to pelvis, upper instrumented vertebra at or above L1, and 2 years of follow-up. Descriptive, univariate and multivariate analyses were employed. RESULTS The sample included 333 patients. RLL-6w showed the highest success rate (58.3% aligned), but 16.5% of patients were classified in the "Severe hypolordosis" and "Hyperlordosis" subgroups. RPV-6w was the most challenging to realign, with 51.6% moderate or severe retroversion. Regarding RSA-6w, 21.9% had severe positive malalignment. Correct alignment of RPV-6w (p = 0.025) and RSA-6w (p = 0.002) proved to be protective factors against the development of mechanical complications. Severe pelvic retroversion (p = 0.026) and severe positive malalignment (p = 0.007) were risk factors for mechanical complications. RSA-6w "Severe positive malalignment" was associated with less improvement in PROMs: ∆ODI (8.83 vs 17.2; p = 0.011), ∆SRS-22 total (0.54 vs 0.87; p = 0.007), and ∆SF-36PCS (3.47 vs 7.76; p = 0.04); MCID for ODI (37.0 vs 55.5%; p = 0.023), and SRS-22 (40.8 vs 60.1%; p = 0.015); and PASS for ODI (17.6 vs 31.7%; p = 0.047). CONCLUSIONS RPV was the most underperformed modifiable parameter. Severe pelvic retroversion and severe positive malalignment influenced the occurrence of mechanical complications. Severe positive malalignment affected PROMs improvement.
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Affiliation(s)
- Riccardo Raganato
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain.
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | | | - José Miguel Sánchez-Márquez
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Nicomedes Fernández-Baíllo
- Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | | | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Serratrice N, Faddoul J, Tarabay B, Attieh C, Taifour S, Benkessou B, Obeid I, Abi Lahoud GN. Radiological factors affecting functional outcome after the implantation of BDYN TM dynamic stabilization system for low-grade lumbar degenerative spondylolisthesis. Neurochirurgie 2023:101456. [PMID: 37236539 DOI: 10.1016/j.neuchi.2023.101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The objectives of this study are to identify radiological factors associated with good functional outcomes after the implantation of BDYNTM dynamic stabilization system in the setting of painful low-grade degenerative lumbar spondylolisthesis (LDS). MATERIAL AND METHODS In this monocentric, retrospective study, we followed 50 patients, a 5-years period, with chronic lower back pain, radiculopathy and/or neurogenic claudication evolving for at least one year that failed conservative treatment. All patients presented low-grade LDS and underwent lumbar dynamic stabilization. Radiological and clinical outcomes were assessed pre-operatively and 24 months after surgery. Functional evaluation was based on the Oswestry Disability Index (ODI), the Numerical Rating Scale (NRS), and the Walking Distance (WD). Radiological analysis was based on lumbar X-rays and MRI parameters. Patients were divided into two groups according to the reduction in the postoperative ODI score (more or less than 15 points), and statistical analysis was performed between both groups to find predictive radiological factors for a satisfying functional outcome. RESULTS Clinically, 80% (40 patients) had a satisfying functional result, and 20% (10 patients) were considered having a poor outcome according to the ODI score. Radiologically, the loss in segmental lordosis was statistically associated with bad functional outcomes (18° for ODI decrease >15 versus 11° for ODI decrease <15). There is also a tendency showing that a higher Pfirmann disc signal grade (grade IV) and a severe canal stenosis according to Schizas classification (grade C & D) are predictive of a poor clinical result, but that must be confirmed in future studies. CONCLUSIONS BDYNTM appears safe and well-tolerated. This new device should be effective for the treatment of patients with low-grade LDS. It provides significant improvement in terms of daily life activity and pain. Moreover, we have been able to deduce that a kyphotic disc is associated with a bad functional outcome after BDYNTM device implantation. It may represent a contraindication for the implantation of such DS device. Moreover, it seems that it is better to implant BDYNTM in LDS with mild or moderate disc degeneration and canal stenosis.
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Affiliation(s)
| | - J Faddoul
- ICVNS - CMC Bizet, Paris, France; Centre Hospitalier de la Côte Basque, Bayonne, France.
| | | | - C Attieh
- ICVNS - CMC Bizet, Paris, France.
| | | | - B Benkessou
- Clinical research and innovation department, Hexagone Santé Paris, Paris, France.
| | - I Obeid
- Clinique du dos, Bordeaux, France.
| | - G N Abi Lahoud
- ICVNS - CMC Bizet, Paris, France; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
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Haddad S, Yasuda T, Vila-Casademunt A, Yilgor Ç, Nuñez-Pereira S, Ramirez M, Pizones J, Alanay A, Kleinstuck F, Obeid I, Pérez-Grueso FJS, Matsuyama Y, Pellisé F. Revision surgery following long lumbopelvic constructs for adult spinal deformity: prospective experience from two dedicated databases. Eur Spine J 2023; 32:1787-1799. [PMID: 36939889 DOI: 10.1007/s00586-023-07627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE Pan Lumbar Arthodesis (PLA) are often required for Adult Spinal Deformity (ASD) correction, reducing significantly the compensatory capacity in case of postoperative sagittal malalignment. Few papers have investigated outcomes and complications in this vulnerable subset of patients. The objective of this study was to assess revision surgery rate for PLA in ASD, its risk factors and impact on clinical outcomes. METHODS Retrospective multicenter review of prospective ASD data from 7 hospitals covering Europe and Asia. ASD patients included in two prospective databases having a posterior instrumentation spanning the whole lumbar region with more than 2-years of follow-up were reviewed. Demographic, surgical, radiographic parameters and Health-Related Quality of Life (HRQoL) scores were analyzed. Univariate and multivariate regression models analyzed risk factors for revision surgery as well as surgical outcomes. Patients with Early versus Late and PJK versus Non-PJK mechanical complications were also compared. RESULTS Out of 1359 ASD patients included in the database 589 (43%) had a PLA and 357 reached 2-years mark. They were analyzed and compared to non-PLA patients. Average age was 67 and 82% were females. 100 Patients (28.1%) needed 114 revision surgeries (75.4% for mechanical failures). Revised patients were more likely to have a nerve system disorder, higher BMI and worst immediate postoperative alignment (as measured by GAP Parameters). These risk factors were also associated with earlier mechanical complications and PJK. Deformity and HRQoL parameters were comparable at baseline. Non-revised patients had significantly better clinical outcomes at 2-years (SRS 22 scores, ODI, Back pain). Multivariate analysis could identify nerve system disorder (OR 4.8; CI 1.8-12.6; p = 0.001), postoperative sagittal alignment (GAP Score) and high BMI (OR 1.07; CI 1.01-1.13; p = 0.004) as independent risk factors for revisions. CONCLUSIONS Revision surgery due to mechanical failures is relatively common after PLA leading to worse clinical outcomes. Prevention strategies should focus on individualized restoration of sagittal alignment and better weight control to decrease stress on these rigid constructs in non-compliant spines. Nerve system disorders independently increase revision risk in PLA. LEVEL OF EVIDENCE II Prognosis.
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Affiliation(s)
- Sleiman Haddad
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain.
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain.
| | - Tatsuya Yasuda
- Department of Orthopedic Surgery, Iwata City Hospital, Iwata-City, Shizuoka, Japan
| | | | - Çaglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey
| | - Susana Nuñez-Pereira
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - Manuel Ramirez
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
| | - Javier Pizones
- Spine Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey
| | | | - Ibrahim Obeid
- Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | | | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu-City, Shizuoka, Japan
| | - Ferran Pellisé
- Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain
- Spine Surgery Unit, Vall d'Hebron University Hospital, Pg Vall Hebron 119-129, 08035, Barcelona, Spain
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Bourghli A, Boissiere L, Konbaz F, Larrieu D, Almusrea K, Obeid I. Domino connector for thoracic pedicle subtraction osteotomy reduction: surgical technique and patient series. Eur Spine J 2023; 32:1800-1809. [PMID: 36935453 DOI: 10.1007/s00586-023-07650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/16/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE Different techniques have been previously described to close the pedicle subtraction osteotomy (PSO) site for correction of sagittal malalignment; the use of a side-to-side domino connector as a correction tool in the thoracic spine has not been specifically studied. METHODS Twenty adult patients who underwent single-level thoracic PSO from T1 to T12 were included and retrospectively reviewed (two centers). Preoperative and postoperative full-body X-rays, perioperative data, clinical data and complications were recorded with a minimum 2 years of follow-up. Surgical technique and the nuances in using the domino connector were described in detail. RESULTS Patients had a mean age of 40y; 40% were female. Two different techniques involving the domino were applied for closure of the PSO site depending on the type of kyphosis (smooth vs. angular deformity). Both techniques provided significant correction of the local kyphosis (from 48° to 18°) with reciprocal reduction of compensatory cervical lordosis (from 37.6° to 18.6°, p < 0.01) in upper thoracic PSO or lumbar lordosis (from 74.5° to 46.6°, p < 0.01) in lower thoracic PSO. Four patients presented postoperative complications that resolved (hemothorax, GI bleeding), and two patients presented transient neurological deficit. Oswestry Disability Index score improved in the majority of the patients (from 32.7 to 22.5, p < 0.05). There were no pseudarthroses, symptomatic instrumentation breakage, or surgical site infection. CONCLUSION Use of a side-to-side domino connector in combination with two different rod cantilever techniques is effective for the reduction of thoracic pedicle subtraction osteotomy achieving satisfactory radiological and clinical outcome.
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Affiliation(s)
- Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Faisal Konbaz
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Daniel Larrieu
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Khaled Almusrea
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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Pizones J, Boissiere L, Moreno-Manzanaro L, Vila-Casademunt A, Perez-Grueso FJS, Sánchez-Márquez JM, Baíllo NF, Kleinstück F, Alanay A, Pellisé F, Obeid I. Does the use of postoperative brace help preventing mechanical complications following adult deformity surgery? Eur Spine J 2023; 32:914-925. [PMID: 36592207 DOI: 10.1007/s00586-022-07521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE There is scarce information regarding the effectiveness of postoperative braces in decreasing mechanical complications and reinterventions following adult deformity surgery. METHODS Retrospective matched cohort study from a prospective adult deformity multicenter database. We selected operated patients, fused to the pelvis, > 6 instrumented levels, and minimum 2 year follow-up. Three hundred and eighty patients were separated into two groups (Brace-3 months TLSO-vs No Brace) and then matched controlling for age, gender and frailty. We studied demographic, intraoperative, and postoperative spinopelvic parameters. Both groups were compared regarding complications and reinterventions in the first 2 postoperative years, using univariate and multivariate logistic regression analysis. RESULTS We finally analyzed 359 matched patients, mean age of 65.3 ± 8.9 years, frailty-index (0.43 ± 0.15), and mostly females (84%). 224 patients wore a postoperative brace (B) and 135 didn't (NoB). They showed no difference in intraoperative variables and postoperative spinopelvic alignment. They differed (P < 0.05) in: Pelvic incidence (B:58° ± 13 vs NoB:54.5° ± 13); BMI (B:25.8 ± 4 vs NoB:27.4 ± 5); upper instrumented vertebra (B:81.7% T8-L1 vs NoB:72.6% T8-L1), and the use of multiple rods (B:47.3% vs NoB:18.5%). Univariate analysis showed a higher rate of mechanical complications and reinterventions when not using a brace. As well as higher NRS-back and leg pain at 6 weeks. However, multivariate analysis selected the use of multiple rods as the only independent factor protecting against mechanical complications (OR: 0.38; CI 95% 0.22-0.64) and reinterventions (OR: 0.41; CI 95% 0.216-0.783). CONCLUSION After controlling for potential confounders, our study could not identify the protective effect of postoperative braces preventing mechanical complications and reinterventions in the first two postoperative years.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Louis Boissiere
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | | | - José Miguel Sánchez-Márquez
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Nicomedes Fernández Baíllo
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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26
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Bourghli A, Al Araki A, Konbaz F, Almusrea K, Boissière L, Obeid I. Delayed atlantoaxial rotatory dislocation in a child with Crohn's disease: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22515. [PMID: 36794742 PMCID: PMC10550607 DOI: 10.3171/case22515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/21/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Atlantoaxial rotatory dislocation (AARD) in children may be caused by neck trauma or an upper respiratory tract infection. Here the authors describe the very rare association between inflammatory bowel disease and AARD in a child. OBSERVATIONS A 7-year-old girl presented with an 11-month history of torticollis that occurred spontaneously without a trauma context. Her history revealed a recent diagnosis of Crohn's disease. Physical exam of the cervical spine revealed a "cock-robin" posture. Neck radiography and three-dimensional computed tomography reconstruction established the diagnosis of AARD. Given the duration of the symptoms and failure of previous conservative treatments, the patient was taken to the operating room and underwent open reduction through posterior approach with a C1-2 fusion according to the Harms technique. The torticollis resolved with no recurrence at the last follow-up and minimal restriction of rotation. LESSONS This is the third report to describe the very rare association between inflammatory bowel disease and AARD but at a very early age, the youngest in the literature. One should be aware of such association as early diagnosis may prevent aggressive surgical management.
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Affiliation(s)
- Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmad Al Araki
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia; and
| | - Faisal Konbaz
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khaled Almusrea
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, 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
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Balaban B, Yilgor C, Yucekul A, Zulemyan T, Obeid I, Pizones J, Kleinstueck F, Sanchez Perez-Grueso FJ, Pellise F, Alanay A, Sezerman OU. Corrigendum to “Building clinically actionable models for predicting mechanical complications in postoperatively well-aligned adult spinal deformity patients using XGBoost algorithm”. Informatics in Medicine Unlocked 2023. [DOI: 10.1016/j.imu.2023.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Balaban B, Yilgor C, Yucekul A, Zulemyan T, Obeid I, Pizones J, Kleinstueck F, Perez-Grueso FJS, Pellise F, Alanay A, Sezerman OU. Building clinically actionable models for predicting mechanical complications in postoperatively well-aligned adult spinal deformity patients using XGBoost algorithm. Informatics in Medicine Unlocked 2023. [DOI: 10.1016/j.imu.2023.101191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Ignasiak D, Behm P, Mannion AF, Galbusera F, Kleinstück F, Fekete TF, Haschtmann D, Jeszenszky D, Zimmermann L, Richner-Wunderlin S, Vila-Casademunt A, Pellisé F, Obeid I, Pizones J, Sánchez Pérez-Grueso FJ, Karaman MI, Alanay A, Yilgor Ç, Ferguson SJ, Loibl M. Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity. Eur Spine J 2023; 32:571-583. [PMID: 36526952 DOI: 10.1007/s00586-022-07477-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sagittal malalignment is a risk factor for mechanical complications after surgery for adult spinal deformity (ASD). Spinal loads, modulated by sagittal alignment, may explain this relationship. The aims of this study were to investigate the relationships between: (1) postoperative changes in loads at the proximal segment and realignment, and (2) absolute postoperative loads and postoperative alignment measures. METHODS A previously validated musculoskeletal model of the whole spine was applied to study a clinical sample of 205 patients with ASD. Based on clinical and radiographic data, pre-and postoperative patient-specific alignments were simulated to predict loads at the proximal segment adjacent to the spinal fusion. RESULTS Weak-to-moderate associations were found between pre-to-postop changes in lumbar lordosis, LL (r = - 0.23, r = - 0.43; p < 0.001), global tilt, GT (r = 0.26, r = 0.38; p < 0.001) and the Global Alignment and Proportion score, GAP (r = 0.26, r = 0.37; p < 0.001), and changes in compressive and shear forces at the proximal segment. GAP score parameters, thoracic kyphosis measurements and the slope of upper instrumented vertebra were associated with changes in shear. In patients with T10-pelvis fusion, moderate-to-strong associations were found between postoperative sagittal alignment measures and compressive and shear loads, with GT showing the strongest correlations (r = 0.75, r = 0.73, p < 0.001). CONCLUSIONS Spinal loads were estimated for patient-specific full spinal alignment profiles in a large cohort of patients with ASD pre-and postoperatively. Loads on the proximal segments were greater in association with sagittal malalignment and malorientation of proximal vertebra. Future work should explore whether they provide a causative mechanism explaining the associated risk of proximal junction complications.
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Affiliation(s)
- Dominika Ignasiak
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland.
| | - Pascal Behm
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Anne F Mannion
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Fabio Galbusera
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Frank Kleinstück
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Tamás F Fekete
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Dezsö Jeszenszky
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Laura Zimmermann
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Çaglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Stephen J Ferguson
- Institute for Biomechanics, ETH Zurich, HPP O13, Hönggerbergring 64, 8093, Zurich, Switzerland
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Klinik, Zurich, Switzerland
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Abul K, Yilgor C, Yucekul A, Alanay NA, Yavuz Y, Zulemyan T, Boissiere L, Bourghli A, Obeid I, Pizones J, Kleinstueck F, Perez-Grueso FJS, Pellise F, Alanay A. Long-term opioid medication profile of European adult spinal deformity patients: minimum five years follow-up study. Spine J 2023; 23:209-218. [PMID: 36336253 DOI: 10.1016/j.spinee.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/03/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND CONTEXT There remains significant variability in the use of postoperative opioids. On one end, it is proven that appropriate pain control is a critical aspect of patient management; on the other end, past few decades have been associated with major increases in opioid-related overdoses and addiction treatment. We hypothesized that several pre- and postoperative risk factors affecting long-term opioid use could be identified. PURPOSE Evaluation of factors associated with minimum 5-year postoperative opioid use following adult spinal deformity surgery. STUDY DESIGN/SETTING Prospectively followed study group database. PATIENT SAMPLE Adult spinal deformity patients who underwent elective spine surgery between 2009 and 2016 were included. OUTCOME MEASURES Opioid usage or otherwise at minimum 5 years follow-up. Use of nonopioid analgesics, weak and strong opioids METHODS: Retrospective analysis of patients undergoing elective spinal deformity surgery. A total of 37 factors comprising patient characteristics, radiographic measurements, operative details, preoperative and early postoperative opioid use, and mechanical complications and revisions were analyzed. Details on identified factors were provided. RESULTS A total of 265 patients (215F, 50M) from five sites were included. The mean follow-up duration was 68.4±11.7 (60-102) months. On average, 10.6±3.5 levels were fused. Preoperatively, 64 (24.2%) patients were using opioids. The rate of opioid users increased to 33.6% at 6 weeks and decreased to 21.5% at 6 months. During follow-up, there were patients who discontinued opioids, while others have started and/or restarted using opioids. As a result, 59 (22.3%) patients were still on opioids at the latest follow-up. Multivariate analyses showed that factors independently affecting opioid use at an average of 68 months postoperatively, in order of significance, were opioid use at sixth weeks, preoperative opioid use and opioid use at sixth months with the odds ratios of 2.88, 2.51, and 2.38 respectively. At these time points, factors such as age, number of comorbidities, tobacco use, the time of the last prior spine surgery and postoperative sagittal plane alignment affected opioid usage rates. CONCLUSIONS Opioid usage at 6 weeks was found to be more predictive of long-term opioid use compared to preoperative use. Patients should be well informed to have realistic expectations regarding opioid use when considering adult spinal deformity surgery.
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Affiliation(s)
- Kadir Abul
- Clinic of Orthopedics and Traumatology, Basaksehir Pine and Sakura City Hospital, Olimpiyat Bulvarı Yolu, 34480 Basaksehir, Istanbul, Turkey
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem University School of Medicine, Kayisdagi Cad 32, 34752 Icerenkoy, Atasehir, Istanbul, Turkey
| | - Altug Yucekul
- Department of Orthopedics and Traumatology, Acibadem University School of Medicine, Kayisdagi Cad 32, 34752 Icerenkoy, Atasehir, Istanbul, Turkey
| | - Nezih Arin Alanay
- Lycée Français Notre Dame de Sion, Cumhuriyet Cad 127, 34373 Sisli, Istanbul, Turkey
| | - Yasemin Yavuz
- Department of Biostatistics, Ankara University School of Medicine, Adnan Saygun Cad., 06230 Altindag, Ankara, Turkey
| | - Tais Zulemyan
- Comprehensive Spine Center, Acibadem University Maslak Hospital, Buyukdere Cad 40, 34457 Sariyer, Istanbul, Turkey
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, 2 Av. de Terrefort, 33520 Bruges, Bordeaux, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Al Mathar Ash Shamali, 11564 Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, 2 Av. de Terrefort, 33520 Bruges, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Frank Kleinstueck
- Spine Center Division, Department of Orthopedics and Neurosurgery, Schulthess Klinik, Lengghalde 2, 8008 Zurich, Switzerland
| | | | - Ferran Pellise
- Spine Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem University School of Medicine, Kayisdagi Cad 32, 34752 Icerenkoy, Atasehir, Istanbul, Turkey.
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Gomez-Rice A, Capdevila-Bayo M, Núñez-Pereira S, Haddad S, Vila-Casademunt A, Pérez-Grueso F, Kleinstück F, Obeid I, Alanay A, Pellise F, Pizones J. A 5-year follow-up of the effect of corrective surgery in young adults with idiopathic scoliosis. Spine Deform 2023; 11:605-615. [PMID: 36607558 DOI: 10.1007/s43390-023-00642-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/31/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to determine mid-long-term outcomes (5 years) following surgery for young adult idiopathic scoliosis (YAdIS). METHODS This is a retrospective review of a prospective, multicenter adult deformity database including patients operated on idiopathic scoliosis by a single posterior approach, age at surgery between 19 and 29 (considered young adults), and 5-year follow-up. Demographic, radiographic and PROMS were analyzed preoperatively, at 2 years and at final follow-up. RESULTS Forty-two patients were included. Mean preoperative major curve angle was 59.65 ± 18.94. Main coronal curve initial correction was 56.38%, with 6% loss at 5 years. From baseline to 5 years after surgery, there was improvement in all PROMs (P < 0.004)-especially self-image-, except NRS-leg pain. This improvement was present at 6 months for all PROMs except for functional outcomes (SRS-Function and ODI) in which the improvement took place between 6 months and 2 years. In the 2- to 5-year follow-up period, no significant changes were seen in any PROMs. The percentage of patients reaching MCID from baseline at 5 years was: 75% for SRS-image, 45% for SRS-pain, 47.5% for SRS-function, 51.3% for SRS-mental, 42.5% for SRS-total and 15.4% for ODI. Patients reaching PASS at 5 years were: 88.1% for SRS-image, 81% for SRS-pain, 92.9% for SRS-function, 57.1% for SRS-mental, 88.1% for SRS-total, 92.7% for ODI and 69% for NRS pain. 11 minor and 4 major complications were identified. CONCLUSION YAdIS surgery resulted in an early and significant improvement in PROMs, especially for self-image, significantly reaching MCID and PASS thresholds. These results were maintained during long-term (5-year) follow-up.
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Affiliation(s)
- Alejandro Gomez-Rice
- Hospital Universitario Ramón y Cajal, Carretera de Colmenar Viejo Km 9, 100, 28034, Madrid, Spain.
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Mannion AF, Elfering A, Fekete TF, Pizones J, Pellise F, Pearson AM, Lurie JD, Porchet F, Aghayev E, Vila-Casademunt A, Mariaux F, Richner-Wunderlin S, Kleinstück FS, Loibl M, Pérez-Grueso FS, Obeid I, Alanay A, Vengust R, Jeszenszky D, Haschtmann D. Development of a mapping function ("crosswalk") for the conversion of scores between the Oswestry Disability Index (ODI) and the Core Outcome Measures Index (COMI). Eur Spine J 2022; 31:3337-3346. [PMID: 36329252 DOI: 10.1007/s00586-022-07434-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/10/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The Oswestry Disability Index (ODI) and the Core Outcome Measures Index (COMI) are two commonly used self-rating outcome instruments in patients with lumbar spinal disorders. No formal crosswalk between them exists that would otherwise allow the scores of one to be interpreted in terms of the other. We aimed to create such a mapping function. METHODS We performed a secondary analysis of ODI and COMI data previously collected from 3324 patients (57 ± 17y; 60.3% female) at baseline and 1y after surgical or conservative treatment. Correlations between scores and Cohen's kappa for agreement (κ) regarding achievement of the minimal clinically important change (MCIC) score on each instrument (ODI, 12.8 points; COMI, 2.2 points) were calculated, and regression models were built. The latter were tested for accuracy in an independent set of registry data from 634 patients (60 ± 15y; 56.8% female). RESULTS All pairs of measures were significantly positively correlated (baseline, 0.73; 1y follow-up (FU), 0.84; change-scores, 0.73). MCIC for COMI was achieved in 53.9% patients and for ODI, in 52.4%, with 78% agreement on an individual basis (κ = 0.56). Standard errors for the regression slopes and intercepts were low, indicating excellent prediction at the group level, but root mean square residuals (reflecting individual error) were relatively high. ODI was predicted as COMI × 7.13-4.20 (at baseline), COMI × 6.34 + 2.67 (at FU) and COMI × 5.18 + 1.92 (for change-score); COMI was predicted as ODI × 0.075 + 3.64 (baseline), ODI × 0.113 + 0.96 (FU), and ODI × 0.102 + 1.10 (change-score). ICCs were 0.63-0.87 for derived versus actual scores. CONCLUSION Predictions at the group level were very good and met standards justifying the pooling of data. However, we caution against using individual values for treatment decisions, e.g. attempting to monitor patients over time, first with one instrument and then with the other, due to the lower statistical precision at the individual level. The ability to convert scores via the developed mapping function should open up more centres/registries for collaboration and facilitate the combining of data in meta-analyses.
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Affiliation(s)
- A F Mannion
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - A Elfering
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - T F Fekete
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - J Pizones
- Spine Unit, Department of Orthopedic Surgery, University Hospital La Paz, Madrid, Spain
| | - F Pellise
- Spine Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - A M Pearson
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - J D Lurie
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - F Porchet
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - E Aghayev
- Spine Tango Task Force, EUROSPINE, Uster, Switzerland
| | | | - F Mariaux
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - S Richner-Wunderlin
- Spine Center Division, Department of Teaching, Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - F S Kleinstück
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - M Loibl
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - F S Pérez-Grueso
- Spine Unit, Department of Orthopedic Surgery, University Hospital La Paz, Madrid, Spain
| | - I Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - A Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - R Vengust
- Department of Orthopedic Surgery, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - D Jeszenszky
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
| | - D Haschtmann
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zurich, Switzerland
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Boishardy A, Bouyer B, Boissière L, Larrieu D, Pereira SN, Kieser D, Pellisé F, Alanay A, Kleinstuck F, Pizones J, Obeid I. Surgical site infection is a major risk factor of pseudarthrosis in adult spinal deformity surgery. Spine J 2022; 22:2059-2065. [PMID: 36084897 DOI: 10.1016/j.spinee.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite the evidence in appendicular skeletal surgery, the effect of infection on spinal fusion remains unclear, particularly after Adult Spinal Deformity (ASD) surgery. PURPOSE The purpose of this study was to determine the impact of surgical site infection (SSI) in ASD surgery fusion rates and its association with other risks factors of pseudarthrosis. STUDY DESIGN We conducted an international multicenter retrospective study on a prospective cohort of patients operated for spinal deformity. PATIENT SAMPLE A total of 956 patients were included (762 females and 194 males). OUTCOME MEASURES Patient's preoperative characteristics, pre and postoperative spinopelvic parameters, surgical variables, postoperative complications and were recorded. Surgical site infections were asserted in case of clinical signs associated with positive surgical samples. Each case was treated with surgical reintervention for debridement and irrigation. Presence of pseudarthrosis was defined by the association of clinical symptoms and radiological signs of nonfusion (either direct evidence on CT-scan or indirect radiographic clues such as screw loosening, rod breakage, screw pull out or loss of correction). Each iterative surgical intervention was collected. METHODS Univariate and multivariate analysis with logistic regression models were performed to evaluate the role of risk factors of pseudarthrosis. RESULTS Nine hundred fifty-six surgical ASD patients with more than two years of follow-up were included in the study. 65 of these patients were treated for SSI (6.8%), 138 for pseudarthrosis (14.4%), and 28 patients for both SSI and pseudarthrosis. On multivariate analysis, SSI was found to be a major risk factor of pseudarthrosis (OR=4.4; 95% CI=2.4,7.9) as well as other known risks factors: BMI (OR=1.1; 95% CI=1.0,1.1), smoking (OR=1.6; 95% CI=1.1,2.9), performance of Smith-Petersen osteotomy (OR = 1.6; 95% CI 1.0,2.6), number of vertebrae instrumented (OR=1.1; 95% CI=1.1,1.2) and the caudal level of fusion, with a distal exponential increment of the risk (OR max for S1=6, 95% CI=1.9,18.6). CONCLUSION SSI significantly increases the risk of pseudarthrosis with an OR of 4.4.
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Affiliation(s)
- Alice Boishardy
- Université de Bordeaux, Bordeaux University Hospital, Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France.
| | - Benjamin Bouyer
- Université de Bordeaux, Bordeaux University Hospital, Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Louis Boissière
- Université de Bordeaux, Bordeaux University Hospital, Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France; Clinique du Dos-Bordeaux and ELSAN Polyclinique Jean Villar, 33520, Bruges, France
| | - Daniel Larrieu
- Institut de la colonne vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | | | - David Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Ferran Pellisé
- Spine Surgery Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | - Ahmet Alanay
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ibrahim Obeid
- Université de Bordeaux, Bordeaux University Hospital, Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France; Clinique du Dos-Bordeaux and ELSAN Polyclinique Jean Villar, 33520, Bruges, France
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Kieser DC, Wyatt MC, Boissiere L, Hayashi K, Cawley DT, Yilgor C, Larrieu D, Alanay A, Acaroglu E, Kleinstueck F, Pellisé F, Perez-Grueso FJS, Bourghli A, Vital JM, Gille O, Obeid I. An age and sex matched study on the effect of obesity on the functional outcomes and complication rates in patients with adult spinal deformity undergoing primary multi-level thoracolumbar spinal fusion. Ann Jt 2022; 7:33. [PMID: 38529155 PMCID: PMC10929431 DOI: 10.21037/aoj-22-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/18/2022] [Indexed: 03/27/2024]
Abstract
Background The objective of this study was to determine the effect of obesity on the functional outcomes and complication rates of patients with adult spinal deformity (ASD) undergoing multi-level thoracolumbar fusion. Methods An age and sex matched comparison of functional outcomes [Numeric Rating Scale (NRS) back and leg scores, Core Outcome Measurement Index (COMI) back scores, Scoliosis Research Society 22 (SRS22) satisfaction and total scores, Short Form 36 (SF36) general health scores, Physical Component Score (PCS), Mental Component Score (MCS), Oswestry Disability Index (ODI) (including all domains)] at 6 months, 1, 2, 3 and 4 years and the complication rates at final follow-up between obese [body mass index (BMI) >30] and normal BMI (18.5-24.9) patients undergoing more than 3 levels of thoracolumbar fusion with a minimum 2-year follow-up. Patients who had undergone any previous spinal surgery were excluded. Results Thirty patients were included in each arm of the study. Baseline demographics, including the number of levels fused, were similar between the groups. Estimated blood loss (EBL) was higher in obese patients (1,916 vs. 1,099 mL, P=0.001), but operative time was similar (282 vs. 320 min, P=0.351). The functional outcomes and satisfaction scores were consistently poorer in the obese group at all time-points, but their satisfaction scores were similar. Obese patients had a higher complication rate (OR 3.05, P=0.038) predominantly due to dural tears and nerve root injuries, but a similar reoperation rate. Conclusions In patients with ASD undergoing multi-level thoracolumbar fusion, obesity results in a higher blood loss, poorer sagittal correction, poorer post-operative functional scores and higher complication rates than patients with a normal BMI. However, obesity does not affect operative times, length of hospital stay or reoperation rates. Furthermore, patients with obesity have similar post-operative satisfaction scores to patients with normal BMIs.
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Affiliation(s)
- David Christopher Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Michael Charles Wyatt
- 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
| | - Kazunori Hayashi
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | | | - Caglar Yilgor
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Daniel Larrieu
- L'Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, Bordeaux, France
| | - Ahmet Alanay
- Acibadem University School of Medicine, Istanbul, Turkey
| | - Emre Acaroglu
- Spine Surgery Unit, Ankara Acibadem ARTES Spine Center, Ankara, Turkey
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Jean-Marc Vital
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Olivier Gille
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Ibrahim Obeid
- L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
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Bourghli A, Boissiere L, Cawley D, Larrieu D, Pizones J, Alanay A, PelIise F, Kleinstück F, Obeid I. Domino connector is an efficient tool to improve lumbar lordosis correction angle after pedicle subtraction osteotomy for adult spinal deformity. Eur Spine J 2022; 31:2408-2414. [PMID: 35857129 DOI: 10.1007/s00586-022-07322-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/10/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To compare the radiological outcomes and complications of adult spinal deformity patients who underwent a pedicle subtraction osteotomy (PSO) below L2 but categorized according to their construct where either a domino connector was applied for osteotomy correction or not. METHODS Retrospective review of a prospective, multicenter adult spinal deformity database (5 sites). Inclusion criteria were adult patients who underwent PSO between L3 and L5 with a minimum follow-up of 2 years. Among 1243 patients in the database, 79 met the inclusion criteria, 41 in the no-domino (ND) group and 38 in the domino (D) group. The domino technique consisted of using 2 parallel rods connected by a domino on one side of the PSO in order to achieve gradual and controlled compression at the osteotomy site. Demographic data, operative parameters, spinopelvic parameters and complications were collected. RESULTS Demographic data and operative parameters were globally similar between both groups, and they showed a comparable preoperative sagittal malalignment. Segmental lordosis improved by 22° and 31° (p < 0.05) and L1S1 lordosis improved by 23° and 32° (p < 0.05) in the ND and D group, respectively. The use of multiple rods was similar between the groups (58% vs. 57%). Also, mechanical complications rate was globally similar between both groups with no statistically significant difference (22% vs. 28.9%). CONCLUSION Domino connector is a safe, powerful and efficient tool for pedicle subtraction osteotomy site closure. It improved the lumbar lordosis correction angle with an acceptable rate of complications.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, Riyadh, 11671, Saudi Arabia.
| | - Louis Boissiere
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | | | - Daniel Larrieu
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ferran PelIise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
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Bourghli A, Boissiere L, Al Araki A, Alsofyani MA, Obeid I. Surgical correction of a previously operated juvenile idiopathic scoliosis with crankshaft phenomenon: an illustrative case report. J Spine Surg 2022; 8:397-404. [PMID: 36285099 PMCID: PMC9547701 DOI: 10.21037/jss-22-31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022]
Abstract
Background Crankshaft phenomenon secondary to posterior fusion for scoliotic deformity at a young age has become rare and its management can be very challenging. Case Description We report the case of an 11-year-old girl who has been complaining of a progressively increasing hump in her back with waist and shoulders asymmetry during the past 6 months. Three years prior to presentation, she underwent in another institution posterior correction fusion from T3 to L3 for a juvenile idiopathic scoliosis with a Cobb angle of 60°. After the initial correction, follow-up X-rays revealed a progressive increase of the scoliosis angulation with the onset of a coronal malalignment mainly at the cervicothoracic junction. Full spine anteroposterior and lateral X-rays revealed a long right thoracolumbar scoliosis of 70° with a rib-vertebra angle difference of 27° and the proximal right screw pulled out from the rod. CT scan confirmed the posterior fusion between the apical vertebras. MRI did not show any congenital anomaly. The patient underwent a revision surgery with instrumentation from T1 to L4, and posterior column osteotomies at 6 levels between T4 and T10. Coronal Cobb angle corrected to 11° with satisfactory sagittal alignment and a maintained correction at 3 years of follow-up. Conclusions This is the first case to thoroughly illustrate surgical management in the onset of a crankshaft phenomenon. Through a posterior-only approach, the use of posterior column osteotomies at the apex of the deformity in order to release the previous fusion is a safe and satisfactory option to reestablish proper coronal and sagittal alignment, with satisfactory clinical and radiological long-term results.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Louis Boissiere
- Spine Clinic, Elsan Jean Villar Private Hospital, Bordeaux, France
| | - Ahmad Al Araki
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Mohammed A. Alsofyani
- Orthopedic Department, College of Medicine and University Hospital, University of Ha’il, Ha’il, Saudi Arabia
| | - Ibrahim Obeid
- Spine Clinic, Elsan Jean Villar Private Hospital, Bordeaux, France
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Mannion AF, Elfering A, Fekete TF, Harding IJ, Monticone M, Obid P, Niemeyer T, Liljenqvist U, Boss A, Zimmermann L, Vila-Casademunt A, Sánchez Pérez-Grueso FJ, Pizones J, Pellisé F, Richner-Wunderlin S, Kleinstück FS, Obeid I, Boissiere L, Alanay A, Bagó J. Shorter and sweeter: the 16-item version of the SRS questionnaire shows better structural validity than the 20-item version in young patients with spinal deformity. Spine Deform 2022; 10:1055-1062. [PMID: 35476321 DOI: 10.1007/s43390-022-00509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/02/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In patients with adult spinal deformity, it was previously shown that 16 of the non-management items of the SRS-instrument showed a better fit to the theoretical four-factor model (pain, function, self-image, mental health) than did all 20 items. Whether the same phenomenon is observed in data from younger (< 20y) patients, for whom the questionnaire was originally designed, is not currently known. METHODS Confirmatory factor analysis was used to evaluate the factor structure of the 20 non-management items of the SRS-instrument completed by 3618 young patients with spinal deformity (75.5% female; mean age, 15.0 ± 2.0 years) and of its equivalence across language versions (2713 English-speaking, 270 Spanish, 264 German, 223 Italian, and 148 French). The root mean square error of approximation (RMSEA) and comparative fit index (CFI) indicated model fit. RESULTS Compared with the 20-item version, the 16-item solution significantly increased the fit (p < 0.001) across all language versions, to achieve good model fit (CFI = 0.96, RMSEA = 0.06). For both 16-item and 20-item models, equivalence across languages was not reached, with some items showing weaker item-loading for some languages, in particular German and French. CONCLUSION In patients with adolescent idiopathic scoliosis, the shorter 16-item version showed a better fit to the intended 4-factor structure of the SRS-instrument. The wording of some of the items, and/or their equivalence across language versions, may need to be addressed. Questionnaire completion can be a burden for patients; if a shorter, more structurally valid version is available, its use should be encouraged.
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Affiliation(s)
- A F Mannion
- Department Teaching, Research and Development, Spine Subdivision, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland.
| | - A Elfering
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - T F Fekete
- Spine Centre, Schulthess Klinik, Zürich, Switzerland
| | | | - M Monticone
- Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - P Obid
- Dept. of Orthopaedics and Orthopaedic Surgery, Greifswald, University Hospital, Ferdinand-Sauerbruch-Strasse, Greifswald, 17475, Germany
| | - T Niemeyer
- Spine and Scoliosis Center, Asklepios Paulinen Klinik Wiesbaden, Wiesbaden, Germany
| | - U Liljenqvist
- Department Spine Surgery, St Franziskus Hospital, Münster, Germany
| | - A Boss
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - L Zimmermann
- Department Teaching, Research and Development, Spine Subdivision, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland
| | - A Vila-Casademunt
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
| | | | - J Pizones
- Spine Unit, Department of Orthopedic Surgery, University Hospital La Paz, Madrid, Spain
| | - F Pellisé
- Spine Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - S Richner-Wunderlin
- Department Teaching, Research and Development, Spine Subdivision, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Switzerland
| | | | - I Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - L Boissiere
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - A Alanay
- Dept. Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - J Bagó
- Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain
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Adhikari P, Çetin E, Çetinkaya M, Nabi V, Yüksel S, Vila Casademunt A, Obeid I, Sanchez Perez-Grueso F, Acaroğlu E. Ability of Visual Analogue Scale to predict Oswestry Disability Index improvement and surgical treatment decision in patients with adult spinal deformity. Brain Spine 2022; 2:100934. [PMID: 36605390 PMCID: PMC9808375 DOI: 10.1016/j.bas.2022.100934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/26/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
Introduction The effect of pain on HRQoL scores in ASD patients is not well studied. Disability is a major factor on decision and outcomes. On the other hand, little is known about the effect of perceived and reported pain on these parameters, especially in the elderly population. We hypothesized that baseline back and leg pain would not affect the treatment decision whereas may have a negative effect on outcomes. Research question To determine the correlation between preoperative ODI and VAS scores; and to identify the effect of baseline VAS score on treatment decision and ODI improvement following treatment. Material and methods In this retrospective study, patients with a follow-up duration of minimum 2 years were enrolled from a prospective multicentric ASD database. Pearson and Spearman correlation tests were used to evaluate the correlation between ODI and VAS scores; univariate binary logistic regression method was used to analyze the effect of VAS on treatment decision as well as the outcomes. Results 1050 patients (mean age 48.2) were analyzed. Baseline ODI and back, leg pain VAS scores were significantly correlated (P < 0.001). One unit increase in baseline back and leg pain VAS scores, increased the probability of improvement in ODI by 1.219 (P = 0.016) and 1.182 times (P = 0.029), respectively in surgically treated patients; and reduced it by 0.894 times (P = 0.012) for conservatively treated patients. For patients >70 years old, one-unit increase in baseline leg pain VAS score increased the probability of deciding on surgical treatment by 1.121 times (p = 0.016). Discussion and conclusions Preoperative back and leg pain VAS scores were found to be significantly correlated with the preoperative ODI scores. Additionally, preoperative baseline back and leg pain VAS scores were useful in predicting the improvement in disability as assessed by ODI. Another important finding was that, higher baseline leg pain (but not back pain) VAS scores increased the rate of elderly patients preferring surgical treatment.
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Affiliation(s)
- Prashant Adhikari
- Hospital for Advance Medicine and Surgery (HAMS), Dhumbarai, Mandhikatar Road, Kathmandu, Nepal,Corresponding author. Hospital for Advance Medicine and Surgery (HAMS), Dhumbarai, Mandhikatar Road, Kathmandu, Nepal.
| | - Engin Çetin
- Gaziosmanpasa Training and Research Hospital, Karayolları Mahallesi, Osmanbey Caddesi, 621, Sokak, 34255, Gaziosmanpaşa, Istanbul, Turkey
| | - Mehmet Çetinkaya
- Başakşehir Çam ve Sakura City Hospital, Başakşehir Olimpiyat Bulvarı Yolu, 34480, Başakşehir, Istanbul, Turkey
| | - Vugar Nabi
- Antalya Training and Research Hospital, Varlık Mh, Kazım Karabekir Cd, 07100, Antalya, Turkey
| | - Selcen Yüksel
- Yıldırım Beyazıt University, Department of Biostatistics, Yıldırım Beyazıt Üniversitesi Biyoistatistik Departmenı, Ankara, Turkey
| | | | - Ibrahim Obeid
- Bordeaux University Department of Orthopaedics, Bordeaux University Hospital, Department of Orthopaedics, Bordeaux, France
| | | | - Emre Acaroğlu
- Ankara Spine Center, Iran Caddesi 45/2, Kavaklidere, 06700, Ankara, Turkey
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Charles YP, Bauduin E, Pesenti S, Ilharreborde B, Prost S, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Blondel B. Variation of Global Sagittal Alignment Parameters According to Gender, Pelvic Incidence, and Age. Clin Spine Surg 2022; 35:E610-E620. [PMID: 35383599 DOI: 10.1097/bsd.0000000000001321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE The aim was to describe existing global sagittal alignment parameters across ages and to analyze differences according to gender and pelvic incidence (PI). SUMMARY OF BACKGROUND DATA Variability with age has been reported. It remains unclear how gender and spinopelvic morphology could additionally influence global alignment parameters. MATERIALS AND METHODS Radiographs of 2599 individuals (5-93 y) were analyzed. Translation parameters were: Sagittal Vertical Axis (SVA)-C7, SVA-C2, SVA-Center Acoustic Meatus (CAM), C7/Sacrofemoral Distance (SFD) ratio. Inclination parameters were: C7-Vertical Tilt (VT), T1-VT and T9-VT, Odontoid-Hip Axis (OD-HA), OD-CAM. Pelvic compensation parameters were: T1-Pelvic Angle (TPA), Global Tilt (GT), Spino-Sacral Angle (SSA). Global sagittal alignment (GSA) was considered among formulae. The distribution of parameters was analyzed using a Bayesian inference. Correlations with spinopelvic parameters were investigated. RESULTS SVA-C7, SVA-C2, SVA-CAM were larger in males and high PI, and increased significantly after 50 years (Pr>0.9999). C7/SFD decreased during growth and was larger in low PI (Pr=0.951). There was no correlation with spinopelvic parameters. Age-related variations of inclination parameters were nonsignificant. T1-VT and T9-VT increased with PI and were significantly larger in high PI (Pr>0.95). C7-VT was significantly larger in low PI (Pr>0.9999). OD-HA and OD-CAM were constant and increased after 80 years. TPA and GT increased with PI (Pr>0.9999) and age after 35 years (Pr>0.9999). SSA decreased nonsignificantly after 50 years. TPA correlated with PI (ρ=0.6130) and pelvic tilt (PT) (ρ=0.8375). GT correlated with PI (ρ=0.5961) and PT (ρ=0.8996). SSA correlated with sacral slope (ρ=0.9026). GSA was larger in high PI (Pr>0.9999) and increased after 35 years (Pr>0.9999). GSA correlated with PT (ρ=0.7732). CONCLUSION Translation parameters increase with age, more prominently in males and high PI. Variations of inclination parameters are smaller. Pelvic compensation parameters and GSA increase with age and are closely related to PT and spinopelvic morphology. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yann P Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris
| | - Georges N Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris
| | | | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris
| | - Jonathan Lebhar
- Institut Locomoteur de l'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire
| | | | | | - Erik A Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille
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Pellisé F, Vila-Casademunt A, Núñez-Pereira S, Haddad S, Smith JS, Kelly MP, Alanay A, Shaffrey C, Pizones J, Yilgor Ç, Obeid I, Burton D, Kleinstück F, Fekete T, Bess S, Gupta M, Loibl M, Klineberg EO, Sánchez Pérez-Grueso FJ, Serra-Burriel M, Ames CP. Surgeons' risk perception in ASD surgery: The value of objective risk assessment on decision making and patient counselling. Eur Spine J 2022; 31:1174-1183. [PMID: 35347422 DOI: 10.1007/s00586-022-07166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/17/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgeons often rely on their intuition, experience and published data for surgical decision making and informed consent. Literature provides average values that do not allow for individualized assessments. Accurate validated machine learning (ML) risk calculators for adult spinal deformity (ASD) patients, based on 10 year multicentric prospective data, are currently available. The objective of this study is to assess surgeon ASD risk perception and compare it to validated risk calculator estimates. METHODS Nine ASD complete (demographics, HRQL, radiology, surgical plan) preoperative cases were distributed online to 100 surgeons from 22 countries. Surgeons were asked to determine the risk of major complications and reoperations at 72 h, 90 d and 2 years postop, using a 0-100% risk scale. The same preoperative parameters circulated to surgeons were used to obtain ML risk calculator estimates. Concordance between surgeons' responses was analyzed using intraclass correlation coefficients (ICC) (poor < 0.5/excellent > 0.85). Distance between surgeons' and risk calculator predictions was assessed using the mean index of agreement (MIA) (poor < 0.5/excellent > 0.85). RESULTS Thirty-nine surgeons (74.4% with > 10 years' experience), from 12 countries answered the survey. Surgeons' risk perception concordance was very low and heterogeneous. ICC ranged from 0.104 (reintervention risk at 72 h) to 0.316 (reintervention risk at 2 years). Distance between calculator and surgeon prediction was very large. MIA ranged from 0.122 to 0.416. Surgeons tended to overestimate the risk of major complications and reintervention in the first 72 h and underestimated the same risks at 2 years postop. CONCLUSIONS This study shows that expert surgeon ASD risk perception is heterogeneous and highly discordant. Available validated ML ASD risk calculators can enable surgeons to provide more accurate and objective prognosis to adjust patient expectations, in real time, at the point of care.
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Affiliation(s)
- Ferran Pellisé
- Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain.
| | | | | | - Sleiman Haddad
- Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Washington University, St Louis, MO, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey
| | | | - Javier Pizones
- Spine Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Çaglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey
| | - Ibrahim Obeid
- Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Tamas Fekete
- Spine Center Division, Schulthess Klinik, Zurich, Switzerland
| | - Shay Bess
- Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University, St Louis, MO, USA
| | - Markus Loibl
- Spine Center Division, Schulthess Klinik, Zurich, Switzerland
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, CA, USA
| | | | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christopher P Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
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Kieser DC, Yuksel S, Boissiere L, Yilgor C, Cawley DT, Hayashi K, Alanay A, Kleinstueck FS, Pellise F, Perez-Grueso FJS, Jean-Marc V, Bourghli A, Acaroglu ER, Obeid I. Impact of radiologic variables on item responses of ODI, SRS22 and SF-36. in adult spinal deformity patients: differential item functioning (DIF) analysis results from a multi-center database. Eur Spine J 2022; 31:1166-1173. [PMID: 35059861 DOI: 10.1007/s00586-021-07088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/24/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine if responses given to each question of the Scoliosis Research Society-22 (SRS22), Oswestry disability index (ODI) and Short Form-36 (SF-36) questionnaires are influenced by the radiological parameters. METHODS Patients enrolled in a multi-centre prospectively collected adult spinal deformity database who had complete SRS22, ODI and SF-36 data at baseline and at one-year follow-up were analysed. The presence of a differential item function of each question within each score in relation to radiological parameters was analysed using a mixed Rasch model with the radiological threshold value(s) determined. RESULTS Of those patients analysed (n = 1745; 1406 female, average age 51.0 ± 19.8 years), 944 were surgically and 801 were non-surgically treated. For the SRS22, questions (Q) 3, 5 and 18 were sensitive to almost all radiological parameters and the overall score was found sensitive to the Cobb angle. For the ODI, Q3, 6, 9 and 10 were not sensitive to any radiologic parameters whereas Q4 and 5 were sensitive to most. In contrast, only 3 of the SF-36 items were sensitive to radiological parameters. CONCLUSIONS 78% of the SRS-22, 60% of the ODI and 8% of the questions in the SF-36 are sensitive to radiological parameters. Sagittal imbalance is independently associated with a poor overall outcome, but affects mental status and function more than pain and self-image. The assembly of questions responsive to radiological parameters may be useful in establishing a connection between changes in radiologic parameters and HRQL.
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Affiliation(s)
- D C Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, 2 Riccarton Avenue, 8011, Christchurch, New Zealand.
| | - S Yuksel
- School of Medicine Ankara, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - L Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - C Yilgor
- Mater Private Hospital, Dublin, Ireland
| | - D T Cawley
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France.,Mater Private Hospital, Dublin, Ireland
| | - K Hayashi
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - A Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | - F Pellise
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Vital Jean-Marc
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | - A Bourghli
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
| | | | - I Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, 33076, Bordeaux, France
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Charles YP, Prost S, Pesenti S, Ilharreborde B, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Blondel B. Variation of cervical sagittal alignment parameters according to gender, pelvic incidence and age. Eur Spine J 2022; 31:1228-1240. [PMID: 34989876 DOI: 10.1007/s00586-021-07102-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to describe radiographic cervical sagittal alignment variations according to age, gender and pelvic incidence (PI) and to investigate relationships with thoracic alignment. METHODS A total of 2599 individuals (5-93 years) without spinal deformity were studied. Cranial cervical parameters were: McGregor slope, occipita-C2 angle, McGregor-C2 lordosis and C1-C2 lordosis. Caudal cervical parameters were: C2-C7, cranial arch and caudal arch lordosis and C7- and T1-slope. A Bayesian inference compared parameter distributions. Correlations with spinopelvic and global alignment parameters were investigated. RESULTS Among cranial cervical parameters, variations of McGregor slope were non-significant. McGregor-C2 lordosis and C1-C2 lordosis were smaller in males and increased significantly during growth, whereas the occipito-C2 angle decreased (Pr > 0.95). The occipito-C2 angle was larger and McGregor-C2 lordosis was smaller in low PI (Pr > 0.95). Among caudal cervical parameters, C2-C7 lordosis and C7- and T1-slope were larger in males and increased after 50 years (Pr > 0.95). Lordosis changes were non-significant in the cranial arch, whereas values increased in the caudal arch after 35 years (Pr > 0.95). Caudal parameter differences were non-significant between PI groups. Strong correlations existed between C2-C7, caudal arch lordosis, C7-slope, T1-slope and thoracic kyphosis. The sagittal vertical axis C2 correlated with caudal arch lordosis and T1-slope (ρ > 0.5; Pr > 0.95). CONCLUSION Cervical alignment parameters vary according to age, gender and PI. In the cranial cervical spine, changes occur mainly during growth. In the caudal cervical spine, lordosis increases in the caudal arch, which is related to thoracic kyphosis increase with age. The caudal cervical arch acts as a compensatory segment by progressive extension, allowing horizontal gaze.
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Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Centre Orthopédique Santy, Unité du Rachis, Lyon, France
| | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Jonathan Lebhar
- Institut Locomoteur de L'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France
| | | | | | - Erik André Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
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Charles YP, Prost S, Pesenti S, Ilharreborde B, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Blondel B. Correction to: Variation of cervical sagittal alignment parameters according to gender, pelvic incidence and age. Eur Spine J 2022; 31:1330. [PMID: 35301583 DOI: 10.1007/s00586-022-07170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Centre Orthopédique Santy, Unité du Rachis, Lyon, France
| | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Jonathan Lebhar
- Institut Locomoteur de L'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France
| | | | | | - Erik André Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
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Pellisé F, Serra-Burriel M, Vila-Casademunt A, Gum JL, Obeid I, Smith JS, Kleinstück FS, Bess S, Pizones J, Lafage V, Pérez-Grueso FJS, Schwab FJ, Burton DC, Klineberg EO, Shaffrey CI, Alanay A, Ames CP. Quality metrics in adult spinal deformity surgery over the last decade: a combined analysis of the largest prospective multicenter data sets. J Neurosurg Spine 2022; 36:226-234. [PMID: 34598152 DOI: 10.3171/2021.3.spine202140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The reported rate of complications and cost of adult spinal deformity (ASD) surgery, associated with an exponential increase in the number of surgeries, cause alarm among healthcare payers and providers worldwide. The authors conjointly analyzed the largest prospective available ASD data sets to define trends in quality-of-care indicators (complications, reinterventions, and health-related quality of life [HRQOL] outcomes) since 2010. METHODS This is an observational prospective longitudinal cohort study. Patients underwent surgery between January 2010 and December 2016, with > 2 years of follow-up data. Demographic, surgical, radiological, and HRQOL (i.e., Oswestry Disability Index, SF-36, Scoliosis Research Society-22r) data obtained preoperatively and at 3, 6, 12, and 24 months after surgery were evaluated. Trends and changes in indicators were analyzed using local regression (i.e., locally estimated scatterplot smoothing [LOESS]) and adjusted odds ratio (OR). RESULTS Of the 2286 patients included in the 2 registries, 1520 underwent surgery between 2010 and 2016. A total of 1151 (75.7%) patients who were treated surgically at 23 centers in 5 countries met inclusion criteria. Patient recruitment increased progressively (2010-2011 vs 2015-2016: OR 1.64, p < 0.01), whereas baseline clinical characteristics (age, American Society of Anesthesiologists class, HRQOL scores, sagittal deformity) did not change. Since 2010 there has been a sustained reduction in major and minor postoperative complications observed at 90 days (major: OR 0.59; minor: OR 0.65; p < 0.01); at 1 year (major: OR 0.52; minor: 0.75; p < 0.01); and at 2 years of follow-up (major: OR 0.4; minor: 0.80; p < 0.01) as well as in the 2-year reintervention rate (OR 0.41, p < 0.01). Simultaneously, there has been a slight improvement in the correction of sagittal deformity (i.e., pelvic incidence-lumbar lordosis mismatch: OR 1.11, p = 0.19) and a greater gain in quality of life (i.e., Oswestry Disability Index 26% vs 40%, p = 0.02; Scoliosis Research Society-22r, self-image domain OR 1.16, p = 0.13), and these are associated with a progressive reduction of surgical aggressiveness (number of fused segments: OR 0.81, p < 0.01; percent pelvic fixation: OR 0.66, p < 0.01; percent 3-column osteotomies: OR 0.63, p < 0.01). CONCLUSIONS The best available data show a robust global improvement in quality metrics in ASD surgery over the last decade. Surgical complications and reoperations have been reduced by half, while improvement in disability increased and correction rates were maintained, in patients with similar baseline characteristics.
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Affiliation(s)
- Ferran Pellisé
- 1Spine Research Unit, Vall d'Hebron Research Institute, Barcelona
- 2Spine Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Miquel Serra-Burriel
- 3Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | | | - Jeffrey L Gum
- 4Norton Leatherman Spine Center, Louisville, Kentucky
| | - Ibrahim Obeid
- 5Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Justin S Smith
- 6Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | | | - Shay Bess
- 8Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado
| | - Javier Pizones
- 9Spine Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Virginie Lafage
- 10Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | | | - Frank J Schwab
- 10Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Douglas C Burton
- 11Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric O Klineberg
- 12Department of Orthopedic Surgery, University of California, Davis, Sacramento, California
| | | | - Ahmet Alanay
- 14Department of Orthopedics and Traumatology, Acibadem University, Istanbul, Turkey; and
| | - Christopher P Ames
- 15Department of Neurosurgery, University of California, San Francisco, California
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Pizones J, Moreno-Manzanaro L, Vila-Casademunt A, Fernández-Baíllo N, Sánchez-Márquez J, Talavera G, Obeid I, Alanay A, Kleinstück F, Pellisé F, Perez-Grueso FJS. Adult Congenital Spine Deformity: Clinical Features and Motivations for Surgical Treatment. Int J Spine Surg 2022; 15:1238-1245. [PMID: 35078898 DOI: 10.14444/8157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is scarce information available about adult congenital spine deformity (ACSD) in the literature, especially its impact after the pediatric age. The aim was to define ACSD characteristics and to establish the drivers for surgical intervention. METHODS Cross-sectional study of data collected in an adult deformity multicenter database. Only ACSD patients were included. Demographic and radiographic data, as well as patient-reported outcome measures, were assessed. Conservatively (C) vs surgically (S) treated patients were compared using Student t test, χ², and Mann-Whitney U test. RESULTS Fifty-two patients were included. They were young adults (x = 37.7 years), mostly female (71%). Among them, 60% had single hemivertebrae (HV), 35% had multiple HV, and 5% had segmentation defects. Also, 75% had mainly coronal deformity (Cobb 62.5° ± 29.6) and 25% had sagittal deformity.Mean Oswestry Disability Index (ODI) was 29.6% ± 17 and mean Scoliosis Research Society 22-item survey (SRS-22) total score was 3.2 ± 0.8. Of note, mean SRS-22 self-image score was 2.8 ± 0.9 and 36-item Short Form Health Survey (SF-36) physical function score was 40.9 ± 11.Thirty patients were treated conservatively (C), whereas 22 patients underwent surgery (S). No differences were found regarding age, type or location of the deformity, comorbidities, or radiographic parameters. Operated patients had worse Core Outcome Measurement Index (COMI) back scores (C: 3.8 ± 2.4 vs S: 6.7 ± 2.4; P = 0.004); worse SRS-22 self-image (C: 3 ± 0.9 vs S: 2.5 ± 0.9; P = 0.047), and SRS-22 total scores (C: 3.4 ± 0.8 vs S: 2.9 ± 0.7; P = 0.01); worse SF-36 physical component summary (C: 43.3 ± 10.8 vs S: 36.7 ± 10.4; P = 0.048); and worse SF-36 physical role, function, and social function. CONCLUSION Adult congenital deformity patients were mainly female young adults, with formation defects (HV), worried about their image and presenting some degree of functional impairment and pain. These symptoms were the essential drivers for surgery, rather than the radiographic deformity itself. CLINICAL RELEVANCE One of the few studies describing the characteristics and clinical concerns of patients with congenital spinal deformities. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - José Sánchez-Márquez
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Gloria Talavera
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Pizones J, Perez-Grueso FJS, Moreno-Manzanaro L, Escámez F, Yilgor C, Vila-Casademunt A, Fernández-Baíllo N, Sánchez-Márquez JM, Obeid I, Kleinstück F, Alanay A, Pellisé F. Compensatory mechanisms recruited against proximal junctional kyphosis by patients instrumented from the thoracolumbar junction to the iliac. Eur Spine J 2021; 31:112-122. [PMID: 34750669 DOI: 10.1007/s00586-021-07042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The compensatory mechanisms recruited by un-instrumented patients against sagittal imbalance are well documented. However, there is a lack of information regarding instrumented patients. MATERIAL AND METHODS We performed a retrospective analysis of data collected prospectively in a multicenter adult spinal deformity database. We included patients suffering PJK/PJF after (T8-L2) to iliac instrumentation with minimum two-year follow-up. We measured quantitative sagittal spinopelvic and qualitative sagittal distribution parameters in the immediate postoperative period (6w) and at the time of PJK/PJF appearance. We analyzed how these parameters changed comparing these two time points with univariate and multivariate logistic regression analyses. RESULTS A total of 69 patients were included. Two different patterns at PJK/PJF were found: 36 patients activated compensation (defined as an increase in pelvic retroversion (ΔRPV > 5º), and 33 did not (ΔRPV < 5º). The difference in behavior relied mostly on the amount of not surgically restored pelvic rotation at 6w (OR: 0.6; CI95%: 0.4-9.2; P = 0.017). Non-compensators had less rotation reserve (PTx100/PI = 33.9% vs 47.8%;P < 0.001) associated with worse 6w relative pelvic version and lower lumbar arc restoration, worse 6w relative sagittal alignment and GAP-score, compared with compensators (P < 0.001). Compensators' response was based on pelvic retroversion, causing lower lumbar arc decrease, lumbar apex caudal migration, and upper lumbar arc posterior inclination. Despite compensation, a thoracic kyphosis increase in both upper and lower arches gradually evolved into a PJK/PJF. Non-compensators did not react to PJK/PJF, which forced them into kyphosis from the lumbar apex and extending cranially, mainly throughout the upper thoracic arc. CONCLUSIONS In patients fused from the TL junction to the iliac, those having greater postoperative pelvic rotation reserve showed greater capacity to recruit compensatory mechanisms against PJK/PJF.
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Affiliation(s)
- Javier Pizones
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | | | - Lucía Moreno-Manzanaro
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Fernando Escámez
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Nicomedes Fernández-Baíllo
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - José Miguel Sánchez-Márquez
- Department of Orthopedic Surgery, Spine Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Ibrahim Obeid
- Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France
| | - Frank Kleinstück
- Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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47
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Bourghli A, Boissière L, Kieser D, Larrieu D, Pizones J, Alanay A, Pellisé F, Kleinstück F, Obeid I. Multiple-Rod Constructs Do Not Reduce Pseudarthrosis and Rod Fracture After Pedicle Subtraction Osteotomy for Adult Spinal Deformity Correction but Improve Quality of Life. Neurospine 2021; 18:816-823. [PMID: 34670073 PMCID: PMC8752720 DOI: 10.14245/ns.2142596.298] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To compare the radiological and functional outcomes and complications of adult spinal deformity patients who underwent a pedicle subtraction osteotomy (PSO) below L2 but categorized according to their construct where either 2-rod or multiple-rod construct is applied.
Methods Sixty-seven patients met the inclusion criteria, and were categorized into 3 groups: 2 rods (2R), multiple rods around the PSO (MRP), multiple rods around the PSO and lumbosacral junction (MRL). Demographic data, operative parameters, spinopelvic parameters, functional outcomes, and complications were collected.
Results Health-related quality of life scores showed a better outcome at 6 months and last follow-up visits in the MRP and MRL groups which were noted on different domains of Scoliosis Research Society-22 questionnaire, 36-item Short Form Health Surve, and Oswestry Disability Index scores (p<0.05). The 3 groups showed similar rates of rod-related complications with no significant difference (p=0.95). And inside each group, distribution of complications between pseudarthrosis with revision and rod fracture without revision was also similar (p=0.99).
Conclusion The use of multiple rods across the PSO did not show a better outcome when compared to single rods in terms of incidence and types of mechanical complications. However, better postoperative coronal alignment and health-related quality of life scores in the multiple rods group could be seen demonstrating an improved functional outcome.
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Affiliation(s)
- Anouar Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Louis Boissière
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
| | - David Kieser
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine , Dunedin, New Zealand
| | - Daniel Larrieu
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ahmet Alanay
- Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain
| | | | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
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48
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Rostami M, Moghadam N, Obeid I, Jouibari MF, Zarei M, Moosavi M, Khoshnevisan A, Farahbakhsh F, Moosaie F, Ehteshami S, Borghei A, Shafizadeh M, Kordi R, Khadivi M. The Impact of Single-Level Anterior Cervical Discectomy and Fusion on Cervical Sagittal Parameters and Its Correlation With Pain and Functional Outcome of Patients With Neck Pain. Int J Spine Surg 2021; 15:899-905. [PMID: 34625454 DOI: 10.14444/8115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study examines the changes in segmental and global cervical sagittal parameters after single-level anterior cervical discectomy and fusion (ACDF) in patients with cervical radiculopathy or myelopathy. We also investigate whether these changes have any relation with postoperative pain and functional outcome of the patients. METHODS Sixty patients (37 females and 23 males) with a mean age of 45.9 ± 9.5 years who were candidates of single-level ACDF due to cervical myelopathy or radiculopathy participated in the study. At baseline, 1 month, and 6 months after ACDF, outcomes of the study including sagittal balance parameters, pain intensity, and Neck Disability Index (NDI) were measured among the patients. Intensity of pain and neck disability were measured using the visual analog scale (VAS) and validated version of NDI, respectively. Using a standard lateral cervical radiography, the Cobb angle for occiput-C2, C1-C2, and C2-C7 as well as operation-level angle (OA; Cobb's angle at the level of discopathy), the thoracic inlet angle, and C7 and T1 slope angles were measured. RESULTS The intensity of pain and neck disability of patients improved significantly during the follow up of the study comparing with baseline measurements (P < .001). There was a significant correlation between the increase of C2-C7 angle, C1-C2 angle, and OA and improvement in neck pain and NDI at 1- and 6-month follow ups. CONCLUSIONS We found that changes at C2-C7 angle, C1-C2 angle, and OA have positive significant correlation with clinical outcome including pain improvement and decrease of disability in patients who undergo ACDF. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE The results of this study might be beneficial in selection of cervical cages with appropriate size during ACDF surgery, as our findinds showed that larger cages could lead to better functional outcome in patients.
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Affiliation(s)
- Mohsen Rostami
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Navid Moghadam
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Obeid
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Bordeaux Cedex, France
| | - Morteza Faghih Jouibari
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- Department of Orthopedics, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mersad Moosavi
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khoshnevisan
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Farahbakhsh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moosaie
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Ehteshami
- Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Borghei
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Milad Shafizadeh
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Kordi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khadivi
- Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Cawley DT, Boissiere L, Yilgor C, Larrieu D, Fujishiro T, Kieser D, Alanay A, Kleinstück F, Pérez-Grueso FS, Pellisé F, Obeid I. Relative pelvic version displays persistent compensatory measures with normalised sagittal vertical axis after deformity correction. Spine Deform 2021; 9:1449-1456. [PMID: 33914299 DOI: 10.1007/s43390-021-00345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE A normal sagittal vertical axis (SVA) after spinal deformity correction can yield mechanical complications of up to 30%. Post-operative compensatory pelvic orientation can produce a normal SVA. We assess relative pelvic version (RPV), an individualised measure, for persistent post-operative compensatory measures. METHODS Adult spinal deformity (ASD) patients who were treated operatively, with a normal SVA (< ± 50 mm) at 6-week follow-up were included, who were then followed-up after 2 years. These only included patients with fusion of > 4 vertebrae extending to L5 or below. Six-week subgroups were made regarding pelvis orientation, relative pelvic version (RPV: anteversion, aligned, moderate or severe retroversion) with analysis of patient-related outcome measures (PROMs), complications and spino-pelvic sagittal parameters. RESULTS At 6 weeks, 140 patients met the inclusion criteria, 5 (3.6%) patients had anteversion, 59 (42.1%) were aligned, 60 (42.9%) had moderate retroversion and 16 (11.4%) patients had severe retroversion. Follow-up after 2 years demonstrated increased RPV in all groups except the severe RPV group who were more likely to develop SVA > 50 mm. Complications occurred in all groups. Significant 2-year differences were observed between moderate and severe RPV for back pain and PROMs but not between other RPV groups. CONCLUSION Adult spinal deformity patients with a normal SVA after spino-pelvic instrumentation carry a significant risk of retroversion progression post-operatively, followed by increased positive sagittal balance. Relative pelvic version (RPV) measurements when categorised into anteversion, aligned, moderate retroversion and severe retroversion at 6 weeks were predictive of PROMs at 2 years.
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Affiliation(s)
- Derek T Cawley
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France. .,Mater Private Hospital, Eccles St, Dublin 1, Republic of Ireland.
| | - Louis Boissiere
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - Caglar Yilgor
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Daniel Larrieu
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
| | - Takashi Fujishiro
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.,Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - David Kieser
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France.,Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Ahmet Alanay
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | | | | | - Ferran Pellisé
- Spine Surgery Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Ibrahim Obeid
- Institut de la Colonne Vertébrale, Spine Unit 1, Bordeaux University Hospital, Bordeaux, France
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