Artificial intelligence clustering of adult spinal deformity sagittal plane morphology predicts surgical characteristics, alignment, and outcomes

Study Design: Historical cohort study. Objective: To evaluate progression in the coronal and sagittal planes in nonsurgical patients with adult spinal deformity (ASD). Methods: A retrospective analysis of nonsurgical ASD patients between 2005 and 2017 was performed. Magnitude of the coronal and sagittal planes were compared on the day of presentation and at most recent follow-up. Previous reported prognostic factors for progression in the coronal plane, including the direction of scoliosis, curve magnitude, and the position of the intercrest line (passing through L4 or L5 vertebra), were studied. Results: Fifty-eight patients were included with a mean follow-up of 59.8 ± 34.5 months. Progression in the coronal plane was seen in 72% of patients. Mean Cobb angle on the day of presentation and most recent follow-up was 37.2 ± 14.6° and 40.8° ± 16.5°, respectively. No significant differences were found in curve progression in left- versus right-sided scoliosis (3.3 ± 7.1 vs 3.7 ± 5.4, P = .81), Cobb angle <30° versus ≥30° (2.6 ± 5.0 vs 4.3 ± 6.5, P = .30), or when the intercrest line passed through L4 rather than L5 vertebra (3.4 ± 5.0° vs 3.8 ± 7.1°, P = .79). No significant differences were found in the sagittal plane between presentation and most recent follow-up. Conclusions: This is the first study that describes progression in the coronal and sagittal planes in nonsurgical patients with ASD. Previous reported prognostic factors were not confirmed as truly relevant. Although progression appears to occur, large variation exists and these results may not be directly applicable to the individual patient.

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A Critical Analysis of Sagittal Plane Deformity Correction with Minimally Invasive Adult Spinal Deformity Surgery: A Two-Year Follow-Up Study

The Spine Journal ◽

10.1016/j.spinee.2015.07.113 ◽

2015 ◽

Vol 15 (10) ◽

pp. S126-S127

Author(s):

International Spine Study Group ◽

Gregory M. Mundis ◽

Jay D. Turner ◽

Vedat Deviren ◽

Juan S. Uribe ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Deformity ◽

Critical Analysis ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Follow Up Study ◽

Spinal Deformity Surgery ◽

Plane Deformity

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Multilevel Schwab grade II osteotomies for sagittal plane correction in the management of adult spinal deformity

The Spine Journal ◽

10.1016/j.spinee.2017.05.013 ◽

2017 ◽

Vol 17 (11) ◽

pp. 1594-1600 ◽

Cited By ~ 3

Author(s):

George M. Ghobrial ◽

Nathan H. Lebwohl ◽

Barth A. Green ◽

Joseph P. Gjolaj

Keyword(s):

Spinal Deformity ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Grade Ii

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Artificial Intelligence for Adult Spinal Deformity

Neurospine ◽

10.14245/ns.1938414.207 ◽

2019 ◽

Vol 16 (4) ◽

pp. 686-694 ◽

Cited By ~ 3

Author(s):

Rushikesh S. Joshi ◽

Alexander F. Haddad ◽

Darryl Lau ◽

Christopher P. Ames

Keyword(s):

Artificial Intelligence ◽

Spinal Deformity ◽

Adult Spinal Deformity

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The minimally invasive spinal deformity surgery algorithm: a reproducible rational framework for decision making in minimally invasive spinal deformity surgery

Neurosurgical FOCUS ◽

10.3171/2014.3.focus1413 ◽

2014 ◽

Vol 36 (5) ◽

pp. E6 ◽

Cited By ~ 79

Author(s):

Praveen V. Mummaneni ◽

Christopher I. Shaffrey ◽

Lawrence G. Lenke ◽

Paul Park ◽

Michael Y. Wang ◽

...

Keyword(s):

Decision Making ◽

Minimally Invasive ◽

Spinal Deformity ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Interobserver Reliability ◽

Open Approach ◽

Case Review ◽

Indirect Decompression ◽

Spinal Deformity Surgery

Object Minimally invasive surgery (MIS) is an alternative to open deformity surgery for the treatment of patients with adult spinal deformity. However, at this time MIS techniques are not as versatile as open deformity techniques, and MIS techniques have been reported to result in suboptimal sagittal plane correction or pseudarthrosis when used for severe deformities. The minimally invasive spinal deformity surgery (MISDEF) algorithm was created to provide a framework for rational decision making for surgeons who are considering MIS versus open spine surgery. Methods A team of experienced spinal deformity surgeons developed the MISDEF algorithm that incorporates a patient's preoperative radiographic parameters and leads to one of 3 general plans ranging from MIS direct or indirect decompression to open deformity surgery with osteotomies. The authors surveyed fellowship-trained spine surgeons experienced with spinal deformity surgery to validate the algorithm using a set of 20 cases to establish interobserver reliability. They then resurveyed the same surgeons 2 months later with the same cases presented in a different sequence to establish intraobserver reliability. Responses were collected and tabulated. Fleiss' analysis was performed using MATLAB software. Results Over a 3-month period, 11 surgeons completed the surveys. Responses for MISDEF algorithm case review demonstrated an interobserver kappa of 0.58 for the first round of surveys and an interobserver kappa of 0.69 for the second round of surveys, consistent with substantial agreement. In at least 10 cases there was perfect agreement between the reviewing surgeons. The mean intraobserver kappa for the 2 surveys was 0.86 ± 0.15 (± SD) and ranged from 0.62 to 1. Conclusions The use of the MISDEF algorithm provides consistent and straightforward guidance for surgeons who are considering either an MIS or an open approach for the treatment of patients with adult spinal deformity. The MISDEF algorithm was found to have substantial inter- and intraobserver agreement. Although further studies are needed, the application of this algorithm could provide a platform for surgeons to achieve the desired goals of surgery.

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Prevalence and location of endplate fracture and subsidence after oblique lumbar interbody fusion for adult spinal deformity

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04769-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Gen Inoue ◽

Wataru Saito ◽

Masayuki Miyagi ◽

Takayuki Imura ◽

Eiki Shirasawa ◽

...

Keyword(s):

Spinal Deformity ◽

Interbody Fusion ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Major Complication ◽

Global Alignment ◽

Lumbar Interbody Fusion ◽

Significant Difference ◽

Cage Subsidence ◽

Oblique Lumbar Interbody Fusion

Abstract Background Recently, Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). Endplate fracture during surgery is a major complication of OLIF, but the detailed location of fracture in vertebral endplate in ASD has not yet been determined. We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment. Methods We analyzed 75 levels in 27 patients were analyzed using multiplanar CT to detect the endplate fracture immediately after surgery and subsidence at 1 year postoperatively. The prevalence was compared between anterior and posterior, approach and non-approach sides, and concave and convex side. Their association with fusion status, local and global alignment, and complication was also investigated. Results Endplate fracture was observed in 64 levels (85.3%) in all 27 patients, and the incidence was significantly higher in the posterior area compared with the anterior area (85.3 vs. 68.0%, p=0.02) of affected vertebra in the sagittal plane. In the coronal plane, there was no significant difference in incidence between left (approach) and right (non-approach) sides (77.3 and 81.3%, respectively), or concave and convex sides (69.4 and 79.6%) of wedged vertebra. By contrast, cage subsidence at 1 year postoperatively was noted in 14/75 levels (18.7%), but was not associated with endplate fracture. Fusion status, local and global alignment, and complications were not associated with endplate fracture or subsidence. Conclusion Endplate fracture during OLIF procedure in ASD cases is barely avoidable, possibly induced by the corrective maneuver with ideal rod counter and cantilever force, but is less associated with subsequent cage subsidence, fusion status, and sustainment of corrected alignment in long fusion surgery performed even for elderly patients.

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Sagittal plane correction in pedicle subtraction osteotomy using the Xia 3 SUK Direct Vertebral Rotation System

Journal of Neurosurgery Spine ◽

10.3171/2013.7.spine121162 ◽

2013 ◽

Vol 19 (4) ◽

pp. 507-514 ◽

Cited By ~ 1

Author(s):

Masahiro Kanayama

Keyword(s):

Spinal Deformity ◽

Surgical Procedure ◽

Vertebral Column ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Pedicle Subtraction Osteotomy ◽

Vertebral Rotation ◽

Osteotomy Site ◽

Sagittal Imbalance ◽

Scoliosis Surgery

The Xia 3 SUK Direct Vertebral Rotation (DVR) System was developed for performing the vertebral derotation maneuver in scoliosis surgery. The author applied this device to sagittal plane correction in pedicle subtraction osteotomy for adult spinal deformity. The surgical procedure included 1) preparing secure proximal and distal foundations for correction using mutisegmental pedicle screw-rod fixation (to avoid stress concentration to a specific screw-bone interface), 2) decancellating only the posterior two-thirds of the vertebral column, 3) providing supplemental interbody fusion above and below the osteotomy site (the anterior one-third of the vertebral column and interbody cages serve as an anterior column support and a pivot of correction), 4) closing the osteotomy by gradual approximation of SUK tubes secured to the proximal- and distal-most screw heads, and 5) connecting rods between the proximal and distal screw-rod constructs. Eight consecutive patients with fixed sagittal imbalance were treated using this surgical procedure. No patient required distal fixation points extending to the sacrum and/or pelvis. The sagittal plane correction was 43°. The mean anterior deviation of the C-7 plumb line was improved from 12.7 cm to 4.0 cm immediately after surgery, and it was 6.0 cm at the final follow-up. A pedicle subtraction osteotomy using the Xia 3 SUK DVR System ensures a safe and secure sagittal plane correction in adult spinal deformity.

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