CORR Insights®: Are the Choice of Frame and Intraoperative Patient Positioning Associated with Radiologic and Clinical Outcomes in Long-instrumented Lumbar Fusion for Adult Spinal Deformity?

OBJECTIVEThe clinical outcomes and complications of patients who underwent pedicle subtraction osteotomy (PSO) for various diagnoses were compared. More specifically, the purpose was to identify if outcomes differed between patients with flat-back syndrome after lumbar fusion (FBS-LF) versus patients who underwent surgery for adult spinal deformity (ASD).METHODSA retrospective analysis of 104 patients who underwent a PSO for sagittal plane imbalance was performed. There were 28 patients with FBS-LF and 76 patients with various forms of ASD. Outcome was measured using visual analog scale (VAS)-back, VAS-leg, Oswestry Disability Index (ODI) (range 0–100 for all scales), and EQ-5D scores (range 0–1). Patients also rated their global outcomes as much better, better, unchanged, or worse at follow-up. The minimum follow-up was 1 year (range 1–4 years). Clinical outcomes and complications were compared between the 2 groups of patients.RESULTSThe most common level of PSO was L-3 and L-2; 100 single and 4 double PSOs were performed. The average local correction by PSO itself was 27.2°. The sagittal vertical axis (SVA) improved from a mean preoperative value of 74 ± 23 mm to 49 ± 20 mm at the final follow-up. The VAS-back, ODI, and EQ-5D scores improved significantly for the entire group by 33, 16, and 0.31 points, respectively. In total, 57% of patients reported that they were “much better” or “better” than before surgery. Preoperatively, as well as postoperatively, the FBS-LF patients reported significantly worse VAS scores. According to VAS-back results, the ASD group improved by 34 points compared with 29 points in FBS-LF patients. ODI scores were similar between the 2 groups preoperatively but improved significantly more in the ASD group (18 points) compared with the FBS-LF group (13 points). The EQ-5D scores improved from 0.07 to 0.35 in FBS-LF patients, and from 0.21 to 0.56 on average in ASD patients. Similarly, a “much better” or “better” outcome compared with before surgery was reported by 72% of patients in the ASD group compared with 24% of patients in the FBS-LF group (p < 0.001). The overall reoperation rate was 31%: 46% of patients in the FBS-LF group compared with 25% of patients in the ASD group. There were 19 (18%) dural tears, 14 (13.5%) surgical site infections, 12 (11.5%) instances of pseudarthrosis, 15 (14%) proximal junctional failures, and 2 distal junctional failures. The 12 (11%) neurological complications were dominated by partial weakness of hip flexion and knee extension, and all but 2 of these were temporary.CONCLUSIONSPSO is a safe and effective method for correcting sagittal plane imbalance due to multiple etiologies. The authors found patient satisfaction to be high, and health-related quality of life was greatly improved by the procedure in patients with ASD. In contrast, in FBS-LF patients, a suboptimal outcome was observed and the cautious use of PSO seems warranted in this subset of patients.

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Comparison of Radiographic And Clinical Outcomes Observed After Adult Spinal Deformity Correction Using Iliac Screw Versus S2-Alar-Iliac Screw

10.21203/rs.3.rs-492643/v1 ◽

2021 ◽

Author(s):

Qiang Luo ◽

Yong-Chan Kim ◽

Ki-Tack Kim ◽

Kee-Yong Ha ◽

Joonghyun Ahn ◽

...

Keyword(s):

Clinical Outcomes ◽

Spinal Deformity ◽

Lumbar Lordosis ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Postoperative Change ◽

Iliac Screw ◽

Vas Scores ◽

Correction Surgery

Abstract Background: To date, there is a paucity of reports clarifying the change of spinopelvic parameters in patients with adult spinal deformity (ASD) who underwent long segment spinal fusion using iliac screw (IS) and S2-alar-iliac screw (S2AI) fixation.Methods: A retrospective review of consecutive patients underwent deformity correction surgery for ASD between 2013 and 2017 was performed. Patients were divided into two groups based on whether IS or S2AI fixation was performed. All radiographic parameters were measured preoperatively, immediately postoperatively, and the last follow-up. Demographics, intraoperative and clinical data were analyzed between the two groups. Additionally, the cohort was subdivided according to the postoperative change in pelvic incidence (PI): subgroup (C) was defined as change in PI ≥5° and subgroup (NC) with change <5°. In subgroup analyses, the 2 different types of postoperative change of PI were directly compared.Results: A total of 142 patients met inclusion criteria: 111 who received IS and 31 received S2AI fixation. The IS group (65.6 ± 26, 39.8 ± 13.8) showed a significantly higher change in lumbar lordosis (LL) and upper lumbar lordosis (ULL) than the S2AI group (54.4 ± 17.9, 30.3 ± 9.9) (p<0.05). In subgroup (C), PI significantly increased from 53° preoperatively to 59° postoperatively at least 50% of IS cohort, with a mean change of 5.8° (p<0.05). The clinical outcomes at the last follow-up were significantly better in IS group than in S2AI group in terms of VAS scores for back and leg. The occurrence of sacroiliac joint pain and pelvic screw fracture were significantly greater in S2AI group than in IS group (25.8% vs 9%, p<0.05) and (16.1% vs 3.6%, p<0.05).Conclusions: IS fixation showed a greater change in LL and ULL than S2AI fixation in ASD surgery. PI may be changed under certain circumstances.

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Shoulder Balance in Adult Spinal Deformity Patients Undergoing Selective Lumbar Fusion

Spine ◽

10.1097/brs.0000000000004255 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

R. Kiran Alluri ◽

Basel Sheikh ◽

Jonathan Charles Elysee ◽

Francis Lovecchio ◽

Sachiin Shah ◽

...

Keyword(s):

Spinal Deformity ◽

Lumbar Fusion ◽

Adult Spinal Deformity ◽

Shoulder Balance

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Supine Imaging Is a Superior Predictor of Long-Term Alignment Following Adult Spinal Deformity Surgery

Global Spine Journal ◽

10.1177/2192568220960753 ◽

2020 ◽

pp. 219256822096075

Author(s):

Jonathan Charles Elysee ◽

Francis Lovecchio ◽

Renaud Lafage ◽

Bryan Ang ◽

Alex Huang ◽

...

Keyword(s):

Spinal Deformity ◽

Lumbar Lordosis ◽

Pelvic Incidence ◽

Lumbar Fusion ◽

Adult Spinal Deformity ◽

Multilinear Regression ◽

Sagittal Vertical Axis ◽

Type Curve ◽

Scoliosis Research Society ◽

Correlation Analyses

Study Design: Retrospective cohort study. Objective: To investigate correlations between preoperative supine imaging and postoperative alignment. Methods: A retrospective review was conducted of a single-institution database of patients with adult spinal deformity (ASD). Patients were stratified by fusion location in the lumbar or thoracic spine. Outcomes of interest were postoperative lumbar lordosis (LL) and thoracic kyphosis (TK). Sagittal alignment parameters were compared and correlation analyses were performed. Multilinear stepwise regression was conducted to identify independent predictors of postoperative LL or TK. Regression analyses were repeated within the lumbar and thoracic fusion cohorts. Results: A total of 99 patients were included (mean age 63.2 years, 83.1% female, mean body mass index 27.3 kg/m2). Scoliosis Research Society classification demonstrated moderate to severe sagittal and/or coronal deformity (pelvic tile modifier, 18.2% ++; sagittal vertical axis, 27.3% ++, pelvic incidence minus lumbar lordosis mismatch, 29.3% ++, SRS type, 29.3% N type curve and 68.7% L or D type curve). A total of 73 patients (73.7%) underwent lumbar fusion and 50 (50.5%) underwent thoracic fusion. Correlation analyses demonstrated a significant association between pre- and postoperative LL and TK. Multilinear regression demonstrated that LL supine and pelvic incidence were significant predictors of postoperative LL ( r 2 = 0.568, P < .001). LL supine, TK supine, and age were significant predictors of postoperative TK ( r 2 = 0.490, P < .001). Conclusion: Preoperative supine films are superior to standing in predicting postoperative alignment at 1-year follow-up. Anticipation of undesired alignment changes through supine imaging may be useful in mitigating the risk of iatrogenic malalignment.

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Body Mass Index Greater Than 35 Is Associated With Increased Major and Radiographic Complications After Minimally Invasive Adult Spinal Deformity Surgery

Neurosurgery ◽

10.1093/neuros/nyz310_819 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Khoi D Than ◽

Stacie Tran ◽

Dean Chou ◽

Kai-Ming G Fu ◽

Paul Park ◽

...

Keyword(s):

Body Mass Index ◽

Minimally Invasive ◽

Clinical Outcomes ◽

Body Mass ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Surgical Site Infections ◽

Neurological Complications ◽

Obese Patients ◽

The Impact

Abstract INTRODUCTION As the obesity epidemic continues and the recognition of adult spinal deformity (ASD) increases, a growing number of obese patients are undergoing surgery to correct ASD. Minimally invasive techniques may be advantageous for obese patients to minimize blood loss. To date, the literature examining the impact of obesity on complications after minimally invasive ASD surgery has been scarce. METHODS A multicenter database of ASD patients was reviewed. Patients who had at least 2 yr of follow-up were analyzed. Demographic, radiographic, clinical outcomes, and postoperative complications were assessed. A body mass index (BMI) threshold of 35 was selected to more accurately reflect real-world practices. RESULTS A total of 220 patients were included: 196 had a BMI <35 and 24 had a BMI >35 (26.3 vs 38.4, P < .001). When comparing patients with a BMI threshold of 35, there was no difference in baseline age, levels instrumented, and most pre- and postoperative radiographic parameters and clinical outcomes. Patients with BMI >35 did have higher preopearative back pain than BMI <35 (visual analog scale 7.9 vs 6.8, P = .013) and postoperative Cobb angle (17.8 vs 12.6, P = .031). There was no difference between groups in overall complications, reoperations, infections, implant failures, surgical site infections, or minor, cardiopulmonary, gastrointestinal, and operative complications. Patients with BMI >35 had more major (45.8% vs 23.0%, P = .015) and radiographic (37.5% vs 19.9%, P = .049) complications than patients with BMI <35. Patients with BMI <35 had more neurological complications (17.3% vs 0%, P = .026). CONCLUSION In this retrospective review of a large database of patients undergoing minimally invasive surgery for ASD, patients with BMI > 35 suffered from more major and radiographic complications but fewer neurological complications than patients with BMI <35.

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Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽

10.1093/neuros/nyw072 ◽

2017 ◽

Vol 80 (3) ◽

pp. 489-497 ◽

Cited By ~ 18

Author(s):

Juan S. Uribe ◽

Joshua Beckman ◽

Praveen V. Mummaneni ◽

David Okonkwo ◽

Pierce Nunley ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Clinical Outcomes ◽

Spinal Deformity ◽

Lumbar Lordosis ◽

Adult Spinal Deformity ◽

Radiographic Parameters ◽

Estimated Blood Loss ◽

Significant Difference ◽

The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

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