Clinical and Radiological Outcomes of Corrective Surgery on Adult Spinal Deformity Patients: Comparison of Short and Long Fusion

Despite the accumulated knowledge of spinal alignment and clinical outcomes the full corrective surgery cannot be applied to all the deformity patients as it requires considerable surgical burden to the patients. The aim of this study was to investigate the clinical and radiological outcomes of the patients who have received short and long fusion for ASD. A total of 21 patients who received surgical reconstructive spinal fusion procedures and were followed up for at least one year were retrospectively reviewed. Sixteen cases have received spinal corrective surgery that upper instrumented vertebrate (UIV) was thoracic level (group T), or 5 cases were with UIV in lumbar level (group L). Group L had shorter operation time, smaller intraoperative estimated blood loss, and shorter postoperative hospitalization days. Group T tends to improve more in the magnitude of VAS of lumbar pain compared to group L. Improvement of spinal alignment revealed the advantage of long fusion compared to short fusion, in Cobb angle, sagittal vertical axis (SVA), lumbar lordosis (LL), PI-LL C7 plum line (C7PL), and center sacral vertebral line (CSVL). Pelvic tilt (PT) did not differ between the groups. Disc lordosis was the most acquired in XLIF compared to TLIF and PLF and maintained one year. There were 9 adverse events, 3 cases of pulmonary embolism (PE), one case of delirium, and 6 cases of proximal junctional kyphosis. Current study elucidated that long fusion, UIV, is thoracic and can achieve better spinal alignment compared to short fusion, UIV, in lumbar. XLIF demonstrated strong ability to reconstruct the deformity on intervertebral space that is better to apply as much intervertebral space as possible. For the ASD patients with complications, short fusion can be one of the options.

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Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2014.10.spine14829 ◽

2015 ◽

Vol 22 (6) ◽

pp. 658-665 ◽

Cited By ~ 25

Author(s):

Taemin Oh ◽

Justin K. Scheer ◽

Robert Eastlack ◽

Justin S. Smith ◽

Virginie Lafage ◽

...

Keyword(s):

Adult Spinal Deformity ◽

Corrective Osteotomy ◽

Deformity Correction ◽

Sacral Slope ◽

Corrective Surgery ◽

Inclusion Criteria ◽

Sagittal Vertical Axis ◽

Cervical Alignment ◽

Thoracic Deformity

OBJECT Alignment changes in the cervical spine that occur following surgical correction for thoracic deformity remain poorly understood. The purpose of this study was to evaluate such changes in a cohort of adults with thoracic deformity treated surgically. METHODS The authors conducted a multicenter retrospective analysis of consecutive patients with thoracic deformity. Inclusion criteria for this study were as follows: corrective osteotomy for thoracic deformity, upper-most instrumented vertebra (UIV) between T-1 and T-4, lower-most instrumented vertebra (LIV) at or above L-5 (LIV ≥ L-5) or at the ilium (LIV-ilium), and a minimum radiographic follow-up of 2 years. Sagittal radiographic parameters were assessed preoperatively as well as at 3 months and 2 years postoperatively, including the C-7 sagittal vertical axis (SVA), C2–7 cervical lordosis (CL), C2–7 SVA, T-1 slope (T1S), T1S minus CL (T1S-CL), T2–12 thoracic kyphosis (TK), apical TK, lumbar lordosis (LL), pelvic incidence (PI), PI-LL, pelvic tilt (PT), and sacral slope (SS). RESULTS Fifty-seven patients with a mean age of 49.1 ± 14.6 years met the study inclusion criteria. The preoperative prevalence of increased CL (CL > 15°) was 48.9%. Both 3-month and 2-year apical TK improved from baseline (p < 0.05, statistically significant). At the 2-year follow-up, only the C2–7 SVA increased significantly from baseline (p = 0.01), whereas LL decreased from baseline (p < 0.01). The prevalence of increased CL was 35.3% at 3 months and 47.8% at 2 years, which did not represent a significant change. Postoperative cervical alignment changes were not significantly different from preoperative values regardless of the LIV (LIV ≥ L-5 or LIV-ilium, p > 0.05 for both). In a subset of patients with a maximum TK ≥ 60° (35 patients) and 3-column osteotomy (38 patients), no significant postoperative cervical changes were seen. CONCLUSION Increased CL is common in adult spinal deformity patients with thoracic deformities and, unlike after lumbar corrective surgery, does not appear to normalize after thoracic corrective surgery. Cervical sagittal malalignment (C2–7 SVA) also increases postoperatively. Surgeons should be aware that spontaneous cervical alignment normalization might not occur following thoracic deformity correction.

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Sacrocolpopexy in management of vaginal vault prolapse

Annals of King Edward Medical University ◽

10.21649/akemu.v10i4.1269 ◽

2016 ◽

Vol 10 (4) ◽

Cited By ~ 1

Author(s):

Javed Iqbal ◽

Fauzia Nausheen ◽

Fozia Ali Bhatti ◽

Arif Tajammul Khan ◽

Shahida Sheikh

Keyword(s):

Operation Time ◽

Abdominal Hysterectomy ◽

Vaginal Vault Prolapse ◽

Vaginal Vault ◽

Vault Prolapse ◽

Abdominal Sacrocolpopexy ◽

Estimated Blood Loss ◽

One Year ◽

Study Setting

Aims & Objectives: To review the efficacy of Sacrocolpopexy in the management of vaginal vault prolapse Study Design: Interventional study. Setting & Population: Department of Obstetrics & Gynaecology, Jinnah Hospital, Lahore. Women with vaginal vault prolapse after hysterectomy. Methods and Main-outcome measures: Abdominal Sacrocolpopexy using proline mesh. Follow-up in these patients were carried out at one week, four weeks, six months, and one year. Results: Sacrocolpopexy was carried out in ten patients for vaginal vault prolapse after vaginal (6) and abdominal hysterectomy (4). The mean age was 49.8 years. Parity was between P3 - P6 (Mean parity 4.3). Mean operation time was 79.3 minutes. Estimated blood loss was less than 200m1. No intra-operative or post-operative complications occurred in any case. Conclusion: Abdominal sacrocolpopexy is effective and safe in the treatment of vaginal vault prolapse. This procedure has high success rate in correcting prolapse without a time dependent decrease in efficacy.

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Outcomes of Surgical Treatment for One Hundred Thirty-Eight Patients With Severe Sagittal Deformity at a Minimum 2-Year Follow-up: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opab153 ◽

2021 ◽

Author(s):

Justin K Scheer ◽

Lawrence G Lenke ◽

Justin S Smith ◽

Darryl Lau ◽

Peter G Passias ◽

...

Keyword(s):

Adult Spinal Deformity ◽

Case Series ◽

Major Complication ◽

Vertical Axis ◽

Surgical Correction ◽

Complication Rates ◽

Sagittal Vertical Axis ◽

Estimated Blood Loss ◽

Sagittal Deformity

Abstract BACKGROUND Operative treatment of adult spinal deformity (ASD) can be very challenging with high complication rates. It is well established that patients benefit from such treatment; however, the surgical outcomes for patients with severe sagittal deformity have not been reported. OBJECTIVE To report the outcomes of patients undergoing surgical correction for severe sagittal deformity. METHODS Retrospective review of a prospective, multicenter ASD database. Inclusion criteria: operative patients age ≥18, sagittal vertical axis (SVA) ≥15 cm, mismatch between pelvic incidence and lumbar lordosis (PI-LL) ≥30°, and/or lumbar kyphosis ≥5° with minimum 2 yr follow-up. Health-related quality of life (HRQOL) scores including minimal clinically important difference (MCID)/substantial clinical benefit (SCB), sagittal and coronal radiographic values, demographic, frailty, surgical, and complication data were collected. Comparisons between 2 yr postoperative and baseline HRQOL/radiographic data were made. P < .05 was significant. RESULTS A total of 138 patients were included from 502 operative patients (54.3% Female, Average (Avg) age 63.3 ± 11.5 yr). Avg operating room (OR) time 386.2 ± 136.5 min, estimated blood loss (EBL) 1829.8 ± 1474.6 cc. A total of 71(51.4%) had prior fusion. A total of 89.9% were posterior fusion only. Mean posterior levels fused 11.5 ± 4.1. A total of 44.9% had a 3-column osteotomy. All 2 yr postoperative radiographic parameters were significantly improved compared to baseline (P < .001 for all). All 2yr HRQOL measures were significantly improved compared to baseline (P < .004 for all). A total of 46.6% to 73.8% of patients met either MCID/SCB for all HRQOL. A total of 74.6% of patients had at least 1 complication, 11.6% had 4 or more complications, 33.3% had minimum 1 major complication, and 42(30.4%) had a postop revision. CONCLUSION Patients with severe sagittal malalignment benefit from surgical correction at 2 yr postoperative both radiographically and clinically despite having a high complication rate.

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Be Prepared: Preoperative Coronal Malalignment Often Leads to More Extensive Surgery Than Sagittal Malalignment During Adult Spinal Deformity Surgery

Neurospine ◽

10.14245/ns.2142384.192 ◽

2021 ◽

Vol 18 (3) ◽

pp. 570-579

Author(s):

Scott L. Zuckerman ◽

Christopher S. Lai ◽

Yong Shen ◽

Mena G. Kerolus ◽

Alex S. Ha ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Vertical Axis ◽

Sagittal Vertical Axis ◽

Estimated Blood Loss ◽

Spinal Deformity Surgery ◽

Sagittal Malalignment ◽

Coronal Malalignment ◽

Neutral Alignment ◽

Extensive Surgery

Objective: To evaluate the effect of coronal alignment on: (1) surgical invasiveness and operative complexity and (2) postoperative complications.Methods: A retrospective, cohort study of adult spinal deformity patients was conducted. Alignment groups were: (1) neutral alignment (NA): coronal vertical axis (CVA) ≤ 3 cm and sagittal vertical axis (SVA) ≤ 5 cm; (2) coronal malalignment (CM) only: CVA > 3 cm; (3) Sagittal malalignment (SM) only: SVA > 5 cm; and (4) coronal and sagittal malalignment (CCSM): CVA > 3 cm and SVA > 5 cm.Results: Of 243 patients, alignment groups were: NA 115 (47.3%), CM 48 (19.8%), SM 38 (15.6%), and CCSM 42 (17.3%). Total instrumented levels (TILs) were highest in CM (14.5 ± 3.7) and CCSM groups (14 ± 4.0) (p < 0.001). More 3-column osteotomies (3COs) were performed in SM (21.1%) and CCSM (28.9%) groups than CM (10.4%) (p = 0.003). CM patients had more levels instrumented (p = 0.029), posterior column osteotomies (PCOs) (p < 0.001), and TLIFs (p = 0.002) than SM patients. CCSM patients had more TLIFs (p = 0.012) and higher estimated blood loss (EBL) (p = 0.003) than SM patients. CVA displayed a stronger relationship with TIL (p = 0.002), EBL (p < 0.001), and operative time (p < 0.001) than SVA, which had only one significant association with EBL (p = 0.010). Both SM/CCSM patients had higher readmissions (p = 0.003) and reoperations (p < 0.001) than CM patients.Conclusion: Amount of preoperative CM was a better predictor of surgical invasiveness than the amount of SM, despite 3COs more commonly performed in SM patients. CM patients had more instrumented levels, PCOs, and TLIFs than SM patients.

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One‐level mini‐open pedicle subtraction osteotomy for treating spinal kyphosis in patients with ankylosing spondylitis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03974-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yu Wang ◽

Chunde Li ◽

Long Liu ◽

Longtao Qi

Keyword(s):

Blood Loss ◽

Medical Records ◽

Average Length ◽

Operation Time ◽

Pedicle Subtraction Osteotomy ◽

Operating Table ◽

Sagittal Vertical Axis ◽

Estimated Blood Loss ◽

Mini Open

Abstract Background To report a mini-open pedicle subtraction osteotomy (PSO) technique, to summarize the 2-year follow-up results of 25 patients, and to describe a modified operating table which allows the osteotomy to be closed in a more controllable manner. Methods We retrospectively reviewed the records of patients with AS who received one-level mini-open PSO between July 2015 and January 2018. The 25 patients with complete medical records and 2-year radiographic follow-up were included in the analysis. Estimated blood loss, operation time, incision length, complications, bed rest period, and length of hospitalization were extracted from the medical records and recorded. Results The mean age of the 25 patients (22 males and 3 females) was 39.5 years. The average global kyphosis(GK) decreased from 70.2° before surgery to 22.3° after surgery; the average C7- sagittal vertical axis (C7-SVA) decreased from 15.5 cm before surgery to 5.1 cm after surgery; the average pelvic incidence(PT) decreased from 37.8° before surgery to 22.5° after surgery. The average length of the incision was 10.2 cm. The average surgical time was 263.0 min, the average estimated blood loss was 840.0 ml, and the average time to mobilization was 4.1 days. Conclusions The current report shows that one-level PSO can be performed through an incision of about 10 cm. The one-level mini-open PSO could be superior to traditional PSO surgery with respect to cosmetic outcomes. Further comparative studies are necessary to evaluate the current and conventional techniques.

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Can Proximal Junctional Kyphosis After Surgery for Adult Spinal Deformity Be Predicted by Preoperative Dynamic Sagittal Alignment Change With 3D Gait Analysis? A Case–control Study

10.21203/rs.3.rs-1025712/v1 ◽

2021 ◽

Author(s):

Tomoyuki Asada ◽

Kousei Miura ◽

Masao Koda ◽

Hideki Kadone ◽

Toru Funayama ◽

...

Keyword(s):

Gait Analysis ◽

Thoracic Spine ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Multiple Logistic Regression Analysis ◽

Three Dimensional ◽

Proximal Junctional Kyphosis ◽

Corrective Surgery ◽

Spinal Alignment ◽

Junctional Kyphosis

Abstract PurposeTo investigate whether preoperative dynamic spinal alignment that worsened during gait as detected by three-dimensional (3D) gait analysis can be a predictive factor for proximal junctional kyphosis (PJK) after corrective surgery for adult spinal deformity (ASD) with a minimum 1-year follow-up.MethodWe included 27 patients with ASD who underwent 3D gait analysis before corrective surgery and had >1-year follow-up. Dynamic spinal alignment parameters were obtained using a Nexus motion capture system (Vicon, Oxford, UK) with reflective markers. Spinal alignment was assessed in each region and pelvic alignment was assessed with surface markers. Patients were asked to walk for as long as possible around an oval walkway. We obtained the averaged dynamic parameters in the final lap and compared them between patients with PJK(+) and those with PJK(–).ResultsPJK occurred in 7 patients (26%). Preoperative angle between the thoracic spine and the pelvis was larger in patients with PJK(+) than in those with PJK(–) (32.3 ± 8.1 vs 18.7 ± 13.5, P = 0.020) with sufficient sample size. Multiple logistic regression analysis identified the angle between the thoracic spine and pelvis as an independent risk for PJK.ConclusionPreoperative thoracic kyphosis exacerbated by gait as determined in 3D gait analysis is a preoperative independent risk factor of PJK in patients undergoing ASD corrective surgery.

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Triangular Fixation to Prevent Proximal Screw Pullout in Adult Spinal Deformity Surgery: A Technical Note

10.21203/rs.3.rs-968617/v1 ◽

2021 ◽

Author(s):

Masato Tanaka ◽

Rahul Mehta ◽

Taro Yamauchi ◽

Shinya Arataki ◽

Koji Uotani ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Blood Loss ◽

Minimally Invasive ◽

Adult Spinal Deformity ◽

Operation Time ◽

Low Back ◽

Lower Back ◽

Estimated Blood Loss ◽

Proximal Screw

Abstract Background Adult spinal deformity (ASD) is caused by spinal malalignment and results in severe low back pain, neurological dysfunction, and severe deformity. Proximal screw back-out represents a difficult problem in minimally invasive ASD surgery. We describe a novel technique to prevent screw pullout in ASD. Methods A 71-year-old woman was referred to our hospital with severe low back pain and gait difficulty. Her daily life had been affected by severe lower back pain for more than 6 months. Standing radiograms indicated severe kyphoscoliosis. Two-stage minimally invasive corrective T10-to-pelvis fixation was performed. Results The first surgery was an L1–S1 C-arm-free oblique lumbar interbody fusion, with an operation time of 3 h 57 min and an estimated blood loss of 240 mL. After 1 week, the second percutaneous pedicle screw (PPS) fixation was performed and proximal screws were inserted under a transdiscal approach (T11) and with a lower angulation trajectory (T10) to enhance pullout strength. For this second surgery, operation time was 3 h 33 min, and estimated blood loss was 320 mL. No postoperative complications or neurological compromise was reported. In terms of clinical outcomes, Oswestry Disability Index improved from 56–24%, and visual analog scale score for lower back pain improved from 62 mm to 24 mm at the 1-year follow-up. Conclusions Minimally invasive circumferential surgery with triangular fixation is effective for preventing proximal screw back-out and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure.

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Upper-thoracic versus lower-thoracic upper instrumented vertebra in adult spinal deformity patients undergoing fusion to the pelvis: surgical decision-making and patient outcomes

Journal of Neurosurgery Spine ◽

10.3171/2019.9.spine19557 ◽

2020 ◽

Vol 32 (4) ◽

pp. 600-606 ◽

Cited By ~ 1

Author(s):

Alan H. Daniels ◽

Daniel B. C. Reid ◽

Wesley M. Durand ◽

D. Kojo Hamilton ◽

Peter G. Passias ◽

...

Keyword(s):

Decision Making ◽

Blood Loss ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Complication Rates ◽

Sagittal Vertical Axis ◽

Surgical Decision ◽

Estimated Blood Loss ◽

Upper Thoracic ◽

Surgical Decision Making

OBJECTIVEOptimal patient selection for upper-thoracic (UT) versus lower-thoracic (LT) fusion during adult spinal deformity (ASD) correction is challenging. Radiographic and clinical outcomes following UT versus LT fusion remain incompletely understood. The purposes of this study were: 1) to evaluate demographic, radiographic, and surgical characteristics associated with choice of UT versus LT fusion endpoint; and 2) to evaluate differences in radiographic, clinical, and health-related quality of life (HRQOL) outcomes following UT versus LT fusion for ASD.METHODSRetrospective review of a prospectively collected multicenter ASD database was performed. Patients with ASD who underwent fusion from the sacrum/ilium to the LT (T9–L1) or UT (T1–6) spine were compared for demographic, radiographic, and surgical characteristics. Outcomes including proximal junctional kyphosis (PJK), reoperation, rod fracture, pseudarthrosis, overall complications, 2-year change in alignment parameters, and 2-year HRQOL metrics (Lumbar Stiffness Disability Index, Scoliosis Research Society-22r questionnaire, Oswestry Disability Index) were compared after controlling for confounding factors via multivariate analysis.RESULTSThree hundred three patients (169 LT, 134 UT) were evaluated. Independent predictors of UT fusion included greater thoracic kyphosis (odds ratio [OR] 0.97 per degree, p = 0.0098), greater coronal Cobb angle (OR 1.06 per degree, p < 0.0001), and performance of a 3-column osteotomy (3-CO; OR 2.39, p = 0.0351). While associated with longer operative times (ratio 1.13, p < 0.0001) and greater estimated blood loss (ratio 1.31, p = 0.0018), UT fusions resulted in greater sagittal vertical axis improvement (−59.5 vs −41.0 mm, p = 0.0035) and lower PJK rates (OR 0.49, p = 0.0457). No significant differences in postoperative HRQOL measures, reoperation, or overall complication rates were detected between groups (all p > 0.1).CONCLUSIONSGreater deformity and need for 3-CO increased the likelihood of UT fusion. Despite longer operative times and greater blood loss, UT fusions resulted in better sagittal correction and lower 2-year PJK rates following surgery for ASD. While continued surveillance is necessary, this information may inform patient counseling and surgical decision-making.

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P.089 A comparison of perioperative complication rates in adult spinal deformity correction with one versus two surgeons

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.173 ◽

2017 ◽

Vol 44 (S2) ◽

pp. S36-S36

Author(s):

K Parvez ◽

J Hsu ◽

Z Ivanishvilli ◽

S Boisvert ◽

M Warren ◽

...

Keyword(s):

Blood Loss ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Radicular Pain ◽

Complication Rates ◽

Perioperative Morbidity ◽

Hardware Failure ◽

Estimated Blood Loss ◽

One Year

Background: Morbidity can be high in the management of adult spinal deformity patients. Complications include blood loss (EBL), durotomy, radicular pain, and postoperative hardware failure. Utilization of one versus two spinal surgeons in spinal deformity correction reduces overall perioperative morbidity is unclear. Methods: All procedures were performed by surgeons at a single institution between January 2012-2015. Patients were followed for a minimum of one year and maximum of four years. We retrospectively reviewed 60 cases of adult spinal deformity. Our cohort was divided into 1 versus 2 surgeons (12 vs 48 cases). We analyzed these cases for estimated blood loss and peri-operative complications. Results: Cases involving long thoracic to pelvis correction (T3-T6) was 20.8% in the 2 surgeons group and 8.3% in the 1 surgeon group. The EBL >3.0 L for 1 versus 2 surgeon groups were 25% and 41.6% respectively. Major complications in the 1 versus 2 surgeon group were 25% and 47.9% and the revision rates were 25% versus 37.5%. The percentage of minor complications in the 1 versus 2 surgeon group was 33.3% versus 14.6%. Conclusions: Utilizing two surgeons did not reduce complication rates. Procedures performed by two surgeons were more extensive deformity corrections. The extent of correction is the likely explanation for differing complication rates.

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Is Sacral Extension a Risk Factor for Early Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery?

Asian Spine Journal ◽

10.31616/asj.2018.0314 ◽

2020 ◽

Vol 14 (2) ◽

pp. 212-219

Author(s):

Sebastian Decker ◽

Renaud Lafage ◽

Christian Krettek ◽

Robert Hart ◽

Christopher Ames ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Vertical Axis ◽

Proximal Junctional Kyphosis ◽

Sagittal Vertical Axis ◽

Increased Risk ◽

Spinal Deformity Surgery ◽

One Year ◽

Junctional Kyphosis

Study Design: Retrospective cohort study.Purpose: To investigate the role of sacral extension (SE) for the development of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery.Overview of Literature: The development of PJK is multifactorial and different risk factors have been identified. Of these, there is some evidence that SE also affects the development of PJK, but data are insufficient. Methods: Using a combined database comprising two propensity-matched groups of fusions following ASD surgery, one with fixation to S1 or S1 and the ilium (SE) and one without SE but with a lower instrumented vertebra of L5 or higher (lumbar fixation, LF), PJK and the role of further parameters were analyzed. The propensity-matched variables included age, the upper-most instrumented vertebra (UIV), preoperative sagittal alignment, and the baseline to one year change of the sagittal alignment.Results: Propensity matching led to two groups of 89 patients each. The UIV, pelvic incidence minus lumbar lordosis, sagittal vertical axis, pelvic tilt, age, and body mass index were similar in both groups (p >0.05). The incidence of PJK at postoperative one year was similar for SE (30.3%) and LF (22.5%) groups (p =0.207). The PJK angle was comparable (p =0.963) with a change of −8.2° (SE) and −8.3° (LF) from the preoperative measures (p =0.954). A higher rate of PJK after SE (p =0.026) was found only in the subgroup of patients with UIV levels between T9 and T12.Conclusions: Instrumentation to the sacrum with or without iliac extension did not increase the overall risk of PJK. However, an increased risk for PJK was found after SE with UIV levels between T9 and T12.

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