scholarly journals Negative Sagittal Balance Following Adult Spinal Deformity Surgery

2017 ◽  
Vol 8 (2) ◽  
pp. 149-155
Author(s):  
Robert K. Merrill ◽  
Jun S. Kim ◽  
Ian T. McNeill ◽  
Samuel C. Overley ◽  
James E. Dowdell ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Sagittal Balance ◽  
Adult Spinal Deformity ◽  
Univariate Analysis ◽  
Deformity Correction ◽  
Sagittal Vertical Axis ◽  
Spinal Deformity Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Study Design: Retrospective cohort study. Objective: Elucidate negative sagittal balance following adult spinal deformity surgery. Methods: We conducted a retrospective review of adult spinal deformity patients who underwent long fusion (>5 levels) to the sacrum by a single surgeon at a single institution between 2011 and 2015. Patients were divided into cohorts of postoperative sagittal vertical axis (SVA) <−10 mm, between −10 and +10 mm, or >+10 mm, denoted as groups 1, 2, and 3, respectively. Univariate analysis compared preoperative factors between the groups, and a multivariable logistic regression model was used to determine independent risk factors for developing a negative sagittal balance (SVA<−10 mm) following adult spinal deformity correction. Results: We reviewed 8 patients in group 1, 9 patients in group 2, and 25 patients in group 3. The average postoperative SVA for group 1, group 2, and group 3 were −30.99, +3.67, and +55.56 mm, respectively. There was a trend toward higher upper-instrumented vertebra (UIV) in group 1 (T2) compared with group 2 (T10) and group 3 (T9) ( P = .05). A trend toward lower preoperative SVA in groups 1 and 2 compared with group 3 was also seen (+53.36 vs +71.73 vs +122.80 mm) ( P = .06). Finally, we found a trend toward lower body mass index in group 1 compared with groups 2 and 3 (24.71 vs 25.92 vs 29.33 kg/m2) ( P = .07). Based on multivariable regression, higher UIV was found to be a statistically significant independent predictor for developing a postoperative negative sagittal balance of <−10 mm ( P = .02, odds ratio = 0.67). Conclusions: Our results demonstrate that a higher UIV may predispose patients undergoing adult spinal deformity correction to have a postoperative negative sagittal balance.

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

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

Reduced occurrence of primary rod fracture after adult spinal deformity surgery with accessory supplemental rods: retrospective analysis of 114 patients with minimum 2-year follow-up

2021 ◽  
pp. 1-12
Author(s):  
Emily P. Rabinovich ◽  
Thomas J. Buell ◽  
Tony R. Wang ◽  
Christopher I. Shaffrey ◽  
Justin S. Smith
Keyword(s):  
Retrospective Analysis ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Vertical Axis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Inclusion Criteria ◽  
Sagittal Vertical Axis ◽  
Rod Fracture

OBJECTIVE Rod fracture (RF) after adult spinal deformity (ASD) surgery is reported in approximately 6.8%–33% of patients and is associated with loss of deformity correction and higher reoperation rates. The authors’ objective was to determine the effect of accessory supplemental rod (ASR) placement on postoperative occurrence of primary RF after ASD surgery. METHODS This retrospective analysis examined patients who underwent ASD surgery between 2014 and 2017 by the senior authors. Inclusion criteria were age > 18 years, ≥ 5 instrumented levels including sacropelvic fixation, and diagnosis of ASD, which was defined as the presence of pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°, coronal Cobb angle ≥ 20°, or pelvic incidence to lumbar lordosis mismatch ≥ 10°. The primary focus was patients with a minimum 2-year follow-up. RESULTS Of 148 patients who otherwise met the inclusion criteria, 114 (77.0%) achieved minimum 2-year follow-up and were included (68.4% were women, mean age 67.9 years, average body mass index 30.4 kg/m2). Sixty-two (54.4%) patients were treated with traditional dual-rod construct (DRC), and 52 (45.6%) were treated with ASR. Overall, the mean number of levels fused was 11.7, 79.8% of patients underwent Smith-Petersen osteotomy (SPO), 19.3% underwent pedicle subtraction osteotomy (PSO), and 66.7% underwent transforaminal lumbar interbody fusion (TLIF). Significantly more patients in the DRC cohort underwent SPO (88.7% of the DRC cohort vs 69.2% of the ASR cohort, p = 0.010) and TLIF (77.4% of the DRC cohort vs 53.8% of the ASR cohort, p = 0.0001). Patients treated with ASR had greater baseline sagittal malalignment (12.0 vs 8.6 cm, p = 0.014) than patients treated with DRC, and more patients in the ASR cohort underwent PSO (40.3% vs 1.6%, p < 0.0001). Among the 114 patients who completed follow-up, postoperative occurrence of RF was reported in 16 (14.0%) patients, with mean ± SD time to RF of 27.5 ± 11.8 months. There was significantly greater occurrence of RF among patients who underwent DRC compared with those who underwent ASR (21.0% vs 5.8%, p = 0.012) at comparable mean follow-up (38.4 vs 34.9 months, p = 0.072). Multivariate analysis demonstrated that ASR had a significant protective effect against RF (OR 0.231, 95% CI 0.051–0.770, p = 0.029). CONCLUSIONS This study demonstrated a statistically significant decrease in the occurrence of RF among ASD patients treated with ASR, despite greater baseline deformity and higher rate of PSO. These findings suggest that ASR placement may provide benefit to patients who undergo ASD surgery.

scholarly journals Clinically Significant Thromboembolic Disease in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 737 Patients

2017 ◽  
Vol 8 (3) ◽  
pp. 224-230 ◽  
Author(s):  
Han Jo Kim ◽  
Sravisht Iyer ◽  
Basel G. Diebo ◽  
Michael P. Kelly ◽  
Daniel Sciubba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Area Under The Curve ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Spinal Deformity Surgery

Study Design: Retrospective cohort study. Objectives: Describe the rate and risk factors for venous thromboembolic events (VTEs; defined as deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in adult spinal deformity (ASD) surgery. Methods: ASD patients with VTE were identified in a prospective, multicenter database. Complications, revision, and mortality rate were examined. Patient demographics, operative details, and radiographic and clinical outcomes were compared with a non-VTE group. Multivariate binary regression model was used to identify predictors of VTE. Results: A total of 737 patients were identified, 32 (4.3%) had VTE (DVT = 14; PE = 18). At baseline, VTE patients were less likely to be employed in jobs requiring physical labor (59.4% vs 79.7%, P < .01) and more likely to have osteoporosis (29% vs 15.1%, P = .037) and liver disease (6.5% vs 1.4%, P = .027). Patients with VTE had a larger preoperative sagittal vertical axis (SVA; 93 mm vs 55 mm, P < .01) and underwent larger SVA corrections. VTE was associated with a combined anterior/posterior approach (45% vs 25%, P = .028). VTE patients had a longer hospital stay (10 vs 7 days, P < .05) and higher mortality rate (6.3% vs 0.7%, P < .01). Multivariate analysis demonstrated osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE ( r2 = .11, area under the curve = 0.74, P < .05). Conclusions: The incidence of VTE in ASD is 4.3% with a DVT rate of 1.9% and PE rate of 2.4%. Osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE. Patients with VTE had a higher mortality rate compared with non-VTE patients.

scholarly journals Neuromonitoring During Surgery for Paediatric Spinal Deformity in Canada (2007)

2009 ◽  
Vol 36 (1) ◽  
pp. 47-50 ◽  
Author(s):  
Jonathan Norton ◽  
Douglas Hedden
Keyword(s):  
Spinal Deformity ◽  
Motor Evoked Potentials ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Standard Of Care ◽  
National Standards ◽  
Spinal Deformity Surgery ◽  
Correction Surgery ◽  
Training Programmes ◽  
Spinal Cord Function

Background:Neuromonitoring during paediatric (and adult) spinal deformity surgery helps to reduce the risk of both permanent and short term neurological damage. A shortage of neurophysiologists and technicians limits the availability of this service. Not all surgeons believe neuromonitoring offers neuroprotection during spinal surgery. This study aimed to document the degree to which paediatric patients undergoing spinal deformity correction surgery have their spinal cord function monitored.Methods:A questionnaire was sent electronically to all of the surgical members of the Canadian Paediatric Spinal Deformity Study Group.Results:Results were received from 9/9 centres indicating that monitoring was performed in 7/9 centres, with one further centre awaiting staffing. Whilst half of those centres that do monitor only monitor sensory and motor evoked potentials, the remaining centres also use EMG and EEG to assess the state of the patient intraoperatively.Conclusions:Despite a shortage of staff, most paediatric spinal deformity surgeons in Canada who wish to, are able to neurophysiologically monitor their surgical cases. Neuromonitoring appears to be becoming a standard of care, at least for paediatric spinal deformity surgery. There is an urgent need for the establishment of national standards for both technologists and interpreters, as well as training programmes for both these groups.

scholarly journals Impact of Navigation on 30-Day Outcomes for Adult Spinal Deformity Surgery

2021 ◽  
pp. 219256822110475
Author(s):  
Austen D. Katz ◽  
Jesse Galina ◽  
Junho Song ◽  
Sayyida Hasan ◽  
Dean Perfetti ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Large Scale ◽  
Operative Time ◽  
Adult Spinal Deformity ◽  
Univariate Analysis ◽  
Improvement Program ◽  
Surgical Quality ◽  
Database Study ◽  
Increased Risk ◽  
Spinal Deformity Surgery

Study Design Retrospective database study. Objective Navigation has been increasingly used to treat degenerative disease, with positive radiographic and clinical outcomes and fewer adverse events and reoperations, despite increased operative time. However, short-term analysis on treating adult spinal deformity (ASD) surgery with navigation is limited, particularly using large nationally represented cohorts. This is the first large-scale database study to compare 30-day readmission, reoperation, morbidity, and value-per-operative time for navigated and conventional ASD surgery. Methods Adults were identified in the National Surgical Quality Improvement Program (NSQIP) database. Multivariate regression was used to compare outcomes between navigated and conventional surgery and to control for predictors and baseline differences. Results 3190 ASD patients were included. Navigated and conventional patients were similar. Navigated cases had greater operative time (405 vs 320 min) and mean RVUs per case (81.3 vs 69.7), and had more supplementary pelvic fixations (26.1 vs 13.4%) and osteotomies (50.3 vs 27.7%) ( P <.001). In univariate analysis, navigation had greater reoperation (9.9 vs 5.2%, P = .011), morbidity (57.8 vs 46.8%, P = .007), and transfusion (52.2 vs 41.8%, P = .010) rates. Readmission was similar (11.9 vs 8.4%). In multivariate analysis, navigation predicted reoperation (OR = 1.792, P = .048), but no longer predicted morbidity or transfusion. Most reoperations were infectious and hardware-related. Conclusions Despite controlling for patient-related and procedural factors, navigation independently predicted a 79% increased odds of reoperation but did not predict morbidity or transfusion. Readmission was similar between groups. This is explained, in part, by greater operative time and transfusion, which are risk factors for infection. Reoperation most frequently occurred for wound- and hardware-related reasons, suggesting navigation carries an increased risk of infectious-related events beyond increased operative time.

scholarly journals Risk Factors for Postoperative Coronal Balance in Adult Spinal Deformity Surgery

2018 ◽  
Vol 8 (7) ◽  
pp. 690-697 ◽  
Author(s):  
Stephen J. Lewis ◽  
Sam G. Keshen ◽  
So Kato ◽  
Taylor E. Dear ◽  
Aaron M. Gazendam
Keyword(s):  
Spinal Deformity ◽  
Statistical Tests ◽  
Adult Spinal Deformity ◽  
Vertical Axis ◽  
Retrospective Case ◽  
Sagittal Vertical Axis ◽  
Coronal Balance ◽  
Coronal Imbalance ◽  
Small Series ◽  
Spinal Deformity Surgery

Study Design: A retrospective case-control study. Objectives: To determine factors influencing the ability to achieve coronal balance following spinal deformity surgery. Methods: Following institutional ethics approval, the radiographs of 47 patients treated for spinal deformity surgery with long fusions to the pelvis, were retrospectively reviewed. The postoperative measurements included coronal balance, L4 tilt, and L5 tilt, levels fused, apical vertebral translation and maximum Cobb angle. L4 and L5 tilt angles were measured between the superior endplate and the horizontal. Sagittal parameters including thoracic kyphosis, lumbar lordosis, pelvic incidence, and sagittal vertical axis were recorded. Coronal balance was defined as the distance between the central sacral line and the mid body of C7 being ≤40 mm. Surgical factors, including levels fused, use of iliac fixation with and without connectors, use of S2A1 screws, interbody devices, and osteotomies. Statistical tests were performed to determine factors that contribute to postoperative coronal imbalance. Results: Of the 47 patients reviewed, 32 were balanced after surgery and 14 were imbalanced. Coronal balance was 1.30 cm from center in the balanced group compared to 4.83 cm in the imbalanced group ( P < .01). Both L4 and L5 tilt were statistically different between the groups. Gender and the use of transverse connectors differed between the groups but not statistically. Conclusions: In adult spinal deformity patients undergoing primary fusions to the pelvis, the ability to level the coronal tilt of L4 and L5 had the greatest impact on the ability to achieve coronal balance in this small series. A larger prospective series can help validate this important finding.

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

Neurospine ◽  
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.

scholarly journals Posterior Displacement of L1 May be a Risk Factor for Proximal Junctional Kyphosis After Adult Spinal Deformity Correction

2021 ◽  
pp. 219256822110156
Author(s):  
Zhuo Xi ◽  
Ping-Guo Duan ◽  
Praveen V. Mummaneni ◽  
Jinping Liu ◽  
Jeremy M.V. Guinn ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Vertical Axis ◽  
Proximal Junctional Kyphosis ◽  
Sagittal Vertical Axis ◽  
Posterior Displacement ◽  
Increased Risk ◽  
Junctional Kyphosis

Study Design: Retrospective cohort study. Objective: Overcorrection in adult spinal deformity (ASD) surgery may lead to proximal junctional kyphosis (PJK) because of posterior spinal displacement. The aim of this paper is to determine if the L1 position relative to the gravity line (GL) is associated with PJK. Methods: ASD patients fused from the lower thoracic spine to sacrum by 4 spine surgeons at our hospital were retrospectively studied. Lumbar-only and upper thoracic spine fusions were excluded. Spinopelvic parameters, the L1 plumb line (L1PL), L1 distance to the GL (L1-GL), and Roussouly type were measured. Results: One hundred fourteen patients met inclusion criteria (63 patients with PJK, 51 without). Mean age and follow up was 65.51 and 3.39 years, respectively. There was no difference between the PJK and the non-PJK groups in baseline demographics, pre-operative and immediate post-operative pelvic incidence-lumbar lordosis mismatch, sagittal vertical axis, or coronal Cobb. The immediate postoperative L1-GL was -7.24 cm in PJK and -3.45 cm in non-PJK ( P < 0.001), L1PL was 1.71 cm in PJK and 3.07 cm in non-PJK ( P = 0.004), and PT (23.76° vs 18.90°, P = 0.026) and TK (40.56° vs 31.39°, P < 0.001) were larger in PJK than in non-PJK. After univariate and multivariate analyses, immediate postoperative TK and immediate postoperative L1-GL were independent risk factors for PJK without collinearity. Conclusions: A dorsally displaced L1 relative to the GL was associated with an increased risk of PJK after ASD surgery. The postoperative L1-GL distance may be a factor to consider during ASD surgery.

scholarly journals Evaluation of the Influence of HaloGravity Traction upon the Results of Severe Neuromuscular Deformity Treatment

2016 ◽  
Vol 23 (2) ◽  
pp. 12-17
Author(s):  
S. V Kolesov ◽  
A. N Baklanov ◽  
A. I Shavyrin ◽  
S. A Kudryakov ◽  
A. N Shaboldin ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Postoperative Period ◽  
Deformity Correction ◽  
Preoperative Preparation ◽  
Treatment Results ◽  
Ponte Osteotomy ◽  
Halo Traction ◽  
One Step ◽  
Group 2 ◽  
Group 1

Evaluation of the effect of traction preoperative preparation on the degree of neuromuscular spinal deformity correction was performed. Treatment results for 50 patients with paralytic deformities operated on in 3 different clinics were analyzed. The patients were divided in 2 comparable groups, 25 patients in each group. In group 1 one-step intervention, i.e. dorsal correction under halo-traction and Ponte osteotomy was performed. In group 2 two-step correction, i.e. 12-14 days gradual halo-gravity traction followed by dorsal correction and Ponte osteotomy. Postoperative deformity correction made up 49 and 50% in the 1st and 2nd groups, respectively. In patients from the 2nd group the postoperative period was smoother. Thus, the study did not detect any influence of traction preparation on the degree of the deformity correction.

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