Clinical and radiographic parameters for patients with adult spinal deformity

Background: Improved medical care and increased life expectancy have led to a focus on the impact of adult spinal deformity (ASD) on health-related quality of life (HRQoL) in the field of the spine. Recently, there has been a paradigm shift in the evaluation and management of ASD regarding the important correlation between sagittal imbalance and clinical outcomes.Current Concepts: Loss of lumbar lordosis is recognized as a key driver of ASD followed by forward-leaning of the trunk, reducing thoracic kyphosis, pelvic retroversion, and knee flexion. Radiological assessment has been critical for evaluating ASD from the anteroposterior and lateral view of the whole spine radiograph. Important parameters include coronal, regional, global, and sagittal spinopelvic parameters. Especially, sagittal spinopelvic parameters significantly correlate with disability and HRQoL in patients with ASD, which can influence the process of decision-making with respect to the choice between conservative treatment and surgery.Discussion and Conclusion: Sagittal imbalance has been recently emphasized in patients with ASD. Therefore, the decision-making of ASD treatment should be focused on restoring harmonious alignment to prevent catastrophic complications and improvement of HRQoL.

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Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study

Journal of Neurosurgery Spine ◽

10.3171/2014.2.spine1347 ◽

2014 ◽

Vol 20 (5) ◽

pp. 515-522 ◽

Cited By ~ 55

Author(s):

Jotham C. Manwaring ◽

Konrad Bach ◽

Amir A. Ahmadian ◽

Armen R. Deukmedjian ◽

Donald A. Smith ◽

...

Keyword(s):

Minimally Invasive ◽

Cobb Angle ◽

Spinal Deformity ◽

Lumbar Lordosis ◽

Interbody Fusion ◽

Adult Spinal Deformity ◽

Spinal Instrumentation ◽

Sagittal Imbalance ◽

Lumbar Interbody Fusion ◽

Spinopelvic Parameters

Object Minimally invasive (MI) fusion and instrumentation techniques are playing a new role in the treatment of adult spinal deformity. The open pedicle subtraction osteotomy (PSO) and Smith-Petersen osteotomy (SPO) are proven segmental methods for improving regional lordosis and global sagittal parameters. Recently the MI anterior column release (ACR) was introduced as a segmental method for treating sagittal imbalance. There is a paucity of data in the literature evaluating the alternatives to PSO and SPO for sagittal balance correction. Thus, the authors conducted a preliminary retrospective radiographic review of prospectively collected data from 2009 to 2012 at a single institution. The objectives of this study were to: 1) investigate the radiographic effect of MI-ACR on spinopelvic parameters, 2) compare the radiographic effect of MI-ACR with PSO and SPO for treatment of adult spinal deformity, and 3) investigate the radiographic effect of percutaneous posterior spinal instrumentation on spinopelvic parameters when combined with MI transpsoas lateral interbody fusion (LIF) for adult spinal deformity. Methods: Patient demographics and radiographic data were collected for 36 patients (9 patients who underwent MI-ACR and 27 patients who did not undergo MI-ACR). Patients included in the study were those who had undergone at least a 2-level MI-LIF procedure; adequate preoperative and postoperative 36-inch radiographs of the scoliotic curvature; a separate second-stage procedure for the placement of posterior spinal instrumentation; and a diagnosis of degenerative scoliosis (coronal Cobb angle > 10° and/or sagittal vertebral axis > 5 cm). Statistical analysis was performed for normality and significance testing. Results Percutaneous transpedicular spinal instrumentation did not significantly alter any of the spinopelvic parameters in either the ACR group or the non-ACR group. Lateral MI-LIF alone significantly improved coronal Cobb angle by 16°, and the fractional curve significantly improved in a subgroup treated with L5–S1 transforaminal lumbar interbody fusion. Fifteen ACRs were performed in 9 patients and resulted in significant coronal Cobb angle correction, lumbar lordosis correction of 16.5°, and sagittal vertebral axis correction of 4.8 cm per patient. Segmental analysis revealed a 12° gain in segmental lumbar lordosis and a 3.1-cm correction of the sagittal vertebral axis per ACR level treated. Conclusions The lateral MI-LIF with ACR has the ability to powerfully restore lumbar lordosis and correct sagittal imbalance. This segmental MI surgical technique boasts equivalence to SPO correction of these global radiographic parameters while simultaneously creating additional disc height and correcting coronal imbalance. Addition of posterior percutaneous instrumentation without in situ manipulation or overcorrection does not alter radiographic parameters when combined with the lateral MI-LIF.

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Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity: Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up

Global Spine Journal ◽

10.1177/21925682211009178 ◽

2021 ◽

pp. 219256822110091

Author(s):

Yu-Cheng Yao ◽

Han Jo Kim ◽

Mathieu Bannwarth ◽

Justin Smith ◽

Shay Bess ◽

...

Keyword(s):

Spinal Deformity ◽

Sagittal Alignment ◽

Adult Spinal Deformity ◽

Operating Time ◽

Patient Demographics ◽

Lowest Instrumented Vertebra ◽

Related Quality ◽

Health Related

Study Design: Retrospective cohort study. Objective: To compare the outcomes of patients with adult spinal deformity (ASD) following spinal fusion with the lowest instrumented vertebra (LIV) at L4/L5 versus S1/ilium. Methods: A multicenter ASD database was evaluated. Patients were categorized into 2 groups based on LIV levels—groups L (fusion to L4/L5) and S (fusion to S1/ilium). Both groups were propensity matched by age and preoperative radiographic alignments. Patient demographics, operative details, radiographic parameters, revision rates, and health-related quality of life (HRQOL) scores were compared. Results: Overall, 349 patients had complete data, with a mean follow-up of 46 months. Patients in group S (n = 311) were older and had larger sagittal and coronal plane deformities than those in group L (n = 38). After matching, 28 patients were allocated to each group with similar demographic, radiographic, and clinical parameters. Sagittal alignment restoration at postoperative week 6 was significantly better in group S than in group L, but it was similar in both groups at the 2-year follow-up. Fusion to S1/ilium involved a longer operating time, higher PJK rates, and greater PJK angles than that to L4/L5. There were no significant differences in the complication and revision rates between the groups. Both groups showed significant improvements in HRQOL scores. Conclusions: Fusion to S1/ilium had better sagittal alignment restoration at postoperative week 6 and involved higher PJK rates and greater PJK angles than that to L4/L5. The clinical outcomes and rates of revision surgery and complications were similar between the groups.

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Impact of Three-Column Osteotomy on Health Related Quality of Life Measures in Patients With Adult Spinal Deformity: A Systematic Review and Meta-Analysis

The Spine Journal ◽

10.1016/j.spinee.2017.10.026 ◽

2017 ◽

Vol 17 (11) ◽

pp. S324

Author(s):

Muralidharan Venkatesan ◽

Sarang Sapare ◽

Jagdeep Singh ◽

Nasir Quraishi

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Meta Analysis ◽

Health Related Quality ◽

Quality Of Life Measures ◽

Related Quality ◽

Health Related

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Frailty and Health-Related Quality of Life Improvement Following Adult Spinal Deformity Surgery

World Neurosurgery ◽

10.1016/j.wneu.2018.01.079 ◽

2018 ◽

Vol 112 ◽

pp. e548-e554 ◽

Cited By ~ 19

Author(s):

Daniel B.C. Reid ◽

Alan H. Daniels ◽

Tamir Ailon ◽

Emily Miller ◽

Daniel M. Sciubba ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Health Related Quality ◽

Related Quality ◽

Spinal Deformity Surgery ◽

Health Related ◽

Life Improvement

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Impact of compensatory mechanism on health-related quality of life in adult spinal deformity surgery

Scoliosis ◽

10.1186/1748-7161-10-s1-o54 ◽

2015 ◽

Vol 10 (S1) ◽

Author(s):

Sho Kobayashi ◽

Tomohiko Hasegawa ◽

Yu Yamato ◽

Tatsuya Yasuda ◽

Hideyuki Arima ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Compensatory Mechanism ◽

Health Related Quality ◽

Related Quality ◽

Spinal Deformity Surgery ◽

Health Related

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QOLP-03. MEASURING CHANGE IN HEALTH-RELATED QUALITY OF LIFE: THE ADDED VALUE OF ANALYSIS ON THE INDIVIDUAL PATIENT LEVEL IN GLIOMA PATIENTS IN CLINICAL DECISION MAKING

Neuro-Oncology ◽

10.1093/neuonc/noz175.823 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi197-vi198 ◽

Cited By ~ 1

Author(s):

Marijke Coomans ◽

Martin Taphoorn ◽

Neil Aaronson ◽

Brigitta Baumert ◽

Martin van den Bent ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Scale Item ◽

Individual Patient Level ◽

Patient Level ◽

Related Quality ◽

The Individual ◽

The Impact ◽

Over Time

Abstract BACKGROUND: Health-related quality of life (HRQoL) is an important outcome in glioma research, reflecting the impact of disease and treatment on a patient’s functioning and wellbeing. Data on changes in HRQoL scores provide important information for clinical decision-making, but different analytical methods may lead to different interpretations of the impact of treatment on HRQoL. This study aimed to study whether different methods to evaluate change in HRQoL result in different interpretations. Methods: HRQoL and sociodemographical/clinical data from 15 randomized clinical trials were combined. Change in HRQoL scores was analyzed: (1)at the group level, comparing mean changes in scale/item scores between treatment arms over time, (2)at the patient level per scale/item by calculating the percentage of patients that deteriorated, improved or remained stable on a scale/item per scale/item, and (3)at the individual patient level combining all scales/items. Results: Data were available for 3727 patients. At the group scale/item level (method 1), only the item ‘hair loss’ showed a significant and clinically relevant change (i.e. ≥10 points) over time, whereas change scores on the other scales/items showed a statistically significant change only (all p< .001, range in change score:0.1–6.2). Analyses on the patient level per scale (method 2) indicated that, while a large proportion of patients had stable HRQoL over time (range:27–84%), many patients deteriorated (range:6–43%) or improved (range:8–32%) on a specific scale/item. At the individual patient level (method 3), the majority of patients (86%) showed both deterioration and improvement, while only 1% of the patients remained stable on all scales. Conclusion: Different analytical methods of changes in HRQoL result in distinct interpretations of treatment effects, all of which may be relevant for clinical decision-making. Additional information about the joint impact of treatment on all outcomes may help patients and physicians to make the best treatment decision.

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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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