The impact of lumbar alignment targets on mechanical complications after adult lumbar scoliosis surgery.
Adult spinal deformity
Age-adjusted
Global alignment and proportion
Spinal alignment
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
31
08
2021
accepted:
23
03
2022
revised:
02
03
2022
pubmed:
17
4
2022
medline:
18
6
2022
entrez:
16
4
2022
Statut:
ppublish
Résumé
The purpose of this study was to determine the discriminatory ability of age-adjusted alignment offset and the global alignment and proportion (GAP) score parameters to predict postoperative mechanical complications. Surgical patients from the Adult Symptomatic Lumbar Scoliosis cohort were reviewed at 2 year follow up. Age-adjusted alignment offsets and GAP parameters were calculated for each patient. A series of nonlinear logistic regression models were fit, and the odds of mechanical complications were calculated. The discriminatory ability of the GAP score, GAP score parameters, and age-adjusted alignment offsets were determined plotting receiver operative characteristic (ROC) with the C statistic (AUC). A total of 165 patients were included. A total of 49 mechanical complications occurred in 41 patients (21 proximal junctional kyphosis and 28 pseudoarthrosis). The GAP score had no discriminatory ability in this cohort. Relative lumbar lordosis 15 degrees greater than ideal lumbar lordosis was associated with greater mechanical complications. A lumbar distribution index of 90% was associated with fewer mechanical complications compared to a lumbar distribution index of 65%. Age-adjusted offset alignment targets had no discriminatory ability to predict mechanical complications. Radiographic alignment targets using either age-adjusted alignment target offset or GAP score parameters had minimal ability to predict mechanical complications in isolation. Mechanical complications following adult spinal deformity surgery are complex, and patient factors play a critical role. Clinical trial registeration This study was registered at ClinicalTrials.gov (number NCT00854828) in March 2009.
Identifiants
pubmed: 35428916
doi: 10.1007/s00586-022-07200-3
pii: 10.1007/s00586-022-07200-3
doi:
Banques de données
ClinicalTrials.gov
['NCT00854828']
Types de publication
Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1573-1582Subventions
Organisme : NIAMS NIH HHS
ID : R01 AR055176
Pays : United States
Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Ames CP, Scheer JK, Lafage V, Smith JS, Bess S, Berven SH, Mundis GM, Sethi RK, Deinlein DA, Coe JD, Hey LA, Daubs MD (2016) Adult spinal deformity: epidemiology, health impact, evaluation and management. Spine Deform 4:310–322. https://doi.org/10.1016/j.jspd.2015.12.009
doi: 10.1016/j.jspd.2015.12.009
pubmed: 27927522
Bess S, Line B, Fu KM, McCarthy I, Lafage V, Schwab F, Shaffrey C, Ames C, Akbarnia B, Jo H, Kelly M, Burton D, Hart R, Klineberg E, Kebaish K, Hostin R, Mundis G, Mummaneni P (1976) Smith JS (2016) the health impact of symptomatic adult spinal deformity: comparison of deformity types to united states population norms and chronic diseases. Spine (Phila Pa) 41(3):224–233. https://doi.org/10.1097/BRS.0000000000001202
doi: 10.1097/BRS.0000000000001202
Ailon T, Smith JS, Shaffrey CI, Lenke LG, Brodke D, Harrop JS, Fehlings M, Ames CP (2015) Degenerative spinal deformity. Neurosurgery 77(Suppl 4):S75-91. https://doi.org/10.1227/neu.0000000000000938
doi: 10.1227/neu.0000000000000938
pubmed: 26378361
Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30(18):2024–2029
doi: 10.1097/01.brs.0000179086.30449.96
Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine 38(13):E803-812. https://doi.org/10.1097/BRS.0b013e318292b7b9
doi: 10.1097/BRS.0b013e318292b7b9
pubmed: 23722572
Yilgor C, Sogunmez N, Boissiere L, Yavuz Y, Obeid I, Kleinstück F, Pérez-Grueso FJS, Acaroglu E, Haddad S, Mannion AF, Pellise F, Alanay A (2017) Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am 99:1661–1672. https://doi.org/10.2106/jbjs.16.01594
doi: 10.2106/jbjs.16.01594
pubmed: 28976431
Lafage R, Schwab F, Challier V, Henry JK, Gum J, Smith J, Hostin R, Shaffrey C, Kim HJ, Ames C, Scheer J, Klineberg E, Bess S, Burton D, Lafage V (2016) Defining spino-pelvic alignment thresholds: should operative goals in adult spinal deformity surgery account for age? Spine 41(1):62–68. https://doi.org/10.1097/brs.0000000000001171
doi: 10.1097/brs.0000000000001171
pubmed: 26689395
Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30(3):346–353
doi: 10.1097/01.brs.0000152379.54463.65
Sebaaly A, Grobost P, Mallam L, Roussouly P (2018) Description of the sagittal alignment of the degenerative human spine. Eur spine J: Off Publ Eur Spine Soc Eur Spin Deform Soc Eur Sect Cerv Spine Res Soc 27:489–496. https://doi.org/10.1007/s00586-017-5404-0
doi: 10.1007/s00586-017-5404-0
Lafage R, Schwab F, Glassman S, Bess S, Harris B, Sheer J, Hart R, Line B, Henry J, Burton D, Kim H, Klineberg E, Ames C, Lafage V (2017) Age-adjusted alignment goals have the potential to reduce PJK. Spine 42(17):1275–1282. https://doi.org/10.1097/brs.0000000000002146
doi: 10.1097/brs.0000000000002146
pubmed: 28263226
Kelly MP, Lurie JD, Yanik EL, Shaffrey CI, Baldus CR, Boachie-Adjei O, Buchowski JM, Carreon LY, Crawford CH 3rd, Edwards C 2nd, Errico TJ, Glassman SD, Gupta MC, Lenke LG, Lewis SJ, Kim HJ, Koski T, Parent S, Schwab FJ, Smith JS, Zebala LP, Bridwell KH (2019) Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis. J Bone Joint Surg Am 101:338–352. https://doi.org/10.2106/jbjs.18.00483
doi: 10.2106/jbjs.18.00483
pubmed: 30801373
Team R Core (2019) R: A language and environment for statistical computing. In R Foundation for Statistical Computing, Austria
Frank E, Harrell J (2001) Regression modeling strategies: with applications to linear models, logistic regression and survival analysis. Springer International Publishing, New York
Sebaaly A, Gehrchen M, Silvestre C, Kharrat K, Bari TJ, Kreichati G, Rizkallah M, Roussouly P (2020) Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur spine J: offl Publ Eur Spine Soc, Eur Spin Deform Soc Eur Sec Cerv Spine Res Soc 29:904–913. https://doi.org/10.1007/s00586-019-06253-1
doi: 10.1007/s00586-019-06253-1
Baum GR, Ha AS, Cerpa M, Zuckerman SL, Lin JD, Menger RP, Osorio JA, Morr S, Leung E, Lehman RA, Sardar Z, Lenke LG (2020) Does the global alignment and proportion score overestimate mechanical complications after adult spinal deformity correction? J Neurosurg Spine 34(1):1–7. https://doi.org/10.3171/2020.6.Spine20538
doi: 10.3171/2020.6.Spine20538
Kawabata A, Yoshii T, Sakai K, Hirai T, Yuasa M, Inose H, Utagawa K, Hashimoto J, Matsukura Y, Tomori M, Torigoe I, Kusano K, Otani K, Mizuno K, Satoshi S, Kazuyuki F, Tomizawa S, Arai Y, Shindo S, Okawa A (2020) Identification of predictive factors for mechanical complications after adult spinal deformity surgery: a multi-institutional retrospective study. Spine 45:1185–1192. https://doi.org/10.1097/brs.0000000000003500
doi: 10.1097/brs.0000000000003500
pubmed: 32205686
Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine 25(5):575–586. https://doi.org/10.1097/00007632-200003010-00008
doi: 10.1097/00007632-200003010-00008
pubmed: 10749634
Yilgor C, Sogunmez N, Yavuz Y, Abul K, Boissiere L, Haddad S, Obeid I, Kleinstuck F, Sanchez Perez-Grueso FJ, Acaroglu E, Mannion AF, Pellise F, Alanay A, European Spine Study G (2017) Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence-based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis. Neurosurg Focus 43:E5. https://doi.org/10.3171/2017.8.FOCUS17498
doi: 10.3171/2017.8.FOCUS17498
Kwan KYH, Lenke LG, Shaffrey CI, Carreon LY, Dahl BT, Fehlings MG, Ames CP, Boachie-Adjei O, Dekutoski MB, Kebaish KM, Lewis SJ, Matsuyama Y, Mehdian H, Qiu Y, Schwab FJ, Cheung KMC (2021) Are higher global alignment and proportion scores associated with increased risks of mechanical complications after adult spinal deformity surgery? An external validation. Clin Orthop Relat Res 479:312–320. https://doi.org/10.1097/corr.0000000000001521
doi: 10.1097/corr.0000000000001521
pubmed: 33079774
Ha AS, Hong DY, Coury JR, Cerpa M, Baum G, Sardar Z, Lenke LG (2020) Partial intraoperative global alignment and proportion scores do not reliably predict postoperative mechanical failure in adult spinal deformity surgery. Glob Spine J. https://doi.org/10.1177/2192568220935438
doi: 10.1177/2192568220935438
Bari TJ, Ohrt-Nissen S, Hansen LV, Dahl B, Gehrchen M (2019) Ability of the global alignment and proportion score to predict mechanical failure following adult spinal deformity surgery-validation in 149 patients with two-year follow-up. Spine Deform 7:331–337. https://doi.org/10.1016/j.jspd.2018.08.002
doi: 10.1016/j.jspd.2018.08.002
pubmed: 30660230
Katsuura Y, Lafage R, Kim HJ, Smith JS, Line B, Shaffrey C, Burton DC, Ames CP, Mundis GM, Jr., Hostin R, Bess S, Klineberg EO, Passias PG, Lafage V, International Spine Study G (2021) Alignment targets curve proportion and mechanical loading: preliminary analysis of an ideal shape toward reducing proximal junctional kyphosis. Glob Spine J. https://doi.org/10.1177/2192568220987188
doi: 10.1177/2192568220987188
Line BG, Bess S, Lafage R, Lafage V, Schwab F, Ames C, Kim HJ, Kelly M, Gupta M, Burton D, Hart R, Klineberg E, Kebaish K, Hostin R, Mundis G, Eastlack R, Shaffrey C, Smith JS, International Spine Study G (2020) Effective prevention of proximal junctional failure in adult spinal deformity surgery requires a combination of surgical implant prophylaxis and avoidance of sagittal alignment overcorrection. Spine 45(4):258–267. https://doi.org/10.1097/BRS.0000000000003249
doi: 10.1097/BRS.0000000000003249
Mendoza-Lattes S, Ries Z, Gao Y, Weinstein SL (2011) Proximal junctional kyphosis in adult reconstructive spine surgery results from incomplete restoration of the lumbar lordosis relative to the magnitude of the thoracic kyphosis. Iowa Orthop J 31:199–206
pubmed: 22096442
pmcid: 3215136
Kim YJ, Bridwell KH, Lenke LG, Glattes CR, Rhim S (1976) Cheh G (2008) Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up. Spine (Phila Pa) 33(20):2179–2184. https://doi.org/10.1097/BRS.0b013e31817c0428
doi: 10.1097/BRS.0b013e31817c0428
Lau D, Clark AJ, Scheer JK, Daubs MD, Coe JD, Paonessa KJ, LaGrone MO, Kasten MD, Amaral RA, Trobisch PD, Lee JH, Fabris-Monterumici D, Anand N, Cree AK, Hart RA, Hey LA (1976) Ames CP (2014) Committee SRSASD proximal junctional kyphosis and failure after spinal deformity surgery: a systematic review of the literature as a background to classification development. Spine (Phila Pa) 39(25):2093–2102. https://doi.org/10.1097/BRS.0000000000000627
doi: 10.1097/BRS.0000000000000627
Yagi M, Rahm M, Gaines R, Maziad A, Ross T, Kim HJ, Kebaish K (1976) Boachie-Adjei O (2014) Complex spine study g characterization and surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity. Spine (Phila Pa) 39(10):E607-614. https://doi.org/10.1097/BRS.0000000000000266
doi: 10.1097/BRS.0000000000000266
Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A (1976) Edwards C (2005) 2nd Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence outcomes and risk factor analysis. Spine (Phila Pa) 30(14):1643–1649. https://doi.org/10.1097/01.brs.0000169451.76359.49
doi: 10.1097/01.brs.0000169451.76359.49
Mancino F, Cacciola G, Di Matteo V, Perna A, Proietti L, Greenberg A, Ma M, Sculco PK, Maccauro G, De Martino I (2020) Surgical implications of the hip-spine relationship in total hip arthroplasty. Orthop Rev (Pavia) 12:8656. https://doi.org/10.4081/or.2020.8656
doi: 10.4081/or.2020.8656
pmcid: 7459374