Pelvic Nonresponse Following Treatment of Adult Spinal Deformity: Influence of Realignment Strategies on Occurrence.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 May 2023
01 May 2023
Historique:
received:
16
03
2022
accepted:
22
04
2022
medline:
14
4
2023
pubmed:
15
9
2022
entrez:
14
9
2022
Statut:
ppublish
Résumé
Despite adequate correction, the pelvis may fail to readjust, deemed pelvic nonresponse (PNR). To assess alignment outcomes [PNR, proximal junctional kyphosis (PJK), postoperative cervical deformity (CD)] following adult spinal deformity (ASD) surgery utilizing different realignment strategies. ASD patients with two-year data were included. PNR defined as undercorrected in age-adjusted pelvic tilt (PT) at six weeks and maintained at two years. Patients classified by alignment utilities: (a) improvement in Scoliosis Research Society-Schwab sagittal vertical axis, (b) matching in age-adjusted pelvic incidence-lumbar lordosis, (c) matching in Roussouly, (d) aligning Global Alignment and Proportionality (GAP) score. Multivariable regression analyses, controlling for age, baseline deformity, and surgical factors, assessed rates of PNR, PJK, and CD development following realignment. A total of 686 patients met the inclusion criteria. Rates of postoperative PJK and CD were not significant in the PNR group (both P >0.15). PNR patients less often met substantial clinical benefit in Oswestry Disability Index by two years [odds ratio: 0.6 (0.4-0.98)]. Patients overcorrected in age-adjusted pelvic incidence-lumbar lordosis, matching Roussouly, or proportioned in GAP at six weeks had lower rates of PNR (all P <0.001). Incremental addition of classifications led to 0% occurrence of PNR, PJK, and CD. Stratifying by baseline PT severity, Low and moderate deformity demonstrated the least incidence of PNR (7.7%) when proportioning in GAP at six weeks, while severe PT benefited most from matching in Roussouly (all P <0.05). Following ASD corrective surgery, 24.9% of patients showed residual pelvic malalignment. This occurrence was often accompanied by undercorrection of lumbopelvic mismatch and less improvement of pain. However, overcorrection in any strategy incurred higher rates of PJK. We recommend surgeons identify a middle ground using one, or more, of the available classifications to inform correction goals in this regard. III.
Identifiants
pubmed: 36102572
doi: 10.1097/BRS.0000000000004464
pii: 00007632-202305010-00007
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
645-652Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976). 2005;30:682–688.
Smith JS, Shaffrey CI, Glassman SD, et al. Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine (Phila Pa 1976). 2011;36:817–824.
Yagi M, Ohne H, Kaneko S, Machida M, Yato Y, Asazuma T. Does corrective spine surgery improve the standing balance in patients with adult spinal deformity? Spine J. 2018;18:36–43.
Smith JS, Klineberg E, Lafage V, et al. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine. 2016;25:1–14.
Lazennec JY, Ramaré S, Arafati N, et al. Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J. 2000;9:47–55.
Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976). 2009;34:E599–E606.
Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery. 2012;70:707–721; Erratum in: Neurosurgery . 2012;70:1324.
Protopsaltis TS, Ayres EW, Soroceanu A, et al. 258. The pelvic tilt response to ASD correction depends on PI, age and alignment. Spine J. 2019;19:S126.
Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976). 2012;37:1077–1082.
Yilgor C, Sogunmez N, Boissiere L, et al. European Spine Study Group (ESSG). 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. 2017;99:1661–1672.
Laouissat F, Sebaaly A, Gehrchen M, Roussouly P. Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J. 2018;27:2002–2011.
Lafage R, Schwab F, Glassman S, et al. Age-adjusted alignment goals have the potential to reduce PJK. Spine (Phila Pa 1976). 2017;42:1275–1282.
Passias PG, Passfall L, Horn SR, et al. International Spine Study Group. Risk-benefit assessment of major versus minor osteotomies for flexible and rigid cervical deformity correction. J Craniovertebr Junction Spine. 2021;12:263–268.
Passias PG, Bortz C, Pierce KE, et al. International Spine Study Group. Comparing and contrasting the clinical utility of sagittal spine alignment classification frameworks: Roussouly vs. SRS-Schwab. Spine (Phila Pa 1976). 2022;47:455–462.
Passias PG, Bortz CA, Pierce KE, et al. A simpler, modified frailty index weighted by complication occurrence correlates to pain and disability for adult spinal deformity patients. Int J Spine Surg. 2020;14:1031–1036.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.
Champain S, Benchikh K, Nogier A, Mazel C, Guise JDe, Skalli W. Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies. Eur Spine J. 2006;15:982–991.
Rillardon L, Levassor N, Guigui P, et al. Validation of a tool to measure pelvic and spinal parameters of sagittal balance. Rev Chir Orthop Reparatrice Appar Mot. 2003;89:218–227.
O’Brien MF, Kuklo TRTR, Blanke KM, Lenke LG. Spinal Deformity Study Group Radiographic Measurement Manual. Memphis, TN: Medtronic Sofamor Danek; 2005.
Smith JS, Shaffrey CI, Lafage V, et al. International Spine Study Group. Comparison of best versus worst clinical outcomes for adult spinal deformity surgery: a retrospective review of a prospectively collected, multicenter database with 2-year follow-up. J Neurosurg Spine. 2015;23:349–359.
Uribe JS, Januszewski J, Wang M, et al. Minimally Invasive Surgery Section of the International Spine Study Group. Patients with high pelvic tilt achieve the same clinical success as those with low pelvic tilt after minimally invasive adult deformity surgery. Neurosurgery. 2018;83:270–276.
Shin MH, Ryu KS, Hur JW, Kim JS, Park CK. Comparative study of lumbopelvic sagittal alignment between patients with and without sacroiliac joint pain after lumbar interbody fusion. Spine (Phila Pa 1976). 2013;38:E1334–E1341.
Inami S, Moridaira H, Takeuchi D, et al. Postoperative status of global sagittal alignment with compensation in adult spinal deformity. Spine (Phila Pa 1976). 2018;43:1631–1637.
Bari TJ, Ohrt-Nissen S, Hansen LV, Dahl B, Gehrchen M. 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. 2019;7:331–337.
Kwan KYH, Lenke LG, Shaffrey CI, et al. 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. 2021;479:312–320.
Byun CW, Cho JH, Lee CS, Lee DH, Hwang CJ. Effect of overcorrection on proximal junctional kyphosis in adult spinal deformity: analysis by age-adjusted ideal sagittal alignment. Spine J. 2022;22:635–645.
Lafage R, Smith JS, Elysee J, et al. International Spine Study Group (ISSG). Sagittal Age-Adjusted Score (SAAS) for adult spinal deformity (ASD) more effectively predicts surgical outcomes and proximal junctional kyphosis than previous classifications. Spine Deform. 2022;10:121–131.
Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976). 2010;35:2224–2231.
Lafage R, Schwab F, Challier V, et al. International Spine Study Group. Defining spino-pelvic alignment thresholds: should operative goals in adult spinal deformity surgery account for age? Spine (Phila Pa 1976). 2016;41:62–68.
Bridwell KH, Lenke LG, Cho SK, et al. Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle. Neurosurgery. 2013;72:899–906.
Kim HJ, Iyer S. Proximal junctional kyphosis. J Am Acad Orthop Surg. 2016;24:318–326.
Kim HJ, Bridwell KH, Lenke LG, et al. Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections. Spine (Phila Pa 1976). 2014;39:E576–E580.
Maruo K, Ha Y, Inoue S, et al. Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity. Spine (Phila Pa 1976). 2013;38:E1469–E1476.
Annis P, Lawrence BD, Spiker WR, et al. Predictive factors for acute proximal junctional failure after adult deformity surgery with upper instrumented vertebrae in the thoracolumbar spine. Evid Based Spine Care J. 2014;5:160–162.
Watanabe K, Lenke LG, Bridwell KH, Kim YJ, Koester L, Hensley M. Proximal junctional vertebral fracture in adults after spinal deformity surgery using pedicle screw constructs: analysis of morphological features. Spine (Phila Pa 1976). 2010;35:138–145.
Wu HH, Chou D, Hindoyan K, et al. Upper instrumented vertebra-femoral angle and correlation with proximal junctional kyphosis in adult spinal deformity. Spine Deform. 2022;10:449–455.
Diebo BG, Shah NV, Stroud SG, Paulino CB, Schwab FJ, Lafage V. Realignment surgery in adult spinal deformity: prevalence and risk factors for proximal junctional kyphosis. Orthopade. 2018;47:301–309.