Revision Free Loss of Sagittal Correction > 3 Years After Adult Spinal Deformity Surgery: Who and Why?
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
17 Oct 2023
17 Oct 2023
Historique:
received:
22
09
2022
accepted:
15
12
2022
pubmed:
17
10
2023
medline:
17
10
2023
entrez:
17
10
2023
Statut:
aheadofprint
Résumé
Multicenter retrospective cohort study. To investigate risk factors for loss of correction within the instrumented lumbar spine following ASD surgery. The sustainability of adult deformity (ASD) surgery remains a health care challenge. Malalignment is a major reason for revision surgery. 321 patients who underwent fusion of the lumbar spine (≥5 levels, LIV pelvis) with a revision-free follow-up ≥3 years were identified. Patients were stratified by change in PI-LL from 6 weeks to 3 years postop as Maintained vs. Loss >5°. Those with instrumentation failure (broken rod, screw pullout, etc.) were excluded before comparisons. Demographics, surgical data, and radiographic alignment were compared. Repeated measure ANOVA was performed to evaluate the maintenance of the correction for L1-L4 and L4-S1. Multivariate logistic regression was conducted to identify independent surgical predictors of correction loss. The cohort had a mean age of 64 yrs, mean BMI 28 kg/m 2 , 80% female. 82 patients (25.5%) lost >5° of PI-LL correction (mean loss 10±5°). After exclusion of patients with instrumentation failure, 52 Loss were compared to 222 Maintained. Demographics, osteotomies, 3CO, IBF, use of BMP, rod material, rod diameter, and fusion length were not significantly different. L1-S1 screw orientation angle was 1.3±4.1 from early postop to 3 years ( P =0.031), but not appreciably different at L4-S1 (-0.1±2.9 P =0.97). Lack of a supplemental rod (OR 4.0, P =0.005) and fusion length (OR 2.2, P =0.004) were associated with loss of correction. Approximately a quarter of revision-free patients lose an average of 10° of their 6-week correction by 3 years. Lordosis is lost proximally through the instrumentation (i.e. tulip/shank angle shifts and/or rod bending). The use of supplemental rods and avoiding sagittal overcorrection may help mitigate this loss.
Sections du résumé
STUDY DESIGN
METHODS
Multicenter retrospective cohort study.
OBJECTIVE
OBJECTIVE
To investigate risk factors for loss of correction within the instrumented lumbar spine following ASD surgery.
SUMMARY OF BACKGROUND DATA
BACKGROUND
The sustainability of adult deformity (ASD) surgery remains a health care challenge. Malalignment is a major reason for revision surgery.
METHODS
METHODS
321 patients who underwent fusion of the lumbar spine (≥5 levels, LIV pelvis) with a revision-free follow-up ≥3 years were identified. Patients were stratified by change in PI-LL from 6 weeks to 3 years postop as Maintained vs. Loss >5°. Those with instrumentation failure (broken rod, screw pullout, etc.) were excluded before comparisons. Demographics, surgical data, and radiographic alignment were compared. Repeated measure ANOVA was performed to evaluate the maintenance of the correction for L1-L4 and L4-S1. Multivariate logistic regression was conducted to identify independent surgical predictors of correction loss.
RESULTS
RESULTS
The cohort had a mean age of 64 yrs, mean BMI 28 kg/m 2 , 80% female. 82 patients (25.5%) lost >5° of PI-LL correction (mean loss 10±5°). After exclusion of patients with instrumentation failure, 52 Loss were compared to 222 Maintained. Demographics, osteotomies, 3CO, IBF, use of BMP, rod material, rod diameter, and fusion length were not significantly different. L1-S1 screw orientation angle was 1.3±4.1 from early postop to 3 years ( P =0.031), but not appreciably different at L4-S1 (-0.1±2.9 P =0.97). Lack of a supplemental rod (OR 4.0, P =0.005) and fusion length (OR 2.2, P =0.004) were associated with loss of correction.
CONCLUSIONS
CONCLUSIONS
Approximately a quarter of revision-free patients lose an average of 10° of their 6-week correction by 3 years. Lordosis is lost proximally through the instrumentation (i.e. tulip/shank angle shifts and/or rod bending). The use of supplemental rods and avoiding sagittal overcorrection may help mitigate this loss.
Identifiants
pubmed: 37847773
doi: 10.1097/BRS.0000000000004852
pii: 00007632-990000000-00489
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.