Frail patients require instrumentation of a more proximal vertebra for a successful outcome after surgery for adult spine deformity.
Journal
The bone & joint journal
ISSN: 2049-4408
Titre abrégé: Bone Joint J
Pays: England
ID NLM: 101599229
Informations de publication
Date de publication:
01 Nov 2024
01 Nov 2024
Historique:
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
31
10
2024
Statut:
epublish
Résumé
The aim of this study was to investigate the impact of the level of upper instrumented vertebra (UIV) in frail patients undergoing surgery for adult spine deformity (ASD). Patients with adult spinal deformity who had undergone T9-to-pelvis fusion were stratified using the ASD-Modified Frailty Index into not frail, frail, and severely frail categories. ASD was defined as at least one of: scoliosis ≥ 20°, sagittal vertical axis (SVA) ≥ 5 cm, or pelvic tilt ≥ 25°. Means comparisons tests were used to assess differences between both groups. Logistic regression analyses were used to analyze associations between frailty categories, UIV, and outcomes. A total of 477 patients were included (mean age 60.3 years (SD 14.9), mean BMI 27.5 kg/m Frail patients are at risk of a poor outcome after surgery for adult spinal deformity due to their comorbidities. Although a definitively prescriptive upper instrumented vertebra remains elusive, these patients appear to be at greater risk for a poor outcome if the upper instrumented vertebra is sited more distally.
Identifiants
pubmed: 39481445
doi: 10.1302/0301-620X.106B11.BJJ-2024-0369.R2
pii: BJJ-2024-0369.R2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1342-1347Informations de copyright
© 2024 The British Editorial Society of Bone & Joint Surgery.
Déclaration de conflit d'intérêts
P. P. Jankowski reports royalties or licenses from Seaspine and consulting fees from Spine Vision, Seaspine, and Spine Art, all of which are unrelated to this study. R. Lafage reports consulting fees from Carlsmed, unrelated to this study. J. S. Smith reports grants or contracts from ISSG Foundation, DePuy Synthes, AOSpine, SeaSpine, Orthofix, and NREF, royalties or licenses from HighRidge, and Globus/ NuVasive, consulting fees from HighRidge, Cerapedics, Medtronic, DePuy Synthes, SeaSpine, Orthofix, and Carlsmed, support for attending meetings and/or travel from AOSpine, and stock or stock options in Carlsmed Globus/NuVasive, and Alphatec, all of which are unrelated to this study. C. I. Shaffrey reports funding from the ISSG Foundation to Duke University, royalties or licenses from Medtronic, NuVasive/ Globus, and stock or stock options in NuVasive/Globus, all of which are unrelated to this study. V. Lafage reports royalties or licenses from Nuvasive, consulting fees from Globus Medical, AlphatecSpine, and Mainstay Medical, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Stryker, Johnson & Johnson, and Implanet, and stock or stock options in VFT Solutions and SeaSpine, all of which are unrelated to this study. P. G. Passias reports grants or contracts from the International Spine Study Group, Medtronic, and Globus, consulting fees from Medicrea, SpineWave, Terumo, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Globus Medical and Zimmer Biomet, and receipt of equipment, materials, drugs, medical writing, gifts or other services from Allosource, all of which are unrelated to this study.
Références
Diebo BG , Shah NV , Boachie-Adjei O , et al. Adult spinal deformity . Lancet . 2019 ; 394 ( 10193 ): 160 – 172 . 10.1016/S0140-6736(19)31125-0 33769119
Kanter AS , Shaffrey CI , Mummaneni P , Wang MY , Uribe JS . Introduction: adult spinal deformity: pathophysiology and corrective measures . Neurosurg Focus . 2014 ; 36 ( 5 ): Introduction . 10.3171/2014.3.FOCUS14112 24785492
Veronesi F , Borsari V , Martini L , et al. The impact of frailty on spine surgery: systematic review on 10 years clinical studies . Aging Dis . 2021 ; 12 ( 2 ): 625 – 645 . 10.14336/AD.2020.0904 33815887
Laverdière C , Georgiopoulos M , Ames CP , et al. Adult spinal deformity surgery and frailty: a systematic review . Global Spine J . 2022 ; 12 ( 4 ): 689 – 699 . 10.1177/21925682211004250 33769119
Miller EK , Neuman BJ , Jain A , et al. An assessment of frailty as a tool for risk stratification in adult spinal deformity surgery . Neurosurg Focus . 2017 ; 43 ( 6 ): E3 . 10.3171/2017.10.FOCUS17472 29191099
Eleswarapu A , O’Connor D , Rowan FA , et al. Sarcopenia is an independent risk factor for proximal junctional disease following adult spinal deformity surgery . Global Spine J . 2022 ; 12 ( 1 ): 102 – 109 . 10.1177/2192568220947050 32865046
Lee B-J , Bae SS , Choi HY , et al. Proximal junctional kyphosis or failure after adult spinal deformity surgery - review of risk factors and its prevention . Neurospine . 2023 ; 20 ( 3 ): 863 – 875 . 10.14245/ns.2346476.238 37798982
Passias PG , Bortz CA , Segreto FA , et al. Pelvic incidence affects age-adjusted alignment outcomes in a population of adult spinal deformity . Clin Spine Surg . 2021 ; 34 ( 1 ): E51 – E56 . 10.1097/BSD.0000000000001025 32568861
Passias PG , Williamson TK , Pierce KE , et al. The importance of incorporating proportional alignment in adult cervical deformity corrections relative to regional and global alignment . Spine (Phila Pa 1986) . 2024 ; 49 ( 2 ): 116 – 127 . 10.1097/BRS.0000000000004843 37796161
Lowe T , Berven SH , Schwab FJ , Bridwell KH . The SRS classification for adult spinal deformity: building on the King/Moe and Lenke classification systems . Spine (Phila Pa 1976) . 2006 ; 31 ( 19 Suppl ): S119 – 25 . 10.1097/01.brs.0000232709.48446.be 16946628
Fairbank JC , Couper J , Davies JB , O’Brien JP . The Oswestry low back pain disability questionnaire . Physiotherapy . 1980 ; 66 ( 8 ): 271 – 273 . 6450426
Rabin R , Charro F de . EQ-SD: a measure of health status from the EuroQol Group . Ann Med . 2001 ; 33 ( 5 ): 337 – 343 . 10.3109/07853890109002087 11491192
Haher TR , Gorup JM , Shin TM , et al. Results of the Scoliosis Research Society Instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis . Spine (Phila Pa 1986) . 1999 ; 24 ( 14 ): 1435 . 10.1097/00007632-199907150-00008 10423788
Yoshida G , Hasegawa T , Yamato Y , et al. Minimum clinically important differences in Oswestry Disability Index domains and their impact on adult spinal deformity surgery . Asian Spine J . 2019 ; 13 ( 1 ): 35 – 44 . 10.31616/asj.2018.0077 30326683
Lovecchio F , Lafage R , Line B , et al. Optimizing the definition of proximal junctional kyphosis: a sensitivity analysis . Spine (Phila Pa 1976) . 2023 ; 48 ( 6 ): 414 – 420 . 10.1097/BRS.0000000000004564 36728798
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 ( 3 ): 218 – 227 . 12844045
O’Brien MF , Kuklo TR , Blanke KM , Lenke LG . Spinal Deformity Study Group Radiographic Measurement Manual . Medtronic Sofamor Danek USA . 2008 . https://www.oref.org/docs/default-source/default-document-library/sdsg-radiographic-measuremnt-manual.pdf?sfvrsn=2&sfvrsn=2 ( date last accessed 3 October 2024 ).
Champain S , Benchikh K , Nogier A , Mazel C , Guise JD , Skalli W . Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies . Eur Spine J . 2006 ; 15 ( 6 ): 982 – 991 . 10.1007/s00586-005-0927-1 15965708
Cho Y , Jo DJ , Hyun SJ , Park JH , Yang NR . From the spinopelvic parameters to global alignment and proportion scores in adult spinal deformity . Neurospine . 2023 ; 20 ( 2 ): 467 – 477 . 10.14245/ns.2346374.187 37401065
Te Hennepe N , Spruit M , Pouw MH , Hinderks M , Heesterbeek P . Supine traction versus prone bending radiographs for assessing the curve flexibility in spinal deformity . Global Spine J . 2022 ; 12 ( 7 ): 1345 – 1351 . 10.1177/2192568220979136 33504207
Lafage R , Smith JS , Elysee J , et al. 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 ( 1 ): 121 – 131 . 10.1007/s43390-021-00397-1 34460094
Yilgor C , Sogunmez N , Boissiere L , Yavuz Y , Obeid I , Kleinstück F , et al. 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-A ( 19 ): 1661 – 1672 . 10.2106/JBJS.16.01594 28976431
Schwab F , Ungar B , Blondel B , et al. Scoliosis Research Society—Schwab Adult Spinal Deformity classification . Spine . 2012 ; 37 ( 12 ): 1077 – 1082 . 10.1097/BRS.0b013e31823e15e2 22045006
Lafage R , Schwab F , Glassman S , et al. Age-adjusted alignment goals have the potential to reduce PJK . Spine . 2017 ; 42 ( 17 ): 1275 – 1282 . 10.1097/BRS.0000000000002146 28263226
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 ( 6 ): 1031 – 1036 . 10.14444/7154 33560265
Passias PG , Moattari K , Pierce KE , et al. Performance of the Modified Adult Spinal Deformity Frailty Index in preoperative risk assessment . Spine . 2022 ; 47 ( 20 ): 1463 – 1469 . 10.1097/BRS.0000000000004342 35125455
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 ( 5 ): 373 – 383 . 10.1016/0021-9681(87)90171-8 3558716
Chan V , Wilson JRF , Ravinsky R , et al. Frailty adversely affects outcomes of patients undergoing spine surgery: a systematic review . Spine J . 2021 ; 21 ( 6 ): 988 – 1000 . 10.1016/j.spinee.2021.01.028 33548521
Beauchamp-Chalifour P , Flexman AM , Street JT , et al. The impact of frailty on patient-reported outcomes after elective thoracolumbar degenerative spine surgery . J Neurosurg Spine . 2021 ; 35 ( 5 ): 607 – 615 . 10.3171/2021.2.SPINE201879 34359047
Metcalf T , Chanbour H , Chen J , et al. 3. Choosing an upper instrumented vertebra of T9-T10 over T11-L2 will reduce mechanical complications in adult spinal deformity surgery . Spine J . 2023 ; 23 ( 9 ): S2 . 10.1016/j.spinee.2023.06.025
Chen J , Chanbour H , Johnson G , et al. P106. Selecting the upper instrumented vertebrae in ASD surgery: what happens when you stop in the mid-thoracic spine? Spine J . 2023 ; 23 ( 9 ): S159 . 10.1016/j.spinee.2023.06.331
Luo M , Wang P , Wang W , Shen M , Xu G , Xia L . Upper thoracic versus lower thoracic as site of upper instrumented vertebrae for long fusion surgery in adult spinal deformity: a meta-analysis of proximal junctional kyphosis . World Neurosurg . 2017 ; 102 : 200 – 208 . 10.1016/j.wneu.2017.02.126 28315802
Virk S , Platz U , Bess S , et al. Factors influencing upper-most instrumented vertebrae selection in adult spinal deformity patients: qualitative case-based survey of deformity surgeons . J Spine Surg . 2021 ; 7 ( 1 ): 37 – 47 . 10.21037/jss-20-598 33834126
Cho K-J , Suk S-I , Park S-R , Kim J-H , Jung J-H . Selection of proximal fusion level for adult degenerative lumbar scoliosis . Eur Spine J . 2013 ; 22 ( 2 ): 394 – 401 . 10.1007/s00586-012-2527-1 23064878
Hey HWD , Tan K-A , Neo CS-E , et al. T9 versus T10 as the upper instrumented vertebra for correction of adult deformity-rationale and recommendations . Spine J . 2017 ; 17 ( 5 ): 615 – 621 . 10.1016/j.spinee.2016.11.008 27856380