Bertrand Moal1, Frank Schwab2, Christopher P Ames3, Justin S Smith4, Devon Ryan2, Praveen V Mummaneni3, Gregory M Mundis5, Jamie S Terran2, Eric Klineberg6, Robert A Hart7, Oheneba Boachie-Adjei8, Christopher I Shaffrey4, Wafa Skalli9, Virginie Lafage10. 1. Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, 306 E. 15th Street, Suite 1F, New York, NY 10003, USA; Laboratory of Biomechanics, Arts et Metier ParisTech, 51, Boulevard de l'hopital, 75013 Paris, France. 2. Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, 306 E. 15th Street, Suite 1F, New York, NY 10003, USA. 3. Department of Neurosurgery, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA 94122, USA. 4. Department of Neurosurgery, University of Virginia Medical Center, Neurosurgery Home, PO Box 800212, Charlottesville, VA 22908, USA. 5. Department of Orthopedic Surgery, San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr., Suite 300, La Jolla, CA 92037, USA. 6. Department of Orthopedic Surgery, University of California Davis, 3301 C St., Suite 1500, Sacramento, CA 95816, USA. 7. Department of Orthopedic Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA. 8. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA. 9. Laboratory of Biomechanics, Arts et Metier ParisTech, 51, Boulevard de l'hopital, 75013 Paris, France. 10. Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, 306 E. 15th Street, Suite 1F, New York, NY 10003, USA. Electronic address: virginie.lafage@gmail.com.
Abstract
STUDY DESIGN: Multicenter, prospective, consecutive, surgical case series from the International Spine Study Group. OBJECTIVES: To evaluate the effectiveness of surgical treatment in restoring spinopelvic (SP) alignment. SUMMARY OF BACKGROUND DATA: Pain and disability in the setting of adult spinal deformity have been correlated with global coronal alignment (GCA), sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT). One of the main goals of surgery for adult spinal deformity is to correct these parameters to restore harmonious SP alignment. METHODS: Inclusion criteria were operative patients (age greater than 18 years) with baseline (BL) and 1-year full-length X-rays. Thoracic and thoracolumbar Cobb angle and previous mentioned parameters were calculated. Each parameter at BL and 1 year was categorized as either pathological or normal. Pathologic limits were: Cobb greater than 30°, GCA greater than 40 mm, SVA greater than 40 mm, PI-LL greater than 10°, and PT greater than 20°. According to thresholds, corrected or worsened alignment groups of patients were identified and overall radiographic effectiveness of procedure was evaluated by combining the results from the coronal and sagittal planes. RESULTS: A total of 161 patients (age, 55 ± 15 years) were included. At BL, 80% of patients had a Cobb angle greater than 30°, 25% had a GCA greater than 40 mm, and 42% to 58% had a pathological sagittal parameter of PI-LL, SVA, and/or PT. Sagittal deformity was corrected in about 50% of cases for patients with pathological SVA or PI-LL, whereas PT was most commonly worsened (24%) and least often corrected (24%). Only 23% of patients experienced complete radiographic correction of the deformity. CONCLUSIONS: The frequency of inadequate SP correction was high. Pelvic tilt was the parameter least likely to be well corrected. The high rate of SP alignment failure emphasizes the need for better preoperative planning and intraoperative imaging. Published by Elsevier Inc.
STUDY DESIGN: Multicenter, prospective, consecutive, surgical case series from the International Spine Study Group. OBJECTIVES: To evaluate the effectiveness of surgical treatment in restoring spinopelvic (SP) alignment. SUMMARY OF BACKGROUND DATA: Pain and disability in the setting of adult spinal deformity have been correlated with global coronal alignment (GCA), sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT). One of the main goals of surgery for adult spinal deformity is to correct these parameters to restore harmonious SP alignment. METHODS: Inclusion criteria were operative patients (age greater than 18 years) with baseline (BL) and 1-year full-length X-rays. Thoracic and thoracolumbar Cobb angle and previous mentioned parameters were calculated. Each parameter at BL and 1 year was categorized as either pathological or normal. Pathologic limits were: Cobb greater than 30°, GCA greater than 40 mm, SVA greater than 40 mm, PI-LL greater than 10°, and PT greater than 20°. According to thresholds, corrected or worsened alignment groups of patients were identified and overall radiographic effectiveness of procedure was evaluated by combining the results from the coronal and sagittal planes. RESULTS: A total of 161 patients (age, 55 ± 15 years) were included. At BL, 80% of patients had a Cobb angle greater than 30°, 25% had a GCA greater than 40 mm, and 42% to 58% had a pathological sagittal parameter of PI-LL, SVA, and/or PT. Sagittal deformity was corrected in about 50% of cases for patients with pathological SVA or PI-LL, whereas PT was most commonly worsened (24%) and least often corrected (24%). Only 23% of patients experienced complete radiographic correction of the deformity. CONCLUSIONS: The frequency of inadequate SP correction was high. Pelvic tilt was the parameter least likely to be well corrected. The high rate of SP alignment failure emphasizes the need for better preoperative planning and intraoperative imaging. Published by Elsevier Inc.
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