Yu Yamato1, Tomohiko Hasegawa2, Daisuke Togawa3, Go Yoshida2, Tomohiro Banno2, Hideyuki Arima2, Shin Oe3, Yuki Mihara2, Hiroki Ushirozako2, Sho Kobayashi2, Tatsuya Yasuda4, Yukihiro Matsuyama2. 1. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1, Handayama, Hamamatsu, Shizuoka Prefecture 431-3192, Japan. Electronic address: yamato@hama-med.ac.jp. 2. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1, Handayama, Hamamatsu, Shizuoka Prefecture 431-3192, Japan. 3. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1, Handayama, Hamamatsu, Shizuoka Prefecture 431-3192, Japan; Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1 Chome-20-1, Handayama, Hamamatsu, Shizuoka Prefecture 431-3192, Japan. 4. Department of Orthopedic Surgery, Hamamatsu Medical Center, 328 Tomizuka-cho, Naka-ku, Hamamatsu-shi 432-8580, Japan.
Abstract
STUDY DESIGN: Retrospective analysis of a prospectively collected consecutive case series. OBJECTIVES: To determine the effect of spinopelvic correction on clinical outcomes and discuss the approach to target alignment in elderly or extremely elderly spinal deformity patients. SUMMARY OF BACKGROUND DATA: Age-dependent target alignment during corrective fusion surgery in elderly patients remains controversial. Age-related target spinal alignment should be examined based on the outcomes data of patients with fused, nonphysiological spines. METHODS: Consecutive adult spinal deformity (ASD) patients aged 45 years or older who underwent thoracolumbar corrective fusion of at least five levels were included. Spinopelvic radiographic parameters, health-related quality of life (Oswestry Disability Index [ODI]), and the scores on a numeric rating scale of low back pain were investigated before and after the operation. The patients were stratified into three groups according to age as follows: Middle-Age, 45-64 years; Elderly, 65-74 years; and Extremely Elderly, ≥75 years. We also stratified the patients into three groups according to lumber lordosis (LL) as follows: ideal (within ±5° of ideal LL), moderate (between -5° and -20° of ideal LL), and under (under ideal LL by -20°). RESULTS: A total of 149 patients (Middle-Age, 38; Elderly, 68; and Extremely Elderly, 43) were included in this study. No significant difference was observed in any of the radiographic parameters in each age group. The ODI and numeric rating scale scores of the ideal-correction group at two years after surgery were significantly better than those of the undercorrection group across all ages. A significant correlation with ODI was observed between sagittal spinopelvic parameters in the Elderly and Extremely Elderly groups. A stronger correlation was observed in the Extremely Elderly group compared with the Elderly group. CONCLUSIONS: Rigorous realignment of sagittal vertical axis is correlated with ODI outcomes, especially in very elderly patients. LEVEL OF EVIDENCE: Level 4.
STUDY DESIGN: Retrospective analysis of a prospectively collected consecutive case series. OBJECTIVES: To determine the effect of spinopelvic correction on clinical outcomes and discuss the approach to target alignment in elderly or extremely elderly spinal deformitypatients. SUMMARY OF BACKGROUND DATA: Age-dependent target alignment during corrective fusion surgery in elderly patients remains controversial. Age-related target spinal alignment should be examined based on the outcomes data of patients with fused, nonphysiological spines. METHODS: Consecutive adult spinal deformity (ASD) patients aged 45 years or older who underwent thoracolumbar corrective fusion of at least five levels were included. Spinopelvic radiographic parameters, health-related quality of life (Oswestry Disability Index [ODI]), and the scores on a numeric rating scale of low back pain were investigated before and after the operation. The patients were stratified into three groups according to age as follows: Middle-Age, 45-64 years; Elderly, 65-74 years; and Extremely Elderly, ≥75 years. We also stratified the patients into three groups according to lumber lordosis (LL) as follows: ideal (within ±5° of ideal LL), moderate (between -5° and -20° of ideal LL), and under (under ideal LL by -20°). RESULTS: A total of 149 patients (Middle-Age, 38; Elderly, 68; and Extremely Elderly, 43) were included in this study. No significant difference was observed in any of the radiographic parameters in each age group. The ODI and numeric rating scale scores of the ideal-correction group at two years after surgery were significantly better than those of the undercorrection group across all ages. A significant correlation with ODI was observed between sagittal spinopelvic parameters in the Elderly and Extremely Elderly groups. A stronger correlation was observed in the Extremely Elderly group compared with the Elderly group. CONCLUSIONS: Rigorous realignment of sagittal vertical axis is correlated with ODI outcomes, especially in very elderly patients. LEVEL OF EVIDENCE: Level 4.
Authors: Alice Baroncini; Filippo Migliorini; Francesco Langella; Paolo Barletta; Per Trobisch; Riccardo Cecchinato; Marco Damilano; Emanuele Quarto; Claudio Lamartina; Pedro Berjano Journal: J Clin Med Date: 2021-12-28 Impact factor: 4.241