Themistocles S Protopsaltis1, Alexandra Soroceanu2, Jared C Tishelman1, Aaron J Buckland1, Gregory M Mundis3, Justin S Smith4, Alan Daniels5, Lawrence G Lenke6, Han Jo Kim7, Eric O Klineberg8, Christopher P Ames9, Robert A Hart10, Shay Bess11, Christopher I Shaffrey4, Frank J Schwab7, Virginie Lafage7. 1. Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY. 2. Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada. 3. San Diego Center for Spinal Disorders, La Jolla, CA. 4. Department of Neurological Surgery, University of Virginia Medical Center, Charlottesville, VA. 5. Department of Orthopaedic Surgery, Brown University, Providence, RI. 6. Department of Orthopaedic Surgery, Columbia University, New York, NY. 7. Department of Orthopaedic Surgery, Hospital for Special Surgery New York, NY. 8. Department of Orthopaedic Surgery, University of California, Davis, Davis, CA. 9. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA. 10. Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA. 11. Rocky Mountain Scoliosis and Spine, Denver, CO.
Abstract
STUDY DESIGN: Retrospective analysis. OBJECTIVE: Determine whether deformity corrections should vary by pelvic incidence (PI). SUMMARY OF BACKGROUND DATA: Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for adult spinal deformity (ASD) surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific. METHODS: A prospective database of consecutive ASD patients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and Short Form 36 Survey (SF-36) Physical Component Score (PCS). Baseline relationships between TPA, age, PI, and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values. RESULTS: Nine hundred three ASD patients (mean 53.7 yr) and 111 normative subjects (mean 50.7 yr) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40-75, >75); and age: elderly (>65 yr, n = 375), middle age (45-65 yr, n = 387), and young (18-45 yr, n = 141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r = 0.42, P < 0.0001). ODI correlated with PCS (r = 0.71, P < 0.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age. CONCLUSION: Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI. LEVEL OF EVIDENCE: 3.
STUDY DESIGN: Retrospective analysis. OBJECTIVE: Determine whether deformity corrections should vary by pelvic incidence (PI). SUMMARY OF BACKGROUND DATA: Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for adult spinal deformity (ASD) surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific. METHODS: A prospective database of consecutive ASDpatients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and Short Form 36 Survey (SF-36) Physical Component Score (PCS). Baseline relationships between TPA, age, PI, and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values. RESULTS: Nine hundred three ASDpatients (mean 53.7 yr) and 111 normative subjects (mean 50.7 yr) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40-75, >75); and age: elderly (>65 yr, n = 375), middle age (45-65 yr, n = 387), and young (18-45 yr, n = 141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r = 0.42, P < 0.0001). ODI correlated with PCS (r = 0.71, P < 0.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age. CONCLUSION: Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI. LEVEL OF EVIDENCE: 3.
Authors: Noor Shaikh; Honglin Zhang; Stephen H M Brown; Hamza Lari; Oliver Lasry; John Street; David R Wilson; Thomas Oxland Journal: Sci Rep Date: 2021-10-11 Impact factor: 4.379