Amer Sebaaly1,2,3, Martin Gehrchen4, Clément Silvestre5, Khalil Kharrat6,7, Tanvir Johanning Bari4, Gabi Kreichati6,7, Maroun Rizkallah6,7, Pierre Roussouly5. 1. Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, Lyon, France. amersebaaly@hotmail.com. 2. Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon. amersebaaly@hotmail.com. 3. Faculty of Medicine, Saint Joseph University, Beirut, Lebanon. amersebaaly@hotmail.com. 4. Department of Orthopaedic Surgery, Rigshospitalet, University Hospital of Copenhagen, 9 Blegdamsvej, 200, Copenhagen, Denmark. 5. Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, Lyon, France. 6. Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Alfred Naccache Boulevard, Beirut, Lebanon. 7. Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Abstract
PURPOSE: To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. METHODS: This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. RESULTS: A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5-4.3; p < 0.001) CONCLUSION: In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. LEVEL OF EVIDENCE: IV cross-sectional observational study. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. METHODS: This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. RESULTS: A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5-4.3; p < 0.001) CONCLUSION: In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. LEVEL OF EVIDENCE: IV cross-sectional observational study. These slides can be retrieved under Electronic Supplementary Material.
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