Nicolas Plais1,2, Hongda Bao3,4, Renaud Lafage3, Munish Gupta5, Justin S Smith6, Christopher Shaffrey6, Gregory Mundis7,8, Douglas Burton9, Christopher Ames10, Eric Klineberg11, Shay Bess12, Frank Schwab3, Virginie Lafage3. 1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. nicolas.plais@me.com. 2. Hospital Universitario San Cecilio, Granada, Spain. nicolas.plais@me.com. 3. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. 4. Nanjing Drum Tower Hospital, Nanjing University, 321 Zhongshan Rd, Gulou Qu, Nanjing Shi, 210008, Jiangsu Sheng, China. 5. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA. 6. Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, USA. 7. San Diego Spine Foundation, 6190 Cornerstone Ct. Suite 212, San Diego, CA, 92121, USA. 8. Scripps Clinic, 10666 N Torrey Pines Rd, La Jolla, CA, 92036, USA. 9. Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA. 10. Department of Neurosurgery, University of California San Francisco, San Francisco, CA, 94143, USA. 11. Department of Orthopaedic Surgery, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA. 12. Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO, 80205, USA.
Abstract
STUDY DESIGN: Retrospective review of multicenter adult spine deformity (ASD) database. OBJECTIVES: A recent publication demonstrated that the laterality of the coronal offset is a key parameter that directly impacts postoperative outcomes. The objective of this study is to analyze the relationship between global coronal malalignment (GCM) and functional outcomes in a North American population of ASD patients with no history of previous surgery. The clinical impact of GCM in patients with ASD remains controversial. METHODS: Primary patients were drawn from a multicenter database of ASD patients and categorized with the Qiu classification: Type A = GCM < 3 cm; Type B = GCM > 3 cm toward the concave side of the curve; and Type C = GCM > 3 cm toward the convex side. In addition to the classic radiographic parameter, the coronal truncal inclination was investigated in regard to the pelvic obliquity. Clinical outcomes, radiographic parameters, and demographics were compared across the three Qiu Types using analysis of variance. The analysis was repeated after propensity matching of the three types by age and sagittal alignment (PI-LL mismatch, pelvic tilt, and sagittal vertical axis). RESULTS: 576 ASD patients (mean age 58.8 years) were included. Type B patients had significantly worse functional scores (Oswestry Disability Index, 36-item Short Form Survey physical component summary, and Scoliosis Research Society-22) and a more severe coronal deformity in terms of maximum Cobb angle, global coronal deformity angle, and coronal malalignment; they were also older (65.4 vs. 58.8 years, p = 0.004) and displayed more severe sagittal malalignment. Similar findings were observed after propensity matching. CONCLUSIONS: This study is the first to establish an association between functional outcomes and the severity of the coronal plane deformity in the setting of a specific coronal curve pattern in patients without previous surgery. Coronal malalignment significantly affects the health status of patients when the offset is greater than 3 cm in the direction of curve concavity. LEVEL OF EVIDENCE: III.
STUDY DESIGN: Retrospective review of multicenter adult spine deformity (ASD) database. OBJECTIVES: A recent publication demonstrated that the laterality of the coronal offset is a key parameter that directly impacts postoperative outcomes. The objective of this study is to analyze the relationship between global coronal malalignment (GCM) and functional outcomes in a North American population of ASD patients with no history of previous surgery. The clinical impact of GCM in patients with ASD remains controversial. METHODS: Primary patients were drawn from a multicenter database of ASD patients and categorized with the Qiu classification: Type A = GCM < 3 cm; Type B = GCM > 3 cm toward the concave side of the curve; and Type C = GCM > 3 cm toward the convex side. In addition to the classic radiographic parameter, the coronal truncal inclination was investigated in regard to the pelvic obliquity. Clinical outcomes, radiographic parameters, and demographics were compared across the three Qiu Types using analysis of variance. The analysis was repeated after propensity matching of the three types by age and sagittal alignment (PI-LL mismatch, pelvic tilt, and sagittal vertical axis). RESULTS: 576 ASD patients (mean age 58.8 years) were included. Type B patients had significantly worse functional scores (Oswestry Disability Index, 36-item Short Form Survey physical component summary, and Scoliosis Research Society-22) and a more severe coronal deformity in terms of maximum Cobb angle, global coronal deformity angle, and coronal malalignment; they were also older (65.4 vs. 58.8 years, p = 0.004) and displayed more severe sagittal malalignment. Similar findings were observed after propensity matching. CONCLUSIONS: This study is the first to establish an association between functional outcomes and the severity of the coronal plane deformity in the setting of a specific coronal curve pattern in patients without previous surgery. Coronal malalignment significantly affects the health status of patients when the offset is greater than 3 cm in the direction of curve concavity. LEVEL OF EVIDENCE: III.
Entities:
Keywords:
Adult spine deformity (ASD); Coronal malalignment; Global coronal deformity angle; Health-Related Quality of Life (HRQL) scoring; Scoliosis
Authors: Scott L Zuckerman; Zeeshan M Sardar; Christopher S Lai; Gerard F Marciano; Mena G Kerolus; Ian A Buchanan; Alex S Ha; Meghan Cerpa; Michael P Kelly; Stéphane Bourret; Kazuhiro Hasegawa; Hee-Kit Wong; Gabriel Liu; Hwee Weng Dennis Hey; Hend Riahi; Jean-Charles Le Huec; Lawrence G Lenke Journal: Eur Spine J Date: 2021-05-19 Impact factor: 3.134