دورية أكاديمية
Which sagittal plane assessment method is most predictive of complications after adult spinal deformity surgery?
العنوان: | Which sagittal plane assessment method is most predictive of complications after adult spinal deformity surgery? |
---|---|
المؤلفون: | Pizones J; Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. javierpizones@gmail.com., Hills J; University of Texas, San Antonio, TX, USA., Kelly M; Rady Children Hospital San Diego, University of California, San Diego, CA, USA., Yilgor C; Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey., Moreno-Manzanaro L; Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain., Perez-Grueso FJS; Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain., Kleinstück F; Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland., Obeid I; Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France., Alanay A; Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey., Pellisé F; Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain. |
مؤلفون مشاركون: | ESSG European Spine Study Group |
المصدر: | Spine deformity [Spine Deform] 2024 Jul; Vol. 12 (4), pp. 1127-1136. Date of Electronic Publication: 2024 Apr 12. |
نوع المنشور: | Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: Springer Nature Country of Publication: England NLM ID: 101603979 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2212-1358 (Electronic) Linking ISSN: 2212134X NLM ISO Abbreviation: Spine Deform Subsets: MEDLINE |
أسماء مطبوعة: | Publication: 2020- : London : Springer Nature Original Publication: New York, N.Y. : Elsevier |
مواضيع طبية MeSH: | Postoperative Complications*/etiology , Postoperative Complications*/epidemiology , Spinal Fusion*/adverse effects , Spinal Fusion*/methods, Humans ; Female ; Retrospective Studies ; Male ; Middle Aged ; Adult ; Aged ; Spinal Curvatures/surgery ; Spinal Curvatures/diagnostic imaging ; Thoracic Vertebrae/surgery ; Lumbar Vertebrae/surgery ; Follow-Up Studies |
مستخلص: | Purpose: Different methods of sagittal alignment assessment compete for predicting adverse events after adult spinal deformity (ASD) surgery. We wanted to study which method provides greater benefit. Methods: Retrospective study of 391 patients operated for ASD, with > 6 instrumented levels, fused to the pelvis, and 2 years of follow-up. Three alignment methods were analyzed 6-week postoperatively: (1) Roussouly mismatch; (2) GAP score/GAP categories; (3) T4-L1-Hip axis. Binary logistic regression generated models that best predict the following adverse events: mechanical complications (MC): in general and isolated (PJK, PJF, rod breakage); reinterventions (in general and after MC); and readmissions. ROC/AUC analysis was also implemented. In a second regression round, we added different variables that were selected on univariate analysis-demographic, surgical, and radiographic-to complete the models. Results: The best predictor parameters in most models were T4-L1PA mismatch and GAP score; we could not prove a predictive ability of the Roussouly mismatch. The T4-L1PA mismatch best predicted general MC, PJK, PJK + PJF, and readmission, while the GAP score best predicted PJF and reinterventions (for MC and for any complication). However, the variance explained by these models was limited (Nagelkerke's R2 = 0.031-0.113), with odds ratios ranging from 1.070 to 1.456. ROC curves plotted an AUC between 0.57 and 0.70. Introducing additional variables (demographic, surgical, and radiographic) improved prediction in all the models (Nagelkerke's R2 = 0.082-0.329) and allowed predicting rod breakage. Conclusion: The T4-L1-Hip axis and GAP score show potential in predicting adverse events, surpassing the Roussouly method. Despite partial efficacy in complication anticipation, recognizing postoperative sagittal alignment as a key modifiable risk factor, the crucial need arises to integrate diverse variables, both modifiable and non-modifiable, for enhanced predictive accuracy. Level of Evidence: Level IV. (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.) |
References: | Stagnara P, De Mauroy JC, Dran G et al (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine 7:335–342. https://doi.org/10.1097/00007632-198207000-00003. (PMID: 10.1097/00007632-198207000-000037135066) Duval-Beaupère G, Schmidt C, Cosson P (1992) A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 20:451–462. https://doi.org/10.1007/BF02368136. (PMID: 10.1007/BF023681361510296) Glassman SD, Berven S, Bridwell K et al (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30:682–688. https://doi.org/10.1097/01.brs.0000155425.04536.f7. (PMID: 10.1097/01.brs.0000155425.04536.f715770185) Glassman SD, Bridwell K, Dimar JR et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029. (PMID: 10.1097/01.brs.0000179086.30449.9616166889) Schwab F, Farcy J-P, Bridwell K et al (2006) A clinical impact classification of scoliosis in the adult. Spine 31:2109–2114. https://doi.org/10.1097/01.brs.0000231725.38943.ab. (PMID: 10.1097/01.brs.0000231725.38943.ab16915098) Takemoto M, Boissière L, Vital J-M et al (2017) Are sagittal spinopelvic radiographic parameters significantly associated with quality of life of adult spinal deformity patients? Multivariate linear regression analyses for pre-operative and short-term post-operative health-related quality of life. Eur Spine J 26:2176–2186. https://doi.org/10.1007/s00586-016-4872-y. (PMID: 10.1007/s00586-016-4872-y27864681) Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353. (PMID: 10.1097/01.brs.0000152379.54463.6515682018) Schwab F, Ungar B, Blondel B et al (2012) Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine 37:1077–1082. https://doi.org/10.1097/BRS.0b013e31823e15e2. (PMID: 10.1097/BRS.0b013e31823e15e222045006) Yilgor C, Sogunmez N, Boissière L et al (2017) Global alignment and proportion (GAP) score. J Bone Joint Surg 99:1661–1672. https://doi.org/10.2106/JBJS.16.01594. (PMID: 10.2106/JBJS.16.0159428976431) Hills J, Lenke LG, Sardar ZM et al (2022) The T4–L1-Hip axis: defining a normal sagittal spinal alignment. Spine 47:1399–1406. https://doi.org/10.1097/BRS.0000000000004414. (PMID: 10.1097/BRS.000000000000441435867583) Passias PG, Pierce KE, Raman T et al (2021) Does matching roussouly spinal shape and improvement in SRS-Schwab modifier contribute to improved patient-reported outcomes? Spine 46:1258–1263. https://doi.org/10.1097/BRS.0000000000003999. (PMID: 10.1097/BRS.000000000000399934435989) Liu Y, Liu Z, Zhu F et al (2013) Validation and reliability analysis of the new SRS-Schwab classification for adult spinal deformity. Spine 38:902–908. https://doi.org/10.1097/BRS.0b013e318280c478. (PMID: 10.1097/BRS.0b013e318280c47823222646) Terran J, Schwab F, Shaffrey CI et al (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73:559–568. https://doi.org/10.1227/NEU.0000000000000012. (PMID: 10.1227/NEU.000000000000001223756751) Sebaaly A, Gehrchen M, Silvestre C et al (2019) Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J 37:1763–1810. https://doi.org/10.1007/s00586-019-06253-1. (PMID: 10.1007/s00586-019-06253-1) Bari TJ, Ohrt-Nissen S, Hansen LV et al (2019) Ability of the global alignment and proportion score to predict mechanical failure following adult spinal deformity surgery-validation in 149 patients with two-year follow-up. Spine Deformity 7:331–337. https://doi.org/10.1016/j.jspd.2018.08.002. (PMID: 10.1016/j.jspd.2018.08.00230660230) Kwan KYH, Lenke LG, Shaffrey CI et al (2021) Are higher global alignment and proportion scores associated with increased risks of mechanical complications after adult spinal deformity surgery? An external validation. Clin Orthop Relat Res 479:312–320. https://doi.org/10.1097/CORR.0000000000001521. (PMID: 10.1097/CORR.000000000000152133079774) Gupta MC, Yilgor C, Moon HJ et al (2021) Evaluation of global alignment and proportion score in an independent database. Spine J 21:1549–1558. https://doi.org/10.1016/j.spinee.2021.04.004. (PMID: 10.1016/j.spinee.2021.04.00433857668) Jacobs E, van Royen BJ, van Kuijk SMJ et al (2019) Prediction of mechanical complications in adult spinal deformity surgery-the GAP score versus the Schwab classification. Spine J 19:781–788. https://doi.org/10.1016/j.spinee.2018.11.013. (PMID: 10.1016/j.spinee.2018.11.01330503298) Sun X, Sun W, Sun S et al (2021) Which sagittal evaluation system can effectively predict mechanical complications in the treatment of elderly patients with adult degenerative scoliosis? Roussouly classification or Global Alignment and Proportion (GAP) Score. J Orthop Surg Res 16:641–649. https://doi.org/10.1186/s13018-021-02786-8. (PMID: 10.1186/s13018-021-02786-8347023338549320) Passias PG, Bortz C, Pierce KE et al (2022) Comparing and contrasting the clinical utility of sagittal spine alignment classification frameworks: Roussouly versus SRS-Schwab. Spine 47:455–462. https://doi.org/10.1097/BRS.0000000000004300. (PMID: 10.1097/BRS.000000000000430034812196) Teles AR, Aldebeyan S, Aoude A et al (2022) Mechanical complications in adult spinal deformity surgery: can spinal alignment explain everything? Spine 47:E1–E9. https://doi.org/10.1097/BRS.0000000000004217. (PMID: 10.1097/BRS.000000000000421734468439) Laouissat F, Sebaaly A, Gehrchen M, Roussouly P (2017) Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J 18:40–10. https://doi.org/10.1007/s00586-017-5111-x. (PMID: 10.1007/s00586-017-5111-x) Quarto E, Zanirato A, Pellegrini M et al (2022) GAP score potential in predicting post-operative spinal mechanical complications: a systematic review of the literature. Eur Spine J 31:3286–3295. https://doi.org/10.1007/s00586-022-07386-6. (PMID: 10.1007/s00586-022-07386-636153789) Pizones J, Perez-Grueso FJS, Moreno-Manzanaro L et al (2020) Ideal sagittal profile restoration and ideal lumbar apex positioning play an important role in postoperative mechanical complications after a lumbar PSO. Spine Deformity 8:491–498. https://doi.org/10.1007/s43390-019-00005-3. (PMID: 10.1007/s43390-019-00005-331925761) Soroceanu A, Diebo BG, Burton D et al (2015) Radiographical and implant-related complications in adult spinal deformity surgery: incidence, patient risk factors, and impact on health-related quality of life. Spine 40:1414–1421. https://doi.org/10.1097/BRS.0000000000001020. (PMID: 10.1097/BRS.000000000000102026426712) Yilgor C, Sogunmez N, Yavuz Y et al (2017) Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence-based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis. Neurosurg Focus 43:E5-9. https://doi.org/10.3171/2017.8.FOCUS17498. (PMID: 10.3171/2017.8.FOCUS1749829191103) Noh SH, Ha Y, Park JY et al (2021) Modified global alignment and proportion scoring with body mass index and bone mineral density analysis in global alignment and proportion score of each 3 categories for predicting mechanical complications after adult spinal deformity surgery. Neurospine 18:484–491. https://doi.org/10.14245/ns.2142470.235. (PMID: 10.14245/ns.2142470.235346106798497256) Ohba T, Ebata S, Oba H et al (2019) Predictors of poor global alignment and proportion score after surgery for adult spinal deformity. Spine 44:E1136–E1143. https://doi.org/10.1097/BRS.0000000000003086. (PMID: 10.1097/BRS.000000000000308631261271) Pizones J, Moreno-Manzanaro L, Sánchez Pérez-Grueso FJ et al (2019) Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications. Eur Spine J 14:925. https://doi.org/10.1007/s00586-019-06176-x. (PMID: 10.1007/s00586-019-06176-x) Steyerberg EW, Vickers AJ, Cook NR et al (2010) Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology 21:128–138. https://doi.org/10.1097/EDE.0b013e3181c30fb2. (PMID: 10.1097/EDE.0b013e3181c30fb2200102153575184) Ignasiak D, Behm P, Mannion AF et al (2023) Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity. Eur Spine J 32:571–583. https://doi.org/10.1007/s00586-022-07477-4. (PMID: 10.1007/s00586-022-07477-436526952) Katsu M, Ohba T, Ebata S et al (2020) Potential role of paraspinal musculature in the maintenance of spinopelvic alignment in patients with adult spinal deformities. Clin Spine Surg 33:E76–E80. https://doi.org/10.1097/BSD.0000000000000862. (PMID: 10.1097/BSD.000000000000086231385849) Miller EK, Neuman BJ, Jain A et al (2017) An assessment of frailty as a tool for risk stratification in adult spinal deformity surgery. Neurosurg Focus 43:E3. https://doi.org/10.3171/2017.10.FOCUS17472. (PMID: 10.3171/2017.10.FOCUS1747229191099) Safaee MM, Ames CP (2023) Biological age and spine surgery-genomics and the future of risk assessment. World Neurosurg 172:47. https://doi.org/10.1016/j.wneu.2023.02.011. (PMID: 10.1016/j.wneu.2023.02.01136827962) |
معلومات مُعتمدة: | 1 United States CX CSRD VA; 1 United States CX CSRD VA; 2 Medtronic |
فهرسة مساهمة: | Keywords: Adult spinal deformity; Fused to pelvis; Mechanical complications; Predictive models; Reinterventions; Sagittal alignment; Spinal surgery |
تواريخ الأحداث: | Date Created: 20240412 Date Completed: 20240701 Latest Revision: 20240816 |
رمز التحديث: | 20240817 |
DOI: | 10.1007/s43390-024-00864-5 |
PMID: | 38607513 |
قاعدة البيانات: | MEDLINE |
تدمد: | 2212-1358 |
---|---|
DOI: | 10.1007/s43390-024-00864-5 |