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? |
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| 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.) |
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| 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 |
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Full Text Finder | تدمد: | 2212-1358 |
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| DOI: | 10.1007/s43390-024-00864-5 |