Lumbar Lordosis Redistribution and Segmental Correction in Adult Spinal Deformity: Does it Matter?

Autor:	Diebo BG; Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI., Balmaceno-Criss M; Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI., Lafage R; Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY., Daher M; Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI., Singh M; Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI., Hamilton DK; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA., Smith JS; Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA., Eastlack RK; Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA., Fessler R; Department of Neurosurgery, Rush Medical College, Chicago, IL., Gum JL; Norton Leatherman Spine Center, Louisville, KY., Gupta MC; Department of Orthopedic Surgery, Washington University, St. Louis, MO., Hostin R; Department of Orthopaedic Surgery, Southwest Scoliosis Center, Dallas, TX., Kebaish KM; Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Lewis S; Department of Orthopedics, University of Toronto, Toronto, Canada., Line BG; Department of Spine Surgery, Denver International Spine Center, Denver, CO., Nunley PD; Spine Institute of Louisiana, Shreveport, LA., Mundis GM; Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA., Passias PG; Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY., Protopsaltis TS; Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY., Turner J; Barrow Brain and Spine, Phoenix, AZ., Buell T; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA., Scheer JK; Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY., Mullin J; Department of Neurosurgery, University of Buffalo, Amherst, New York, NY., Soroceanu A; Department of Orthopedic Surgery, University of Calgary, Calgary, Canada., Ames CP; Department of Neurological Surgery, University of California, San Francisco, CA., Bess S; Department of Spine Surgery, Denver International Spine Center, Denver, CO., Shaffrey CI; Department of Neurosurgery, Duke Spine Division, Durham, NC., Lenke LG; Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY., Schwab FJ; Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY., Lafage V; Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY., Burton DC; Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS., Daniels AH; Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
Jazyk:	angličtina
Zdroj:	Spine [Spine (Phila Pa 1976)] 2024 Sep 01; Vol. 49 (17), pp. 1187-1194. Date of Electronic Publication: 2024 Jan 25.
DOI:	10.1097/BRS.0000000000004930
Abstrakt:	Study Design: Retrospective analysis of prospectively collected data. Objective: Evaluate the impact of correcting normative segmental lordosis values on postoperative outcomes. Background: Restoring lumbar lordosis magnitude is crucial in adult spinal deformity surgery, but the optimal location and segmental distribution remain unclear. Patients and Methods: Patients were grouped based on offset to normative segmental lordosis values, extracted from recent publications. Matched patients were within 10% of the cohort's mean offset, less than or over 10% were undercorrected and overcorrected. Surgical technique, patient-reported outcome measures, and surgical complications were compared across groups at baseline and two years. Results: In total, 510 patients with a mean age of 64.6, a mean Charlson comorbidity index 2.08, and a mean follow-up of 25 months. L4-5 was least likely to be matched (19.1%), while L4-S1 was the most likely (24.3%). More patients were overcorrected at proximal levels (T10-L2; undercorrected, U: 32.2% vs. matched, M: 21.7% vs. overcorrected, O: 46.1%) and undercorrected at distal levels (L4-S1: U: 39.0% vs. M: 24.3% vs. O: 36.8%). Postoperative Oswestry disability index was comparable across correction groups at all spinal levels except at L4-S1 and T10-L2/L4-S1, where overcorrected patients and matched were better than undercorrected (U: 32.1 vs. M: 25.4 vs. O: 26.5, P =0.005; U: 36.2 vs. M: 24.2 vs. O: 26.8, P =0.001; respectively). Patients overcorrected at T10-L2 experienced higher rates of proximal junctional failure (U: 16.0% vs. M: 15.6% vs. O: 32.8%, P <0.001) and had greater posterior inclination of the upper instrumented vertebrae (U: -9.2±9.4° vs. M: -9.6±9.1° vs. O: -12.2±10.0°, P <0.001), whereas undercorrection at these levels led to higher rates of revision for implant failure (U: 14.2% vs. M: 7.3% vs. O: 6.4%, P =0.025). Conclusions: Patients undergoing fusion for adult spinal deformity suffer higher rates of proximal junctional failure with overcorrection and increased rates of implant failure with undercorrection based on normative segmental lordosis. Level of Evidence: Level IV. Competing Interests: The authors report no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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