Can we use shorter constructs while maintaining satisfactory sagittal plane alignment for adult spinal deformity?
Autor: | Haruki Ueda, Hiromichi Aoki, Satoshi Inami, Hiroshi Taneichi, Hiroshi Moridaira, Daisaku Takeuchi, Takuya Imura |
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Rok vydání: | 2021 |
Předmět: |
Adult
Male Pelvic tilt medicine.medical_specialty Kyphosis Thoracic Vertebrae Disability Evaluation 03 medical and health sciences Postoperative Complications 0302 clinical medicine medicine Deformity Humans Lumbar kyphosis Aged Aged 80 and over Lumbar Vertebrae Cobb angle business.industry General Medicine Middle Aged medicine.disease Sagittal plane Surgery Vertebra Spinal Fusion medicine.anatomical_structure Scoliosis 030220 oncology & carcinogenesis Thoracic vertebrae Lordosis Quality of Life Female medicine.symptom business 030217 neurology & neurosurgery |
Zdroj: | Journal of Neurosurgery: Spine. 34:589-596 |
ISSN: | 1547-5654 |
Popis: | OBJECTIVE Issues with spinopelvic fixation for adult spinal deformity (ASD) include loss of the physiological mobility of the entire lumbar spine, perioperative complications, and medical costs. Little is known about the factors associated with successful short fusion for ASD. The authors evaluated radiographic and clinical outcomes after shorter fusion for different subtypes of ASD at 2 years postoperatively and examined factors associated with successful short fusion. METHODS This was a single-center study of 37 patients who underwent short fusion and a minimum 2 years of follow-up for ASD in which lumbar kyphosis was the main deformity. The exclusion criteria were 1) age < 40 years, 2) previous lumbar vertebral fracture, 3) severe osteoporosis, 4) T10–L2 kyphosis > 20°, 5) scoliotic deformity with an upper end vertebra (UEV) above T12, and 6) concomitant Parkinson’s disease or neurological disease. The surgical procedures, radiographic course, and Oswestry Disability Index (ODI) were assessed, and correlations between radiographic parameters and postoperative ODI at 2 years were analyzed. RESULTS A mean of 3.5 levels were fused. The mean radiographic parameters preoperatively, at 2 weeks, and at 2 years, respectively, were as follows: coronal Cobb angle: 22.9°, 11.5°, and 12.6°; lumbar lordosis (LL): 12.9°, 35.8°, and 32.2°; pelvic incidence (PI) minus LL: 35.5°, 14.7°, and 19.2°; pelvic tilt: 29.4°, 23.1°, and 25.0°; and sagittal vertical axis 85.3, 36.7, and 59.2 mm. Abnormal proximal junctional kyphosis occurred in 8 cases. Revision surgery was performed to extend the length of fusion from a lower thoracic vertebra to the pelvis in 2 cases. The mean ODI scores preoperatively and at 2 years were 50.7% and 24.1%, respectively. Patient age, number of fused intervertebral segments, and radiographic parameters were analyzed by the stepwise method to identify factors contributing to the ODI score at 2 years, preoperative PI, and sagittal vertical axis at 2 years. On receiver operating characteristic curve analysis of the minimal clinically important difference of ODI (15%) and preoperative PI, the cutoff value of the preoperative PI was 47° (area under the curve 0.75). CONCLUSIONS In terms of subtypes of ASD in which lumbar kyphosis is the main deformity, if the PI is < 47°, then the use of short fusion preserving mobile intervertebral segments can produce adequate LL for the PI, improving both postoperative global spinal alignment and quality of life. |
Databáze: | OpenAIRE |
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