Key Role of Preoperative Recumbent Films in the Treatment of Severe Sagittal Malalignment
| Autor: | Jeffrey L. Gum, Lawrence G. Lenke, Linda A. Koester, Patrick A. Sugrue, Owoicho Adogwa, David B. Bumpass, Ryoji Tauchi, Michael P. Kelly, Ramin M. Lalezari, Kathy M Blanke, Aladine A. Elsamadicy, Keith H. Bridwell, Isaac O. Karikari |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Pelvic tilt
Adult Male medicine.medical_specialty medicine.medical_treatment Radiography Osteotomy 03 medical and health sciences Young Adult 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine Postoperative Period Aged Retrospective Studies 030222 orthopedics business.industry Incidence (epidemiology) X-Ray Film Retrospective cohort study Bone Malalignment Middle Aged Sagittal plane Surgery medicine.anatomical_structure Treatment Outcome Orthopedic surgery Female Level iii business 030217 neurology & neurosurgery |
| Zdroj: | Spine deformity. 6(5) |
| ISSN: | 2212-1358 |
| Popis: | Retrospective cohort study.To determine if severe sagittal malalignment (SM) patients without fixed deformities require a three-column osteotomy (3CO) to achieve favorable clinical and radiographic outcomes.3CO performed for severe SM has significantly increased in the last 15 years. Not all severe SM patients require a 3CO.Severe SM patients (sagittal vertical axis [SVA]10 cm) who underwent deformity correction between 2002 and 2011. Patients with33% change in their lumbar lordosis (LL) on a preoperative supine radiograph were classified as stiff deformities, whereas those with ≥33% change were categorized as flexible deformities. The clinical/radiographic outcomes were assessed at minimum two years postoperatively.Seventy patients met the inclusion criteria, 35 patients with flexible and 35 with stiff deformities. Eighteen flexible-deformity patients underwent a 3CO versus 22 stiff-deformity patients. The remaining patients in each group underwent spinal realignment without a 3CO. The flexible-deformity patients not undergoing a 3CO had overall improvement in all sagittal radiographic parameters. Preoperative LL (22°), LL-pelvic incidence (PI) mismatch (43), SVA (17 cm), and pelvic tilt (PT, 34°) improved to 46°, 18, 6 cm, and 26°, respectively, p .05. Flexible-deformity patients who underwent a 3CO also had overall improvement in all radiographic parameters. Preoperative LL (8.5°), LL-PI mismatch (47), SVA (19 cm), and PT (37°) improved to 39°, 15, 7 cm, and 24°, respectively (p.05). Stiff-deformity patients who underwent a 3CO had statistically significant improvement in all radiographic parameters. However, stiff-deformity patients who did not undergo a 3CO had suboptimal improvement in all radiographic parameters, except for SVA (14 cm-9 cm, p.05). Flexible patients who did not undergo a 3CO had statistical improvement in the SRS domains of function and self-mage as well as in their ODI scores (p.05).Severe SM that is flexible can be corrected without a 3CO without compromising clinical and radiographic outcomes.Level III. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink