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Radiographic Outcomes of Adult Spinal Deformity Correction: A Critical Analysis of Variability and Failures Across Deformity Patterns

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Abstract

Study Design

Multicenter, prospective, consecutive, surgical case series from the International Spine Study Group.

Objectives

To evaluate the effectiveness of surgical treatment in restoring spinopelvic (SP) alignment.

Summary of Background Data

Pain and disability in the setting of adult spinal deformity have been correlated with global coronal alignment (GCA), sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT). One of the main goals of surgery for adult spinal deformity is to correct these parameters to restore harmonious SP alignment.

Methods

Inclusion criteria were operative patients (age greater than 18 years) with baseline (BL) and 1-year full-length X-rays. Thoracic and thoracolumbar Cobb angle and previous mentioned parameters were calculated. Each parameter at BL and 1 year was categorized as either pathological or normal. Pathologic limits were: Cobb greater than 30°, GCA greater than 40 mm, SVA greater than 40 mm, PI-LL greater than 10°, and PT greater than 20°. According to thresholds, corrected or worsened alignment groups of patients were identified and overall radiographic effectiveness of procedure was evaluated by combining the results from the coronal and sagittal planes.

Results

A total of 161 patients (age, 55 ± 5 years) were included. At BL, 80% of patients had a Cobb angle greater than 30, 25% had a GCA greater than 40 mm, and 42% to 58% had a pathological sagittal parameter of PI-LL, SVA, and/or PT. Sagittal deformity was corrected in about 50% of cases for patients with pathological SVA or PI-LL, whereas PT was most commonly worsened (24%) and least often corrected (24%). Only 23% of patients experienced complete radiographic correction of the deformity.

Conclusions

The frequency of inadequate SP correction was high. Pelvic tilt was the parameter least likely to be well corrected. The high rate of SP alignment failure emphasizes the need for better preoperative planning and intraoperative imaging.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, 306 E. 15th Street, Suite IF, New York, NY, 10003, USA

    Bertrand Moal MS, Devon Ryan MS, Jamie S. Terran BS & Virginie Lafage PhD

  2. Department of Neurosurgery, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA, 94122, USA

    Christopher P. Ames MD & Praveen V. Mummaneni MD

  3. Department of Neurosurgery, University of Virginia Medical Center, Neurosurgery Home, PO Box 800212, Charlottesville, VA, 22908, USA

    Justin S. Smith MD, PhD & Christopher I. Shaffrey MD

  4. Department of Orthopedic Surgery, San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr., Suite 300, La Jolla, CA, 92037, USA

    Gregory M. Mundis Jr MD

  5. Department of Orthopedic Surgery, University of California Davis, 3301 C St., Suite 1500, Sacramento, CA, 95816, USA

    Eric Klineberg MD

  6. Department of Orthopedic Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, USA

    Robert A. Hart MD

  7. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Oheneba Boachie-Adjei MD

  8. Laboratory of Biomechanics, Boulevard de l’hôpital, Arts et Metier ParisTech, 51, 75013, Paris, France

    Bertrand Moal MS & Wafa Skalli PhD

Authors
  1. Bertrand Moal MS
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  2. Frank Schwab MD
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  3. Christopher P. Ames MD
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  4. Justin S. Smith MD, PhD
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  5. Devon Ryan MS
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  6. Praveen V. Mummaneni MD
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  7. Gregory M. Mundis Jr MD
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  8. Jamie S. Terran BS
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  9. Eric Klineberg MD
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  10. Robert A. Hart MD
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  11. Oheneba Boachie-Adjei MD
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  12. Christopher I. Shaffrey MD
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  13. Wafa Skalli PhD
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  14. Virginie Lafage PhD
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Consortia

International Spine Study Group

Corresponding author

Correspondence to Virginie Lafage PhD.

Additional information

Author disclosures: BM (none); FS (board membership with Nemaris Inc., consultancy for DePuy, MSD; grants from DePuy, ISSG, SRS; payment for lectures including service on speakers bureaus from DePuy, royalties from MSD, stock/stock options from Nemaris Inc., patent with MSD); CPA (consultancy for DePuy, Stryker, Medtronic; royalties from Aesculap, Lanx; grant from Baxano Surgical; stock/stock options from Baxano Surgical, Doctors Research Group, Visualase; patent for Fish and Richardson, PC); JSS (grant from DePuy Spine to ISSG; consultancy/-honorarium from Biomet, DePuy, Medtronic, Globus; fellowship funding and research support from AOSpine; research support from AANS/CNS Joint Spine Section; fellowship support from NREF); DR (none); PVM (royalties from DePuy Spine, Qualified Medical Publishers, Thieme Publishers; honoraria from DePuy Spine and Globus); GMM (personal fees from Nuvasive; grant from Nuvasive; royalties from K2M); JST (none); EK (grants from OREF, Synthes DePuy, AOSpine; personal fees from Syn-thes DePuy, Stryker, AOSpine, Alphasic); RAH (consultancy for DePuy, Eli Lilly, Medtronic; royalties from DePuy Spine, Seaspine; expert testimony to Evans, Craven, and Lackie, Benson, Bertoldo, Baker, and Carter; travel from Synthes, K2M; stocks from Spine Connect; fellowship support from DePuy Spine, Medtronic, Synthes, OREF); OB (consulting for K2M, DePuy; travel from K2M; research support from K2M; royalties from K2M, DePuy); CIS (grant from ISSG; consultancy for Biomet, Medtronic, Globus, Nuvasive, Stryker; royalties from Biomet, Medtronic; patents for Medtronic, Biomet); WS (none); VL (grant from DePuy Synthes Spine; board membership with Nemaris Inc.; consultancy for MSD; grants from DePuy, ISSG, SRS; payment for lectures including service on speakers bureaus for MSD, DePuy, K2M; stock/stock options for Nemaris Inc).

This work was partially funded via a research grant from DePuy Spine and from the Scoliosis Research Society.

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Moal, B., Schwab, F., Ames, C.P. et al. Radiographic Outcomes of Adult Spinal Deformity Correction: A Critical Analysis of Variability and Failures Across Deformity Patterns. Spine Deform 2, 219–225 (2014). https://doi.org/10.1016/j.jspd.2014.01.003

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  • DOI: https://doi.org/10.1016/j.jspd.2014.01.003

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