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Sagittal realignment: surgical restoration of the global alignment and proportion score parameters: a subgroup analysis. What are the consequences of failing to realign?

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Abstract

Introduction

The Global Alignment and Proportion (GAP) score incorporates three domains directly modified with surgery (relative pelvic version–RPV, relative lumbar lordosis—RLL, lumbar distribution index—LDI) and one indirectly restored (relative spinopelvic alignment—RSA). We analyzed our surgical realignment performance and the consequences of domain-specific realignment failure on mechanical complications and PROMs.

Materials and methods

From an adult spinal deformity prospective multicenter database, we selected patients: fused to pelvis, upper instrumented vertebra at or above L1, and 2 years of follow-up. Descriptive, univariate and multivariate analyses were employed.

Results

The sample included 333 patients. RLL-6w showed the highest success rate (58.3% aligned), but 16.5% of patients were classified in the “Severe hypolordosis” and “Hyperlordosis” subgroups. RPV-6w was the most challenging to realign, with 51.6% moderate or severe retroversion. Regarding RSA-6w, 21.9% had severe positive malalignment. Correct alignment of RPV-6w (p = 0.025) and RSA-6w (p = 0.002) proved to be protective factors against the development of mechanical complications. Severe pelvic retroversion (p = 0.026) and severe positive malalignment (p = 0.007) were risk factors for mechanical complications. RSA-6w “Severe positive malalignment” was associated with less improvement in PROMs: ∆ODI (8.83 vs 17.2; p = 0.011), ∆SRS-22 total (0.54 vs 0.87; p = 0.007), and ∆SF-36PCS (3.47 vs 7.76; p = 0.04); MCID for ODI (37.0 vs 55.5%; p = 0.023), and SRS-22 (40.8 vs 60.1%; p = 0.015); and PASS for ODI (17.6 vs 31.7%; p = 0.047).

Conclusions

RPV was the most underperformed modifiable parameter. Severe pelvic retroversion and severe positive malalignment influenced the occurrence of mechanical complications. Severe positive malalignment affected PROMs improvement.

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Availability of data and material

All data comes from a multicenter European database.

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Acknowledgements

This study was presented at the EUROSPINE meeting 2022.

Funding

A DePuy-Synthes Spine and Medtronic research grants were received in partial support of this work.

Author information

Authors and Affiliations

  1. Spine Unit, Department of Orthopedic Surgery, Hospital La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain

    Riccardo Raganato, Javier Pizones, Lucía Moreno-Manzanaro, José Miguel Sánchez-Márquez, Nicomedes Fernández-Baíllo & Francisco Javier Sánchez Pérez-Grueso

  2. Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    Caglar Yilgor & Ahmet Alanay

  3. Spine Research Unit, Vall d’Hebron Institute of Research, Barcelona, Spain

    Alba Vila-Casademunt

  4. Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland

    Frank Kleinstück

  5. Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France

    Ibrahim Obeid

  6. Spine Surgery Unit, Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Ferran Pellisé

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  1. Riccardo Raganato
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  2. Javier Pizones
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ESSG European Spine Study Group

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The device(s)/drug(s) is/are FDA-approved or approved by the corresponding national agency for this indication. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Correspondence to Javier Pizones.

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Raganato, R., Pizones, J., Yilgor, C. et al. Sagittal realignment: surgical restoration of the global alignment and proportion score parameters: a subgroup analysis. What are the consequences of failing to realign?. Eur Spine J 32, 2238–2247 (2023). https://doi.org/10.1007/s00586-023-07649-w

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