Abstract
Purpose
The mechanical complications related to ASD remain a concern due to their morbidity and associated revision surgery. Restoration of each patient’s Roussouly profile may reduce these. Our aim was to examine if the restoration of the Roussouly profile reduced these complications and revision rates in older patients operated for degenerative ASD.
Methods
Retrospective analysis of a single-centre, 2-year minimum follow-up patient database. All patients undergoing corrective surgery (≥ 4 levels) for ASD were included with analysis of demographic data, operative records, restoration of Roussouly sagittal profile, mechanical complications and revision rates. Univariate and multivariate analysis was conducted.
Results
Fifty-two patients were included (mean age was 72.3 years, average follow-up 56.3 months). Twenty-six patients had a “restored” profile (50%) and 26 an “unrestored” profile (50%). The incidence of mechanical complications was 7 (27%) and 23 (88%) for the restored and unrestored groups, respectively (p < 0.001). Revision rates were 4 (15.4%) and 18 (69.2%), respectively (p < 0.000), in the restored and unrestored profiles. Univariate analysis determined that profile restoration and BMI were associated with mechanical complications and revision surgery, whilst only the profile restoration status maintained its statistical power in multivariate analysis (p = 0.002 and p = 0.002, respectively). Age was not a significant factor in univariate analysis. The relative risk for mechanical failure and revision surgery was 5.6 times (CI 1.929–16.39) and 3.08 times (CI 1.642–5.734) greater if the profile was not restored.
Conclusions
Achieving each patient’s ideal Roussouly profile is associated with a reduced incidence of mechanical complications and revision rates in the older population after surgery for degenerative ASD.
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References
Takemoto M, Boissière L, Vital J-M et al (2017) Are sagittal spinopelvic radiographic parameters significantly associated with quality of life of adult spinal deformity patients? Multivariate linear regression analyses for pre-operative and short-term post-operative health-related quality of life. Eur Spine J 26(8):2176–2186. https://doi.org/10.1007/s00586-016-4872-y
Glassman SD, Bridwell K, Dimar JR et al (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029. https://doi.org/10.1097/01.brs.0000179086.30449.96
Jimbo S, Kobayashi T, Aono K et al (2012) Epidemiology of degenerative lumbar scoliosis: a community-based cohort study. Spine 37:1763–1770. https://doi.org/10.1097/BRS.0b013e3182575eaa
Scheer JK, Hostin R, Robinson C et al (2018) Operative management of adult spinal deformity results in significant increases in QALYs gained compared to nonoperative management: analysis of 479 patients with minimum 2-year follow-up. Spine 43:339–47. https://doi.org/10.1097/BRS.0000000000001626
Riouallon G, Bouyer B, Wolf S (2016) Risk of revision surgery for adult idiopathic scoliosis: a survival analysis of 517 cases over 25 years. Eur Spine J 25(8):2527–2534. https://doi.org/10.1007/s00586-016-4505-5
Berthonnaud E, Dimnet J, Roussouly P, Labelle H (2005) Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18(1):40–47. https://doi.org/10.1097/01.bsd.0000117542.88865.77
Laouissat F, Sebaaly A, Gehrchen M, Roussouly P (2018) Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J 27(8):2002–2011. https://doi.org/10.1007/s00586-017-5111-x
Sebaaly A, Grobost P, Mallam L, Roussouly P (2017) Description of the sagittal alignment of the degenerative human spine. Eur Spine J 27:489–496. https://doi.org/10.1007/s00586-017-5404-0
Pizones J, Moreno-Manzanaro L, Sánchez Pérez-Grueso FJ et al (2020) Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications. Eur Spine J 29:54–62. https://doi.org/10.1007/s00586-019-06176-x
Bari TJ, Hansen LV, Gehrchen M (2020) Surgical correction of adult spinal deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications. Spine Deform 8:1027–1037. https://doi.org/10.1007/s43390-020-00112-6
Legaye J, Duval-Beaupère G, Hecquet J et al (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103. https://doi.org/10.1007/s005860050038
Barrey C, Jund J, Noseda O et al (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16:1459–1467. https://doi.org/10.1007/s00586-006-0294-6
Barrey C, Roussouly P, Perrin G et al (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20:626–633. https://doi.org/10.1007/s00586-011-1930-3
Schwab F, Lafage V, Patel A et al (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine J 34:1828–1833. https://doi.org/10.1097/BRS.0b013e3181a13c08
Smith JS, Klineberg E, Schwab F et al (2013) Change in classification grade by the SRS-Schwab adult spinal deformity classification predicts impact on health-related quality of life measures. Spine 38:1663–1671. https://doi.org/10.1097/BRS.0b013e31829ec563
Lafage R, Schwab F, Challier V et al (2016) Defining spino-pelvic alignment thresholds: should operative goals in adult spinal deformity surgery account for age? Spine 41:62–68. https://doi.org/10.1097/BRS.0000000000001171
Yilgor C, Sogunmez N, Boissière L et al (2017) Global alignment and proportion (GAP) score. J Bone Joint Surg 99:1661–1672. https://doi.org/10.2106/JBJS.16.01594
Pizones J, Perez-Grueso FJS, Moreno-Manzanaro L et al (2020) Ideal sagittal profile restoration and ideal lumbar apex positioning play an important role in postoperative mechanical complications after a lumbar PSO. Spine Deform 8(3):491–498. https://doi.org/10.1007/s43390-019-00005-3
Auerbach JD, Lenke LG, Bridwell KH et al (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine 37(14):1198–1210. https://doi.org/10.1097/BRS.0b013e31824fffde
Chan L, Li Y, Hai Y, Liu Y, Zhang Y (2021) Risk factors of unintended return to the operating room in adult spinal deformity. J Orthop Surg Res 16(1):240. https://doi.org/10.1186/s13018-021-02385-7
Pitter FT, Lindberg-Larsen M, Pedersen AB, Dahl B, Gehrchen M (2019) Revision risk after primary adult spinal deformity surgery: a nationwide study with two-year follow-up. Spine Deform 7(4):619-626.e2. https://doi.org/10.1016/j.jspd.2018.10.006
Bianco K, Norton R, Schwab F et al (2014) Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Neurosurg Focus 36(5):E18. https://doi.org/10.3171/2014.2.FOCUS1422
Varshneya K, Bhattacharjya A, Jokhai RT et al (2022) The impact of osteoporosis on adult deformity surgery outcomes in Medicare patients. Eur Spine J 31(1):88–94. https://doi.org/10.1007/s00586-021-06985-z
Gupta A, Cha T, Schwab J et al (2021) Osteoporosis increases the likelihood of revision surgery following a long spinal fusion for adult spinal deformity. Spine J 21(1):134–140. https://doi.org/10.1016/j.spinee.2020.08.002
Sebaaly A, Gehrchen M, Silvestre C et al (2020) Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J 29(4):904–913. https://doi.org/10.1007/s00586-019-06253-1
Park SJ, Lee CS, Chung SS et al (2017) Different risk factors of proximal junctional kyphosis and proximal junctional failure following long instrumented fusion to the sacrum for adult spinal deformity: survivorship analysis of 160 Patients. Neurosurgery 80(2):279–286. https://doi.org/10.1227/NEU.0000000000001240
Bridwell KH, Lenke LG, Cho SK, Pahys JM, Zebala LP, Dorward IG, Cho W, Baldus C, Hill BW, Kang MM (2013) Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle. Neurosurgery 72(6):899–906. https://doi.org/10.1227/NEU.0b013e31828bacd8
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Gessara, A., Patel, M.S., Estefan, M. et al. Restoration of the sagittal profile according to the Roussouly classification reduces mechanical complications and revision surgery in older patients undergoing surgery for adult spinal deformity (ASD). Eur Spine J 33, 563–570 (2024). https://doi.org/10.1007/s00586-023-07885-0
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DOI: https://doi.org/10.1007/s00586-023-07885-0