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Sagittal alignment of diverse mechanical complications following adult spinal deformity surgery

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Abstract

Purpose

To compare the sagittal alignment of patients with diverse mechanical complications (MCs) following adult spinal deformity (ASD) surgery with that of patients without MCs.

Methods

A total of 371 patients who underwent ASD surgery were enrolled. The sagittal spinopelvic parameters were measured preoperatively and at the 6-month and last follow-up, and the global alignment and proportion (GAP) score was calculated. The subjects were divided into non-MC and MCs groups, and the MCs group was further divided into rod fracture (RF), screw breakage (SB), screw dislodgement (SD) and proximal junctional kyphosis (PJK) subgroups.

Results

Preoperatively, the RF group had greater thoracolumbar kyphosis (TLK) and relative upper lumbar lordosis (RULL); the SB group had the largest pelvic incidence (PI) and lumbar lordosis (LL); the SD group had the least global sagittal imbalance; and the PJK group had the highest thoracic kyphosis (TK), TLK and RULL. At the last follow-up, the RF and SB groups featured a large PI minus LL (PI-LL), while the PJK group featured a prominent TK; all the MCs subgroups had sagittal malalignment and a higher GAP score, and the SB group had the most severe cases. Logistic regressions showed that the relative spinopelvic alignment (RSA) score was correlated with RF, SB and SD, while the RSA and age scores were associated with PJK.

Conclusion

Each patient with MCs had individual characteristics in the sagittal plane following ASD surgery, which may be helpful to understand the pathophysiology of poor sagittal alignment with its subsequent MCs and guide an eventual revision strategy.

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Acknowledgements

The authors thank China Scholarship Council for providing the chance of the cooperation.

Funding

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Authors and Affiliations

  1. Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Digital Spine Research Institute, Changsha, 410011, Hunan, China

    Changyu Pan

  2. Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, 11671, Riyadh, Saudi Arabia

    Anouar Bourghli

  3. Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France

    Daniel Larrieu, Louis Boissiere & Ibrahim Obeid

  4. Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain

    Javier Pizones

  5. Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey

    Ahmet Alanay

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

    Ferran PelIise

  7. Spine Center, Schulthess Klinik, Zurich, Switzerland

    Frank Kleinstück

Authors
  1. Changyu Pan
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  2. Anouar Bourghli
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  3. Daniel Larrieu
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  4. Louis Boissiere
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  5. Javier Pizones
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  6. Ahmet Alanay
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  7. Ferran PelIise
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  8. Frank Kleinstück
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  9. Ibrahim Obeid
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Consortia

European Spine Study Group

Contributions

CP and IOd conceived the study design. DL, LB, JP, AA, FP and FK supervised the data collection and analysis. CP drafted the manuscript. AB and IO contributed to the revision. CP and IO are responsible for this article.

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Correspondence to Changyu Pan.

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Pan, C., Bourghli, A., Larrieu, D. et al. Sagittal alignment of diverse mechanical complications following adult spinal deformity surgery. Eur Spine J (2024). https://doi.org/10.1007/s00586-023-08126-0

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  • DOI: https://doi.org/10.1007/s00586-023-08126-0

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