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Do adult spinal deformity patients who achieve and maintain PI–LL < 10 have better patient-reported and clinical outcomes compared to patients with PI–LL ≥ 10? A propensity score-matched analysis

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Abstract

Purpose

To investigate whether patients with spinopelvic mismatch (PI–LL ≥ 10) report worse patient-reported outcomes (PROs) compared to patients who achieve PI–LL < 10 at 2-year postop.

Methods

In this retrospective study, propensity score matching (PSM) was used to analyze patients who underwent posterior spinal fusion due to deformity, as defined by one or more of the following criteria: PI–LL ≥ 25°, T1 pelvic angle ≥ 30°, sagittal vertical axis ≥ 15 cm, thoracic scoliosis ≥ 70°, thoracolumbar scoliosis ≥ 50°, coronal malalignment ≥ 7 cm, or those who underwent a three-column osteotomy or fusion with ≥ 12 levels. Key outcomes were total Scoliosis Research Society-22r, Oswestry Disability Index (PROs), and reoperation at 1- and 2-year postop. Patients were dichotomized based on their 2-year alignment: PI–LL ≥ 10° and PI–LL < 10°. A multivariable logistic regression model identified factors associated with achieving PI–LL < 10°, and independent predictors were matched using propensity score matching. Binary outcomes within matched cohorts were analyzed using the McNemar test, while continuous outcomes were analyzed using the Wilcoxon rank-sum test.

Results

One hundred sixty-four patients with 2-year follow-up were included; mean age was 50.5 (standard error mean (SEM): 1.4) years, body mass index was 24.1(SEM 1.0), and number of operative levels was 13.5 (SEM 0.3). 84 (51.2%) and 80 (48.8%) patients achieved PI–LL < 10 and PI–LL ≥ 10 at 2-year follow-up, respectively. Baseline pelvic incidence [odds ratio (OR): 0.96 (95% CI 0.92–0.99)] and baseline PI–LL [OR: 0.95 (95% CI 0.9–0.99)] were independent predictors of achieving PI–LL < 10 at 2 years. When comparing propensity matched pairs, no significant differences were found in baseline PROs. At both 1- and 2-year follow-up, outcomes on the SRS-22r scale were nearly identical for both groups (function [4.1(0.1) vs 4.0 (0.1), P = 0.75] ,Pain [3.9 (0.2) vs 3.9 (0.2), P = 0.86], appearance [4.2 (0.2) vs 3.8 (0.2), P = 0.08], mental health [4.1 (0.2) vs 4.1 (0.1), P = 0.96], satisfaction [4.4 (0.2) vs 4.4 (0.2), P = 0.72], and total [90.2 (2.5) vs 88.1 (2.5), P = 0.57]). Additionally, ODI scores at 2 years were comparable [18.1 (2.9) vs 22.4 (2.9), P = 0.30]. The 90-day reoperation rate was 2.6% (one patient) in both matched cohorts (P > 0.99). There was no significant difference in 1-year (P > 0.9999) or 2-year (P = 0.2207) reoperation rates between the groups.

Conclusion

Patients who achieve and maintain PI–LL < 10 2-years postop following adult spinal deformity surgery have nearly identical SRS-22r and ODI outcomes, and comparable 2-year reoperation rates as compared to patients who have PI–LL ≥ 10.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Daniel and Jane Och Spine Hospital, New York Presbyterian /Columbia University Irving Medical Center, 5141 Broadway, New York, NY, 10034, USA

    Sarthak Mohanty, Christopher Mikhail, Christopher Lai, Fthimnir M. Hassan, Stephen Stephan, Erik Lewerenz, Zeeshan M. Sardar, Ronald A. Lehman & Lawrence G. Lenke

Authors
  1. Sarthak Mohanty
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  2. Christopher Mikhail
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  3. Christopher Lai
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  4. Fthimnir M. Hassan
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  5. Stephen Stephan
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  6. Erik Lewerenz
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  7. Zeeshan M. Sardar
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  8. Ronald A. Lehman
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Contributions

SM: contributed to the concept/design of the work, acquisition, analysis, and interpretation of the data, drafted the work, approved the version to be published, agrees to be accountable for all aspects of the work. CM: contributed to the concept/design of the work, acquisition, analysis, and interpretation of the data, drafted the work, approved the version to be published, agrees to be accountable for all aspects of the work. CL: contributed to the concept/design of the work, acquisition, analysis, and interpretation of the data, drafted the work, approved the version to be published, agrees to be accountable for all aspects of the work. FMH: contributed to the concept/design of the work, acquisition, analysis, and interpretation of the data, drafted the work, approved the version to be published, agrees to be accountable for all aspects of the work. SS: contributed to the concept/design of the work, acquisition, analysis, and interpretation of the data, drafted the work, approved the version to be published, agrees to be accountable for all aspects of the work. EL: contributed to the concept/design of the work, acquisition, approved the version to be published, agrees to be accountable for all aspects of the work. ZMS: contributed to the concept/design of the work, revised the work critically for important intellectual content, approved the final version to be published, agrees to be accountable for all aspects of the work. RAL: contributed to the concept/design of the work, revised the work critically for important intellectual content, approved the final version to be published, agrees to be accountable for all aspects of the work. LGL: contributed to the concept/design of the work, revised the work critically for important intellectual content, approved the final version to be published, agrees to be accountable for all aspects of the work.

Corresponding author

Correspondence to Fthimnir M. Hassan.

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Conflict of interest

Sarthak Mohanty, Christopher Mikhail, Christopher Lai, Fthimnir M. Hassan, and Erik Lewerenz have no relevant financial or non-financial interests to disclose. Lawrence G. Lenke has received grant support from AO Spine, International Spine Summit Group, Scoliosis Research Society, EOS Technology and Setting Scoliosis Straight Foundation as a study investigator. Ronald A. Lehman has received grant support from the Department of Defense as a study investigator. Zeeshan M. Sardar, Ronald A. Lehman, and Lawrence G. Lenke have received consulting fees from Medtronic. Lawrence G. Lenke has received consulting fees from Acuity Surgical and Abryx. Lawrence G. Lenke has received reimbursements from Broadwater, AO Spine, and Scoliosis Research Society for attending meetings/travel. Ronald A. Lehman and Lawrence G. Lenke have received royalties and are patent holders from Medtronic. Ronald A. Lehman has received royalties and is a patent holder from Stryker.

Ethical approval

AAAR6504—this retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Columbia University Irving Medical Center approved this study.

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Informed consent was obtained from all individual participants included in the study.

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Mohanty, S., Mikhail, C., Lai, C. et al. Do adult spinal deformity patients who achieve and maintain PI–LL < 10 have better patient-reported and clinical outcomes compared to patients with PI–LL ≥ 10? A propensity score-matched analysis. Spine Deform 12, 209–219 (2024). https://doi.org/10.1007/s43390-023-00766-y

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