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What factors are associated with a better restoration of pelvic version after adult spinal deformity surgery?

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Abstract

Introduction

Poor restoration of pelvic version after adult spinal deformity (ASD) surgery is associated with an increased risk of mechanical complications and worse quality of life. We studied the factors linked to the improvement of postoperative pelvic version.

Materials and methods

This is a retrospective analysis of a prospective multicenter ASD database. Selection criteria were: operated patients having preoperative severe pelvic retroversion as per GAP score (Relative Pelvic Version-RPV < − 15°); panlumbar fusions to the pelvis; 2-year follow-up. Group A comprised patients with any postoperative improvement of RPV score, and group B had no improvement. Groups were compared regarding baseline characteristics, surgical factors, and postoperative sagittal parameters. Parametric and non-parametric analyses were employed.

Results

177 patients were studied, median age 67 years (61; 72.5), 83.6% female. Groups were homogeneous in baseline demographics, comorbidities, and preoperative sagittal parameters (p > 0.05). The difference in RPV improvement was 11.56º. Group A (137 patients) underwent a higher percentage of ALIF procedures (OR = 6.66; p = 0.049), and posterior osteotomies (OR = 4.96; p < 0.001) especially tricolumnar (OR = 2.31; p = 0.041). It also showed a lower percentage of TLIF procedures (OR = 0.45; p = 0.028), and posterior decompression (OR = 0.44; p = 0.024). Group A displayed better postoperative L4–S1 angle and relative lumbar lordosis (RLL), leading to improved sacral slope (and RPV), and global alignment (RSA). Group A patients had longer instrumentations (11.45 vs 10; p = 0.047) and hospitalization time (13 vs 11; p = 0.045). All postoperative sagittal parameters remained significantly better in group A through follow-up. However, differences between the groups narrowed over time.

Conclusions

ALIF procedures and posterior column osteotomies improved pelvic version postoperatively, and associated better L4–S1 and lumbar lordosis restoration, indirectly improving all other sagittal parameters. However, these improvements seemed to fade during the 2-year follow-up.

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Data availability

All data come from a multicenter European database.

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Acknowledgements

This study was presented at the GEER meeting 2023 and EUROSPINE meeting 2023.

Funding

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

Author information

Authors and Affiliations

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

    Riccardo Raganato, Lucía Moreno-Manzanaro, Fernando Escámez, Gloria Talavera, José Miguel Sánchez-Márquez, Nicomedes Fernández-Baíllo, Francisco Javier Sánchez Perez-Grueso & Javier Pizones

  2. Spine Unit, Department of Orthopedic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain

    Alejandro Gómez-Rice

  3. Department of Orthopedic Surgery, Hospital Virgen de las Nieves, Granada, Spain

    Antonio Aguilar

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

    Frank Kleinstück

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

    Ahmet Alanay

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

    Ibrahim Obeid

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

    Ferran Pellisé

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

    Riccardo Raganato, Alejandro Gómez-Rice, Lucía Moreno-Manzanaro, Fernando Escámez, Gloria Talavera, Antonio Aguilar, José Miguel Sánchez-Márquez, Nicomedes Fernández-Baíllo, Francisco Javier Sánchez Perez-Grueso, Frank Kleinstück, Ahmet Alanay, Ibrahim Obeid, Ferran Pellisé & Javier Pizones

Authors
  1. Riccardo Raganato
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  3. Lucía Moreno-Manzanaro
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Consortia

ESSG European Spine Study Group

Contributions

All authors have done: substantial contributions to the conception and design of the work, acquisition, analysis, or interpretation of data, drafting the work and revising it critically for important intellectual content, final approval of the version to be published, and all the authors agree to be accountable for the author’s own contributions and for ensuring that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and documented in the literature.

Corresponding author

Correspondence to Javier Pizones.

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Conflict of interest

Riccardo Raganato: nothing to disclose; Alejandro Gómez-Rice: nothing to disclose; Lucía Moreno-Manzanaro: nothing to disclose; Fernando Escámez: nothing to disclose; Gloria Talavera: nothing to disclose; Antonio Aguilar: nothing to disclose; José Miguel Sánchez-Márquez: nothing to disclose; Nicomedes Fernández-Baíllo: nothing to disclose; Francisco Javier Sánchez Perez-Grueso: nothing to disclose; Frank Kleinstück: teaching and speaking for DePuy Synthes; Ahmet Alanay: Medtronic, DePuy Synthes; consultant: Globus medical, ZimVie; Ibrahim Obeid: grants from DePuy Synthes; consulting for DePuy Synthes, Medtronic, Clariance, Spineart, Alphatec; Ferran Pellisé: consultant for Medtronic and DePuy Synthes; Javier Pizones: personal fees from Medtronic and DePuy Synthes, outside the submitted work; ESSG: grants from DePuy Synthes Spine and Medtronic, outside the submitted work.

Institutional review board

Ethical approval was obtained before patient enrollment and data collection protocols. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. All the participating patients gave prior informed consent to their inclusion in the study. Patients signed informed consent regarding publishing their data and photographs.

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Raganato, R., Gómez-Rice, A., Moreno-Manzanaro, L. et al. What factors are associated with a better restoration of pelvic version after adult spinal deformity surgery?. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00863-6

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