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Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone

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Abstract

Object

Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons’ ability to accurately predict postoperative alignment.

Methods

Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician. Surgeon training, practice characteristics, and use of surgical planning software was assessed. Participants predicted if the surgical plan would lead to adequate deformity correction and attempted to predict postoperative radiographic parameters including sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence to lumbar lordosis mismatch (PI-LL), thoracic kyphosis (TK).

Results

Seventeen surgeons participated: 71% within 0 to 10 years of practice; 88% devote >25% of their practice to deformity surgery. Surgeons accurately judged adequacy of the surgical plan to achieve correction to specific thresholds of SVA 69% ± 8%, PT 68% ± 9%, and PI-LL 68% ± 11% of the time. However, surgeons correctly predicted the actual postoperative radiographic parameters only 42% ± 6% of the time. They were more successful at predicting PT (61% ± 10%) than SVA (45% ± 8%), PI-LL (26% ± 11%), or TK change (35% ± 21%; p <.05). Improved performance correlated with greater focus on deformity but not number of years in practice or number of three-column osteotomies performed per year.

Conclusion

Surgeons failed to correctly predict the adequacy of the proposed surgical plan in approximately one third of presented cases. They were better at determining whether a surgical plan would achieve adequate correction than predicting specific postoperative alignment parameters. Pelvic tilt and SVA were predicted with the greatest accuracy.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada

    Tamir Ailon MD

  2. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA

    Justin K. Scheer BS & Tyler Koski MD

  3. Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA

    Virginie Lafage PhD & Frank J. Schwab MD

  4. University of California Davis, 1 Shields Ave, Davis, CA, 95616, USA

    Eric Klineberg MD

  5. Department of Neurosurgery, The Johns Hopkins Medical Institutions, Johns Hopkins University, Baltimore, MD, 21218, USA

    Daniel M. Sciubba MD

  6. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 302 E 17th St #835, New York, NY, 10003, USA

    Themistocles S. Protopsaltis MD & Shay Bess MD

  7. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO, 63110, USA

    Lukas Zebala MD & Michael P. Kelly MD

  8. Department of Orthopedic Surgery, Baylor Scoliosis Center, 4708 Alliance Blvd #800, Plano, TX, 75093, USA

    Richard Hostin MD

  9. Department of Orthopaedic Surgery, Bordeaux University Hospital, Bordeaux, France

    Ibrahim Obeid MD

  10. Department of Neurosurgery, University of Virginia Medical Center, 1215 Lee St, PO Box 800212, Charlottesville, VA, 22908, USA

    Christopher I. Shaffrey MD & Justin S. Smith MD, PhD

  11. Department of Neurosurgery, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA

    Christopher P. Ames MD

Authors
  1. Tamir Ailon MD
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  2. Justin K. Scheer BS
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  3. Virginie Lafage PhD
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  4. Frank J. Schwab MD
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  5. Eric Klineberg MD
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  6. Daniel M. Sciubba MD
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  7. Themistocles S. Protopsaltis MD
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  8. Lukas Zebala MD
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  9. Richard Hostin MD
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  10. Ibrahim Obeid MD
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  11. Tyler Koski MD
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  12. Michael P. Kelly MD
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  13. Shay Bess MD
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  14. Christopher I. Shaffrey MD
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  15. Justin S. Smith MD, PhD
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  16. Christopher P. Ames MD
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Consortia

International Spine Study Group

Corresponding author

Correspondence to Justin S. Smith MD, PhD.

Additional information

Author disclosures

TA (none); JKS (none); VL (grants from SRS, grants from NIH, grants from DePuy Spine Synthesis, personal fees from Medicrea, personal fees from MSD, personal fees from DePuy Spine Synthesis, personal fees from Nemaris INC, personal fees from Nemaris INC, outside the submitted work); FJS (grants from SRS, grants from AO, grants from DePuy Spine Synthesis, personal fees from Medicrea, personal fees from BiometZimmer, personal fees from NuVasive, personal fees from MSD, personal fees from K2M, personal fees from Nemaris INC, outside the submitted work); EK (grants and personal fees from AO Spine, personal fees from DePuy, personal fees from Stryker, personal fees from K2M, outside the submitted work); DMS (other from Medtronic, DePuy-Synthes, Globus, outside the submitted work); TSP (grants from DePuy-Synthes, during the conduct of the study; personal fees from Globus, personal fees from K2M, outside the submitted work); LZ (personal fees from Ulrich Medical USA, personal fees from Broadwater, personal fees from DePuy, personal fees from K2M, grants from AO Spine Fellowship Grant, grants from DePuy, outside the submitted work); RH (personal fees from DePuy Spine, other from NuVasive, other from Seeger, other from DJO, other from DePuy Spine, other from K2M, outside the submitted work); IO (grants and personal fees from DePuy-Synthes Spine, personal fees from Medtronic, personal fees from Alfatec Spine, outside the submitted work); TK (grants and personal fees from Medtronic, personal fees from NuVasive, personal fees from Spinewave, personal fees from Globus, outside the submitted work); MPK (none); SB (grants from DePuy Synthes, during the conduct of the study; grants and personal fees from K2 Medical, grants and personal fees from NuVasive, grants and personal fees from Innovasis, personal fees from Allosource, grants from Stryker, grants from Medtronic, personal fees from Pioneer, outside the submitted work); CIS (grants from DePuy Synthes, during the conduct of the study; personal fees from Biomet, personal fees from Medtronic, personal fees from NuVasive, personal fees from Stryker, grants from AO Spine, grants from DOD, grants from NACTN, grants from NIH, outside the submitted work); JSS (grants from DePuy, during the conduct of the study; personal fees and other from Biomet, personal fees from NuVasive, personal fees from K2M, personal fees from Cerapedics, personal fees from Globus, grants and personal fees from DePuy, outside the submitted work); CPA (personal fees from DePuy, personal fees from Medtronic, personal fees from Stryker, personal fees from Biomet Spine, personal fees from Stryker, personal fees from Doctors Research Group, personal fees from UCSF, outside the submitted work; In addition, Dr. Ames has a patent Fish & Richardson, P.C. issued).

The ISSG is funded through research grants from DePuy-Synthes and individual donations.

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Ailon, T., Scheer, J.K., Lafage, V. et al. Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone. Spine Deform 4, 323–329 (2016). https://doi.org/10.1016/j.jspd.2016.02.003

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  • DOI: https://doi.org/10.1016/j.jspd.2016.02.003

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