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Key Role of Preoperative Recumbent Films in the Treatment of Severe Sagittal Malalignment

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Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Retrospective cohort study.

Objective

To determine if severe sagittal malalignment (SM) patients without fixed deformities require a three-column osteotomy (3CO) to achieve favorable clinical and radiographic outcomes.

Summary of Background Data

3CO performed for severe SM has significantly increased in the last 15 years. Not all severe SM patients require a 3CO.

Methods

Severe SM patients (sagittal vertical axis [SVA] >10 cm) who underwent deformity correction between 2002 and 2011. Patients with <33% change in their lumbar lordosis (LL) on a preoperative supine radiograph were classified as stiff deformities, whereas those with ≥33% change were categorized as flexible deformities. The clinical/radiographic outcomes were assessed at minimum two years postoperatively.

Results

Seventy patients met the inclusion criteria, 35 patients with flexible and 35 with stiff deformities. Eighteen flexible-deformity patients underwent a 3CO versus 22 stiff-deformity patients. The remaining patients in each group underwent spinal realignment without a 3CO. The flexible-deformity patients not undergoing a 3CO had overall improvement in all sagittal radiographic parameters. Preoperative LL (22°), LL–pelvic incidence (PI) mismatch (43), SVA (17 cm), and pelvic tilt (PT, 34°) improved to 46°, 18, 6 cm, and 26°, respectively, p < .05. Flexible-deformity patients who underwent a 3CO also had overall improvement in all radiographic parameters. Preoperative LL (8.5°), LL-PI mismatch (47), SVA (19 cm), and PT (37°) improved to 39°, 15, 7 cm, and 24°, respectively (p < .05). Stiff-deformity patients who underwent a 3CO had statistically significant improvement in all radiographic parameters. However, stiff-deformity patients who did not undergo a 3CO had suboptimal improvement in all radiographic parameters, except for SVA (14 cm-9 cm, p < .05). Flexible patients who did not undergo a 3CO had statistical improvement in the SRS domains of function and self-mage as well as in their ODI scores (p < .05).

Conclusion

Severe SM that is flexible can be corrected without a 3CO without compromising clinical and radiographic outcomes.

Level of Evidence

Level III.

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Authors and Affiliations

  1. Department of Neurosurgery, Duke University Spine Center, 200 Trent Dr, Durham, NC, 27710, USA

    Isaac O. Karikari MD & Aladine A. Elsamadicy BE

  2. The Spine Hospital, Department of Orthopedics, Columbia University Medical Center, 630 W 168th St, New York City, NY, 10032, USA

    Lawrence G. Lenke MD & Kathy Blanke RN

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

    Keith H. Bridwell MD, Michael P. Kelly MD, Ramin Lalezari BS & Linda Koester BS

  4. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Ryoji Tauchi MD

  5. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA

    Patrick A. Sugrue MD

  6. University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA

    David B. Bumpass MD

  7. Department of Neurosurgery, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL, 60612, USA

    Owoicho Adogwa MD, MPH

  8. Norton Leatherman Spine Center, University of Louisville School of Medicine, 323 E Chestnut St, Louisville, KY, 40202, USA

    Jeffrey Gum MD

Authors
  1. Isaac O. Karikari MD
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  2. Lawrence G. Lenke MD
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  3. Keith H. Bridwell MD
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  4. Ryoji Tauchi MD
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  5. Michael P. Kelly MD
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  6. Patrick A. Sugrue MD
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  7. David B. Bumpass MD
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  8. Aladine A. Elsamadicy BE
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  9. Owoicho Adogwa MD, MPH
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  10. Ramin Lalezari BS
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  11. Linda Koester BS
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  12. Kathy Blanke RN
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  13. Jeffrey Gum MD
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Corresponding author

Correspondence to Isaac O. Karikari MD.

Additional information

Author disclosures: IOK (none), LGL (none), KHB (none), RT (none), MPK (none), PAS (none), DBB (none), AE (none), OA (none), RL (none), LK (none), KB (none), JG (none).

IRB Approval Statement: This study was approved by the Institutional Review Board (IRB) of the Washington University School of Medicine, St. Louis, MO.

All surgeries and research for this study were performed at the Department of Orthopedic Surgery, Washington University School of Medicine in St. Louis, MO.

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Karikari, I.O., Lenke, L.G., Bridwell, K.H. et al. Key Role of Preoperative Recumbent Films in the Treatment of Severe Sagittal Malalignment. Spine Deform 6, 568–575 (2018). https://doi.org/10.1016/j.jspd.2018.02.009

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  • DOI: https://doi.org/10.1016/j.jspd.2018.02.009

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