Skip to main content

Advertisement

SpringerLink
Log in

Rigorous Correction of Sagittal Vertical Axis Is Correlated With Better ODI Outcomes After Extensive Corrective Fusion in Elderly or Extremely Elderly Patients With Spinal Deformity

  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Retrospective analysis of a prospectively collected consecutive case series.

Objectives

To determine the effect of spinopelvic correction on clinical outcomes and discuss the approach to target alignment in elderly or extremely elderly spinal deformity patients.

Summary of Background Data

Age-dependent target alignment during corrective fusion surgery in elderly patients remains controversial. Age-related target spinal alignment should be examined based on the outcomes data of patients with fused, nonphysiological spines.

Methods

Consecutive adult spinal deformity (ASD) patients aged 45 years or older who underwent thoracolumbar corrective fusion of at least five levels were included. Spinopelvic radiographic parameters, health-related quality of life (Oswestry Disability Index [ODI]), and the scores on a numeric rating scale of low back pain were investigated before and after the operation. The patients were stratified into three groups according to age as follows: Middle-Age, 45–64 years; Elderly, 65–74 years; and Extremely Elderly, ≥75 years. We also stratified the patients into three groups according to lumber lordosis (LL) as follows: ideal (within ±5° of ideal LL), moderate (between −5° and −20° of ideal LL), and under (under ideal LL by −20°).

Results

A total of 149 patients (Middle-Age, 38; Elderly, 68; and Extremely Elderly, 43) were included in this study. No significant difference was observed in any of the radiographic parameters in each age group. The ODI and numeric rating scale scores of the ideal-correction group at two years after surgery were significantly better than those of the undercorrection group across all ages. A significant correlation with ODI was observed between sagittal spinopelvic parameters in the Elderly and Extremely Elderly groups. A stronger correlation was observed in the Extremely Elderly group compared with the Elderly group.

Conclusions

Rigorous realignment of sagittal vertical axis is correlated with ODI outcomes, especially in very elderly patients.

Level of Evidence

Level 4.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bess S, Line B, Fu K-M, et al. The health impact of symptomatic adult spinal deformity. Spine (Phila Pa 1976) 2016;41:224–33.

    Article  Google Scholar 

  2. Pellisé F, Vila-Casademunt A, Ferrer M, et al. Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 2014;24:3–11.

    Article  PubMed  Google Scholar 

  3. Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 2005;30:682–8.

    Article  Google Scholar 

  4. Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005;30:2024–9.

    Article  Google Scholar 

  5. Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 2009;34:E599–606.

    Article  Google Scholar 

  6. Banno T, Togawa D, Arima H, et al. The cohort study for the determination of reference values for spinopelvic parameters (T1 pelvic angle and global tilt) in elderly volunteers. Eur Spine J 2016;25: 3687–93.

    Article  PubMed  Google Scholar 

  7. Gelb DE, Lenke LG, Bridwell KH, et al. An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 1995;20:1351–8.

    Article  CAS  Google Scholar 

  8. Hammerberg EM. Sagittal profile of the elderly. J Spinal Disord Tech 2003;16:44–50.

    Article  PubMed  Google Scholar 

  9. Hasegawa K, Okamoto M, Hatsushikano S, et al. Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects. Eur Spine J 2016;25:3675–86.

    Article  PubMed  Google Scholar 

  10. Oe S, Togawa D, Nakai K, et al. The influence of age and sex on cervical spinal alignment among volunteers aged over 50. Spine (Phila Pa 1976) 2015;40:1487–94.

    Article  Google Scholar 

  11. Muramoto A, Imagama S, Ito Z, et al. Threshold values of physical performance tests for locomotive syndrome. J Orthop Sci 2013; 18: 618–26.

    Article  PubMed  Google Scholar 

  12. Inami S, Moridaira H, Takeuchi D, et al. Optimum pelvic incidence minus lumbar lordosis value can be determined by individual pelvic incidence. Eur Spine J 2016;25:3638–43.

    Article  PubMed  Google Scholar 

  13. Kim YJ, Bridwell KH, Lenke LG, et al. An analysis of sagittal spinal alignment following long adult lumbar instrumentation and fusion to L5 or S1: can we predict ideal lumbar lordosis? Spine (Phila Pa 1976) 2006;31:2343–52.

    Article  Google Scholar 

  14. Rose PS, Bridwell KH, Lenke LG, et al. Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976) 2009;34:785–91.

    Article  Google Scholar 

  15. Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society–Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 2012;37:1077–82.

    Article  Google Scholar 

  16. Yamato Y, Hasegawa T, Kobayashi S, et al. Calculation of the target lumbar lordosis angle for restoring an optimal pelvic tilt in elderly patients with adult spinal deformity. Spine (Phila Pa 1976) 2016;1: 1689–99.

    Google Scholar 

  17. Lafage R, Schwab F, Challier V, et al. Defining spino-pelvic alignment thresholds. Spine (Phila Pa 1976) 2016;41:62–8.

    Article  Google Scholar 

  18. Protopsaltis TS. Patient-specific spinal alignment and adult deformity surgery. Spine (Phila Pa 1976) 2017;42:S14–5.

    Article  Google Scholar 

  19. Horton WC, Brown CW, Bridwell KH, et al. Is there an optimal patient stance for obtaining a lateral 36” radiograph? A critical comparison of three techniques. Spine (Phila Pa 1976) 2005;30:427–33.

    Article  Google Scholar 

  20. Ryan DJ, Protopsaltis TS, Ames CP, et al. T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally. Spine (Phila Pa 1976) 2014;39:1203–10.

    Article  Google Scholar 

  21. Glattes RC, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976) 2005;30:1643–9.

    Article  Google Scholar 

  22. Acaroğlu RE, Dede Ö, Pellisé F, et al. Adult spinal deformity: a very heterogeneous population of patients with different needs. Acta Orthop Traumatol Turc 2016;50:57–62.

    PubMed  Google Scholar 

  23. Yamato Y, Matsuyama Y, Hasegawa K, et al. A Japanese nationwide multicenter survey on perioperative complications of corrective fusion for elderly patients with adult spinal deformity. J Orthop Sci 2017;22:237–42.

    Article  PubMed  Google Scholar 

  24. Berven SH, Hohenstein NA, Savage JW, et al. Does the outcome of adult deformity surgery justify the complications in elderly (above 70 y of age) patients? J Spinal Disord Tech 2015;28:271–4.

    Article  PubMed  Google Scholar 

  25. Daubs MD, Lenke LG, Cheh G, et al. Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine (Phila Pa 1976) 2007;32:2238–44.

    Article  Google Scholar 

  26. Hassanzadeh H, Jain A, El Dafrawy MH, et al. Three-column osteotomies in the treatment of spinal deformity in adult patients 60 years old and older: outcome and complications. Spine (Phila Pa 1976) 2013;38:726–31.

    Article  Google Scholar 

  27. Scheer JK, Smith JS, Schwab F, et al. Development of a preoperative predictive model for major complications following adult spinal deformity surgery. J Neurosurg Spine 2017;26:736–43.

    Article  PubMed  Google Scholar 

  28. Scheer JK, Lafage V, Smith JS, et al. Impact of age on the likelihood of reaching a minimum clinically important difference in 374 three-column spinal osteotomies. J Neurosurg Spine 2014;20:306–12.

    Article  PubMed  Google Scholar 

  29. Eguchi Y, Suzuki M, Yamanaka H, et al. Associations between sarco-penia and degenerative lumbar scoliosis in older women. Scoliosis Spinal Disord 2017; 12:9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Phan K, Kim JS, Xu J, et al. Nutritional insufficiency as a predictor for adverse outcomes in adult spinal deformity surgery. Global Spine J 2018;8:164–71.

    Article  PubMed  Google Scholar 

  31. Reid DBC, Daniels AH, Ailon T, et al. Frailty and health-related quality of life improvement following adult spinal deformity surgery. World Neurosurg 2018;112:e548–54.

    Article  Google Scholar 

  32. Yilgor C, Sogunmez Z, Yavuz Y, et al. Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence-based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis. Neurosurg Focus 2017;43:E5.

    Article  PubMed  Google Scholar 

  33. Acaroglu E, Guler UO, Olgun ZD, et al. Multiple regression analysis of factors affecting health-related quality of life in adult spinal deformity. Spine Deform 2015;3:360–6.

    Article  PubMed  Google Scholar 

  34. Yilgor C, Sogunmez N, Boissiere L, et al. Global Alignment and Proportion (GAP) Score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am 2017;99: 1661–72.

    Article  PubMed  Google Scholar 

  35. Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 2005;30:346–53.

    Article  Google Scholar 

  36. Ha Y, Maruo K, Racine L, et al. Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae. J Neurosurg Spine 2013;19:360–9.

    Article  PubMed  Google Scholar 

  37. Maruo K, Ha Y, Inoue S, et al. Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity. Spine (Phila Pa 1976) 2013;38:E1469–76.

    Article  Google Scholar 

  38. Scheer JK, Fakurnejad S, Lau D, et al. Results of the 2014 SRS survey on PJK/PJF Spine (Phila Pa 1976) 2015;40:829–40.

    Article  Google Scholar 

  39. Yagi M, King AB, Boachie-Adjei O. Incidence, risk factors, and natural course of proximal junctional kyphosis. Spine (Phila Pa 1976) 2012;37:1479–89.

    Article  Google Scholar 

  40. Yasuda T, Hasegawa T, Yamato Y, et al. Proximal junctional kyphosis in adult spinal deformity with long spinal fusion from T9/T10 to the ilium. J Spine Surg 2017;3:204–11.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Barton C, Noshchenko A, Patel V, et al. Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series. Scoliosis 2015;10:30.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Smith JS, Shaffrey CI, Ames CP, et al. Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. Neurosurgery 2012;71:862–7.

    Article  PubMed  Google Scholar 

  43. Smith JS, Shaffrey E, Klineberg E, et al. Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine 2014;21:994–1003.

    Article  PubMed  Google Scholar 

  44. Yamato Y, Hasegawa T, Kobayashi S, et al. Treatment strategy for rod fractures following corrective fusion surgery in adult spinal deformity depends on symptoms and local alignment change. J Neurosurg Spine 2018;29:59–67.

    Article  PubMed  Google Scholar 

  45. Banno T, Hasegawa T, Yamato Y, et al. Assessment of the change in alignment of fixed segment after adult spinal deformity surgery. Spine (Phila Pa 1976) 2018;43:262–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1 Chome-20-1, Handayama, Hamamatsu, Shizuoka Prefecture, 431-3192, Japan

    Yu Yamato MD, PhD, Tomohiko Hasegawa MD, PhD, Daisuke Togawa MD, PhD, Go Yoshida MD, PhD, Tomohiro Banno MD, PhD, Hideyuki Arima MD, PhD, Shin Oe MD, Yuki Mihara MD, Hiroki Ushirozako MD, Sho Kobayashi MD, PhD & Yukihiro Matsuyama MD, PhD

  2. Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1 Chome-20-1, Handayama, Hamamatsu, Shizuoka Prefecture, 431-3192, Japan

    Daisuke Togawa MD, PhD & Shin Oe MD

  3. Department of Orthopedic Surgery, Hamamatsu Medical Center, 328 Tomizuka-cho, Naka-ku, Hamamatsu-shi, 432-8580, Japan

    Tatsuya Yasuda MD

Authors
  1. Yu Yamato MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomohiko Hasegawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daisuke Togawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Go Yoshida MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomohiro Banno MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hideyuki Arima MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shin Oe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuki Mihara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroki Ushirozako MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sho Kobayashi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tatsuya Yasuda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yukihiro Matsuyama MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yu Yamato MD, PhD.

Additional information

Author disclosures: YY (none), TH (none), DT (other from Meitoku Medical Institute, Jyuzen Memorial Hospital, other from Japan Medical Dynamic Marketing Inc., other fromMedtronicSofamorDanekInc, outside the submitted work; and Deputy Editor, Journal of Bone and Joint Surgery), GY (none), TB (none), HA (none), SO (other from Medtronic Sofamor Danek Inc., other from Japan Medical Dynamic Marketing Inc., other from Meitoku Institute, Jyuzen Memorial Hospital, during the conduct of the study), YM (none), HU (none), SK (none), TY (none), YM (none).

IRB approval: This study was approved by the institutional review board at Hamamatsu University School of Medicine, Shizuoka, Japan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamato, Y., Hasegawa, T., Togawa, D. et al. Rigorous Correction of Sagittal Vertical Axis Is Correlated With Better ODI Outcomes After Extensive Corrective Fusion in Elderly or Extremely Elderly Patients With Spinal Deformity. Spine Deform 7, 610–618 (2019). https://doi.org/10.1016/j.jspd.2018.11.001

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2018.11.001

Keywords

Search

Navigation