Pelvic Nonresponse Following Treatment of Adult Spinal Deformity: Influence of Realignment Strategies on Occurrence

被引:18
作者
Passias, Peter G. E. [1 ,18 ]
Pierce, Katherine E. K. [1 ]
Williamson, Tyler K. [1 ]
Krol, Oscar [1 ]
Lafage, Renaud [2 ]
Lafage, Virginie J. [3 ]
Schoenfeld, Andrew J. S. [4 ]
Protopsaltis, Themistocles S. [1 ]
Vira, Shaleen [5 ]
Line, Breton G. [6 ]
Diebo, Bassel G. P. [7 ]
Ames, Christopher P. [8 ]
Kim, Han Jo S. [2 ]
Smith, Justin S. [9 ]
Chou, Dean H. [8 ]
Daniels, Alan H. L. [10 ]
Gum, Jeffrey L. I. [11 ]
Shaffrey, Christopher I. C. [12 ]
Burton, Douglas C. P. [13 ]
Kelly, Michael P. O. [14 ]
Klineberg, Eric O. A. [15 ]
Hart, Robert A. [16 ]
Bess, Shay J. [6 ]
Schwab, Frank J. C. [3 ]
Gupta, Munish C. [14 ]
Int Spine Study Grp [17 ]
机构
[1] NYU Langone Orthoped Hosp, New York Spine Inst, Dept Orthopaed & Neurol Surg, New York, NY USA
[2] Hosp Special Surg, Dept Orthopaed, New York, NY USA
[3] Northwell Hlth, Lenox Hill Hosp, Dept Orthopaed, New York, NY USA
[4] Harvard Med Sch, Brigham & Womens Hosp, Dept Orthopaed Surg, Boston, MA USA
[5] Univ Texas Southwestern Med Ctr Dallas, Dept Spine Surg, Dallas, TX USA
[6] Presbyterian St Lukes Rocky Mt Hosp Children, Dept Spine Surg, Denver Int Spine Clin, Denver, CO USA
[7] SUNY Downstate, Dept Orthoped Surg, New York, NY USA
[8] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA USA
[9] Univ Virginia, Dept Neurosurg, Charlottesville, VA USA
[10] Brown Univ, Warren Alpert Sch Med, Dept Orthopaed Surg, Providence, RI USA
[11] Norton Leatherman Spine Ctr, Dept Orthopaed Surg, Louisville, KY USA
[12] Duke Univ, Dept Orthopaed & Neurosurg, Med Ctr, Durham, NC USA
[13] Univ Kansas, Dept Orthopaed Surg, Med Ctr, Kansas City, KS USA
[14] Washington Univ, Dept Orthopaed Surg, St. Louis, MO USA
[15] Univ Calif Davis, Dept Orthopaed Surg, Med Ctr, Sacramento, CA USA
[16] Swedish Neurosci Inst, Dept Orthopaed Surg, Seattle, WA USA
[17] Rocky Mt Scoliosis & Spine, Denver, CO USA
[18] NYU Langone Med Ctr, Orthopaed Hosp, NYU Sch Med, Dept Orthopaed & Neurol Surg,New York Spine Inst,D, 301 East 17th St, New York, NY 10003 USA
关键词
adult spinal deformity; pelvic nonresponse; SRS-Schwab modifiers; realignment targets; Global Alignment and Proportion score; health-related quality of life; reoperation; proximal junctional kyphosis; PROXIMAL JUNCTIONAL KYPHOSIS; RISK-BENEFIT ASSESSMENT; GLOBAL ALIGNMENT; MECHANICAL COMPLICATIONS; RADIOGRAPHIC PARAMETERS; SPINOPELVIC ALIGNMENT; SAGITTAL ALIGNMENT; SURGERY; VALIDATION; BALANCE;
D O I
10.1097/BRS.0000000000004464
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose. Despite adequate correction, the pelvis may fail to readjust, deemed pelvic nonresponse (PNR). To assess alignment outcomes [PNR, proximal junctional kyphosis (PJK), postoperative cervical deformity (CD)] following adult spinal deformity (ASD) surgery utilizing different realignment strategies.Materials and Methods. ASD patients with two-year data were included. PNR defined as undercorrected in age-adjusted pelvic tilt (PT) at six weeks and maintained at two years. Patients classified by alignment utilities: (a) improvement in Scoliosis Research Society-Schwab sagittal vertical axis, (b) matching in age-adjusted pelvic incidence-lumbar lordosis, (c) matching in Roussouly, (d) aligning Global Alignment and Proportionality (GAP) score. Multivariable regression analyses, controlling for age, baseline deformity, and surgical factors, assessed rates of PNR, PJK, and CD development following realignment.Results. A total of 686 patients met the inclusion criteria. Rates of postoperative PJK and CD were not significant in the PNR group (both P>0.15). PNR patients less often met substantial clinical benefit in Oswestry Disability Index by two years [odds ratio: 0.6 (0.4-0.98)]. Patients overcorrected in age-adjusted pelvic incidence-lumbar lordosis, matching Roussouly, or proportioned in GAP at six weeks had lower rates of PNR (all P<0.001). Incremental addition of classifications led to 0% occurrence of PNR, PJK, and CD. Stratifying by baseline PT severity, Low and moderate deformity demonstrated the least incidence of PNR (7.7%) when proportioning in GAP at six weeks, while severe PT benefited most from matching in Roussouly (all P<0.05).Conclusions. Following ASD corrective surgery, 24.9% of patients showed residual pelvic malalignment. This occurrence was often accompanied by undercorrection of lumbopelvic mismatch and less improvement of pain. However, overcorrection in any strategy incurred higher rates of PJK. We recommend surgeons identify a middle ground using one, or more, of the available classifications to inform correction goals in this regard.
引用
收藏
页码:645 / 652
页数:8
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