Deformity Angular Ratio Describes the Severity of Spinal Deformity and Predicts the Risk of Neurologic Deficit in Posterior Vertebral Column Resection Surgery

Study Design.Retrospective review of prospectively collected data.Objective.To assess the value of the deformity angular ratio (DAR, maximum Cobb measurement divided by number of vertebrae involved) in evaluating the severity of spinal deformity, and predicting the risk of neurologic deficit in posterior vertebral column resection (PVCR).Summary of Background Data.Although the literature has demonstrated that PVCR in spinal deformity patients has achieved excellent outcomes, it is still high risk neurologically. This study, to our knowledge, is the largest series of PVCR patients from a single center, evaluating deformity severity, and potential neurologic deficit risk.Methods.A total of 202 consecutive pediatric and adult patients undergoing PVCRs from November 2002 to September 2014 were reviewed. The DAR (coronal DAR, sagittal DAR, and total DAR) was used to evaluate the complexity of the deformity.Results.The incidence of spinal cord monitoring (SCM) events was 20.5%. Eight patients (4.0%) had new neurologic deficits. Patients with a high total DAR (25) were significantly younger (20.3 vs. 29.0yr, P=0.001), had more severe coronal and sagittal deformities, were more myelopathic (33.3% vs. 11.7%, P=0.000), needed larger vertebral resections (1.8 vs. 1.3, P=0.000), and had a significantly higher rate of SCM events than seen in the low total DAR (<25) patients (41.1% vs. 10.8%; P=0.000). Patients with a high sagittal DAR (15) also had a significantly higher rate of SCM events (34.0% vs. 15.1%, P=0.005) and a greater chance of neurologic deficits postoperatively (12.5% vs. 0, P=0.000).Conclusion.For patients undergoing a PVCR, the DAR can be used to quantify the angularity of the spinal deformity, which is strongly correlated to the risk of neurologic deficits. Patients with a total DAR greater than or equal to 25 or sagittal DAR greater than or equal to 15 are at much higher risk for intraoperative SCM events and new neurologic deficits.Level of Evidence: 3