Adherence to the Obeid coronal malalignment classification and a residual malalignment below 20 mm can improve surgical outcomes in adult spine deformity surgery

Adult spinal deformity; Coronal alignment; Mechanical complicationsDeformidad espinal del adulto; Alineación coronal; Complicaciones mecánicasDeformitat espinal de l'adult; Alineació coronal; Complicacions mecàniquesPurpose Coronal balance is a major factor impacting the surgical outcomes in adult spinal deformity (ASD). The Obeid coronal malalignment (O-CM) classification has been proposed to improve the coronal alignment in ASD surgery. Aim of this study was to investigate whether a postoperative CM < 20 mm and adherence to the O-CM classification could improve surgical outcomes and decrease the rate of mechanical failure in a cohort of ASD patients. Methods Multicenter retrospective analysis of prospectively collected data on all ASD patients who underwent surgical management and had a preoperative CM > 20 mm and a 2-year follow-up. Patients were divided in two groups according to whether or not surgery had been performed in adherence to the guidelines of the O-CM classification and according to whether or not the residual CM was < 20 mm. The outcomes of interest were radiographic data, rate of mechanical complications and Patient-Reported Outcome Measures. Results At 2 years, adherence to the O-CM classification led to a lower rate of mechanical complications (40 vs. 60%). A coronal correction of the CM < 20 mm allowed for a significant improvement in SRS-22 and SF-36 scores and was associated with a 3.5 times greater odd of achieving the minimal clinical important difference for the SRS-22. Conclusion Adherence to the O-CM classification could reduce the risk of mechanic complications 2 years after ASD surgery. Patients with a residual CM < 20 mm showed better functional outcomes and a 3.5 times greater odd of achieving the MCID for the SRS-22 score.Open Access funding enabled and organized by Projekt DEAL. None

Prise en charge médicochirurgicale des infections de site opératoire sur rachis thoracolombaire instrumenté : facteurs de risque de mauvaise évolution

Surgical site infection (SSI) after thoracolumbar osteosynthesis is a common complication. Its diagnosic and therapeutic management relies on the surgeon-infectiologist tandem. Sometimes infection persists despite this treatment. The aim of our study was to assess the number and occurence of SSI management failure. A retrospective cohort made up of patients hospitalized from 2011 to 2019 at University Hospital of Caen was carried out. The infection rate as well as the time to onset of failure were assessed with a minimum follow-up of 1 year. We compared the failure group with the good evolution group in order to determine risk factors for treatment failure. A total of 92 patients were included in the study corresponding to an SSI rate of 3%. 36% of the patients presented a failure of management. The mean duration of follow-up was 26.5 months with a median onset of failure of 31 days. The risk factors for failure identified were diabete mellitus, multi-microbial infection and the lack of antibiotic therapy delivered as recommended. The prolonged duration of post-operative drainage was a protective factor. The number of failures was significant and occured early in the care. Some of the risk factors identified were modifiable, and a prolonged duration of post-operative drainage seems recommended. The results underline the importance of strict monitoring of thoracolumbar SSI by experts in osteo-articular infections field in order to reduce the risk of failure.L’infection de site opératoire (ISO) après ostéosynthèse thoracolombaire est une complication fréquente. Sa gestion diagnostic et thérapeutique repose sur le tandem chirurgien-infectiologue. Parfois l’infection persiste malgré cette prise en charge. Le but de notre étude était d’évaluer le nombre et la survenue des échecs de gestion d’ISO afin d’en déterminer les facteurs de risque. Une cohorte rétrospective composée de patients hospitalisés de 2011 à 2019 au CHU de Caen pour ISO a été réalisée. Le taux d’infection ainsi que le délai de survenue de l’échec ont été évalués avec un suivi minimum de 1 an. Nous avons comparé le groupe échec au groupe bonne évolution afin de déterminer des facteurs de risque d’échec de prise en charge. Un total de 92 patients a été inclus dans l’étude correspondant à un taux d’ISO de 3%. 36% des patients présentaient un échec de prise en charge. La durée moyenne de suivi était de 26,5 mois avec une médiane de survenu de l’échec de 31 jours. Les facteurs de risque d’échec retrouvés étaient le diabète, l’infection plurimicrobienne et l’absence d’une antibiothérapie délivrée selon les recommandations. La durée prolongée du drainage post opératoire était un facteur protecteur. Le nombre d’échecs était important et survenait précocement dans la prise en charge. Les facteurs de risques retrouvés étaient pour certains modifiables, et un drainage prolongé semble recommandé. Ces résultats soulignent l’importance du suivi strict des ISO du rachis thoracolombaire par des experts en infection osteo-articulaires afin de diminuer le risque d’échec