Is Sacral Extension a Risk Factor for Early Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery?

Study designRetrospective cohort study.PurposeTo investigate the role of sacral extension (SE) for the development of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery.Overview of literatureThe development of PJK is multifactorial and different risk factors have been identified. Of these, there is some evidence that SE also affects the development of PJK, but data are insufficient.MethodsUsing a combined database comprising two propensity-matched groups of fusions following ASD surgery, one with fixation to S1 or S1 and the ilium (SE) and one without SE but with a lower instrumented vertebra of L5 or higher (lumbar fixation, LF), PJK and the role of further parameters were analyzed. The propensity-matched variables included age, the upper-most instrumented vertebra (UIV), preoperative sagittal alignment, and the baseline to one year change of the sagittal alignment.ResultsPropensity matching led to two groups of 89 patients each. The UIV, pelvic incidence minus lumbar lordosis, sagittal vertical axis, pelvic tilt, age, and body mass index were similar in both groups (p >0.05). The incidence of PJK at postoperative one year was similar for SE (30.3%) and LF (22.5%) groups (p =0.207). The PJK angle was comparable (p =0.963) with a change of -8.2° (SE) and -8.3° (LF) from the preoperative measures (p =0.954). A higher rate of PJK after SE (p =0.026) was found only in the subgroup of patients with UIV levels between T9 and T12.ConclusionsInstrumentation to the sacrum with or without iliac extension did not increase the overall risk of PJK. However, an increased risk for PJK was found after SE with UIV levels between T9 and T12

The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases.

Study designA retrospective analysis of a prospective, multicenter database.ObjectiveThe aim of this study was to evaluate the health impact of symptomatic adult spinal deformity (SASD) by comparing Standard Form Version 2 (SF-36) scores for SASD with United States normative and chronic disease values.Summary of background dataRecent data have identified radiographic parameters correlating with poor health-related quality of life for SASD. Disability comparisons between SASD patients and patients with chronic diseases may provide further insight to the disease burden caused by SASD.MethodsConsecutive SASD patients, with no history of spine surgery, were enrolled into a multicenter database and evaluated for type and severity of spinal deformity. Baseline SF-36 physical component summary (PCS) and mental component summary (MCS) values for SASD patients were compared with reported U.S. normative and chronic disease SF-36 scores. SF-36 scores were reported as normative-based scores (NBS) and evaluated for minimally clinical important difference (MCID).ResultsBetween 2008 and 2011, 497 SASD patients were prospectively enrolled and evaluated. Mean PCS for all SASD was lower than U.S. total population (ASD = 40.9; US = 50; P < 0.05). Generational decline in PCS for SASD patients with no other reported comorbidities was more rapid than U.S. norms (P < 0.05). PCS worsened with lumbar scoliosis and increasing sagittal vertical axis (SVA). PCS scores for patients with isolated thoracic scoliosis were similar to values reported by individuals with chronic back pain (45.5 vs 45.7, respectively; P > 0.05), whereas patients with lumbar scoliosis combined with severe sagittal malalignment (SVA >10 cm) demonstrated worse PCS scores than values reported by patients with limited use of arms and legs (24.7 vs 29.1, respectively; P < 0.05).ConclusionsSASD is a heterogeneous condition that, depending upon the type and severity of the deformity, can have a debilitating impact on health often exceeding the disability of more recognized chronic diseases. Health care providers must be aware of the types of SASD that correlate with disability to facilitate appropriate diagnosis, treatment, and research efforts.Level of evidence3

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Acute Reciprocal Changes Distant from the Site of Spinal Osteotomies Affect Global Postoperative Alignment

Introduction. Three-column vertebral resections are frequently applied to correct sagittal malalignment; their effects on distant unfused levels need to be understood. Methods. 134 consecutive adult PSO patients were included (29 thoracic, 105 lumbar). Radiographic analysis included pre- and postoperative regional curvatures and pelvic parameters, with paired independent t-tests to evaluate changes. Results. A thoracic osteotomy with limited fusion leads to a correction of the kyphosis and to a spontaneous decrease of the unfused lumbar lordosis (−8°). When the fusion was extended, the lumbar lordosis increased (+8°). A lumbar osteotomy with limited fusion leads to a correction of the lumbar lordosis and to a spontaneous increase of the unfused thoracic kyphosis (+13°). When the fusion was extended, the thoracic kyphosis increased by 6°. Conclusion. Data from this study suggest that lumbar and thoracic resection leads to reciprocal changes in unfused segments and requires consideration beyond focal corrections

Radiographic Outcomes of Adult Spinal Deformity Correction : A Critical Analysis of Variability and Failures Across Deformity Patterns

International audienceStudy Design: Multicenter, prospective, consecutive, surgical case series from the International Spine Study Group.Objectives: To evaluate the effectiveness of surgical treatment in restoring spinopelvic (SP) alignment.Summary of Background Data: Pain and disability in the setting of adult spinal deformity have been correlated with global coronal alignment (GCA), sagittal vertical axis (SVA), pelvic incidence/lumbar lordosis mismatch (PI-LL), and pelvic tilt (PT). One of the maingoals of surgery for adult spinal deformity is to correct these parameters to restore harmonious SP alignment.Methods: Inclusion criteria were operative patients (age greater than 18 years) with baseline (BL) and 1-year full-length X-rays. Thoracic and thoracolumbar Cobb angle and previous mentioned parameters were calculated. Each parameter at BL and 1 year was categorized as either pathological or normal. Pathologic limits were: Cobb greater than 30 , GCA greater than 40 mm, SVA greater than 40 mm, PI-LL greater than 10 , and PT greater than 20 . According to thresholds, corrected or worsened alignment groups of patients were identified and overall radiographic effectiveness of procedure was evaluated by combining the results from the coronal and sagittal planes

Dural tears in adult deformity surgery: Incidence, risk factors, and outcomes

Study Design: Retrospective cohort study. Objectives: Describe the rate of dural tears (DTs) in adult spinal deformity (ASD) surgery. Describe the risk factors for DT and the impact of this complication on clinical outcomes. Methods: Patients with ASD undergoing surgery between 2008 and 2014 were separated into DT and non-DT cohorts; demographics, operative details, radiographic, and clinical outcomes were compared. Statistical analysis included Results: A total of 564 patients were identified. The rate of DT was 10.8% (n = 61). Patients with DT were older (61.1 vs 56.5 years, Conclusions: The rate of DT was 10.8% in an ASD cohort. This is similar to rates of DT reported following surgery for degenerative pathology. A history of prior spine surgery, decompression, interbody fusion, and osteotomies are all associated with an increased risk of DT, but decompression is the only independent risk factor for DT

En Attendant Centiloid

Aims: Test the robustness of a linear regression transformation of semiquantitative values from different Aβ tracers into a single continuous scale. Study Design: Retrospective analysis. Place and Duration of Study: PET imaging data acquired in Melbourne and Perth, Australia, between August 2006 and May 2014. Methodology: Aβ imaging in 633 participants was performed with four different radiotracers: flutemetamol (n=267), florbetapir (n=195), florbetaben (n=126) and NAV4694 (n=45). SUVR were generated with the methods recommended for each tracer, and classified as high (Aβ+) or low (Aβ-) based on their respective thresholds. Linear regression transformation based on reported head-to-head comparisons of each tracer with PiB was applied to each tracer result. Each tracer native classification was compared with the classification derived from the transformed data into PiB-like SUVR units (or BeCKeT: Before the Centiloid Kernel Transformation) using 1.50 as a cut-off. Results: Misclassification after transformation to PiB-like SUVR compared to native classification was extremely low with only 3/267 (1.1%) of flutemetamol, 1/195 (0.5%) of florbetapir, 1/45 (2.2%) of NAV4694, and 1/126 (0.8%) of florbetaben cases assigned into the wrong category. When misclassification occurred (Conclusion: While a definitive transformation into centesimal units is being established, application of linear regression transformations provide an interim, albeit robust, way of converting results from different Aβ imaging tracers into more familiar PiB-like SUVR units