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Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Frank Schwab, Justin K. Scheer, Themistocles Protopsaltis, Eric Klineberg, Munish Gupta, Richard Hostin, Kai-Ming G. Fu, Gregory M. Mundis Jr., Han Jo Kim, Vedat Deviren, Alex Soroceanu, Robert A. Hart, Douglas C. Burton, Shay Bess, Christopher P. Ames and the International Spine Study Group

Slover J , Abdu WA , Hanscom B , Weinstein JN : The impact of comorbidities on the change in short-form 36 and Oswes-try scores following lumbar spine surgery . Spine (Phila Pa 1976) 31 : 1974 – 1980 , 2006 41 Smith JS , Bess S , Shaffrey CI , Burton DC , Hart RA , Hostin R , : Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction osteotomy: a critical analysis of preoperative planning techniques . Spine (Phila Pa 1976) 37 : 845 – 853 , 2012 42 Smith JS , Fu

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Justin S. Smith, Ellen Shaffrey, Eric Klineberg, Christopher I. Shaffrey, Virginie Lafage, Frank J. Schwab, Themistocles Protopsaltis, Justin K. Scheer, Gregory M. Mundis Jr., Kai-Ming G. Fu, Munish C. Gupta, Richard Hostin, Vedat Deviren, Khaled Kebaish, Robert Hart, Douglas C. Burton, Breton Line, Shay Bess, Christopher P. Ames and The International Spine Study Group

fracture, the retrospective study suggested that residual postoperative sagittal malalignment and greater BMI may be associated with greater risk of rod fracture. The present prospective study confirms the added risk of rod fracture with greater BMI and confirms that sagittal spinopelvic alignment may also be a risk factor, but instead of postoperative residual sagittal malalignment, the present study suggests that it is the magnitude of sagittal alignment correction that may be a more important factor. The findings of the present study demonstrate a markedly higher

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Joshua Bakhsheshian, Justin K. Scheer, Jeffrey L. Gum, Richard Hostin, Virginie Lafage, Shay Bess, Themistocles S. Protopsaltis, Douglas C. Burton, Malla Kate Keefe, Robert A. Hart, Gregory M. Mundis Jr., Christopher I. Shaffrey, Frank Schwab, Justin S. Smith, Christopher P. Ames and The International Spine Study Group

OBJECTIVE

Mental disease burden can have a significant impact on levels of disability and health-related quality of life (HRQOL) measures. Therefore, the authors investigated the significance of mental health status in adults with spinal deformity and poor physical function.

METHODS

A retrospective analysis of a prospective multicenter database of 365 adult spinal deformity (ASD) patients who had undergone surgical treatment was performed. Health-related QOL variables were examined preoperatively and at the 2-year postoperative follow-up. Patients were grouped by their 36-Item Short Form Health Survey mental component summary (MCS) and physical component summary (PCS) scores. Both groups had PCS scores ≤ 25th percentile for matched norms; however, the low mental health (LMH) group consisted of patients with an MCS score ≤ 25th percentile, and the high mental health (HMH) group included patients with an MCS score ≥ 75th percentile.

RESULTS

Of the 264 patients (72.3%) with a 2-year follow-up, 104 (28.5%) met the inclusion criteria for LMH and 40 patients (11.0%) met those for HMH. The LMH group had a significantly higher overall rate of comorbidities, specifically leg weakness, depression, hypertension, and self-reported neurological and psychiatric disease processes, and were more likely to be unemployed as compared with the HMH group (p < 0.05 for all). The 2 groups had similar 2-year postoperative improvements in HRQOL (p > 0.05) except for the greater improvements in the MCS and the Scoliosis Research Society-22r questionnaire (SRS-22r) mental domain (p < 0.05) in the LMH group and greater improvements in PCS and SRS-22r satisfaction and back pain domains (p < 0.05) in the HMH group. The LMH group had a higher rate of reaching a minimal clinically important difference (MCID) on the SRS-22r mental domain (p < 0.01), and the HMH group had a higher rate of reaching an MCID on the PCS and SRS-22r activity domain (p < 0.05). On multivariable logistic regression, having LMH was a significant independent predictor of failure to reach an MCID on the PCS (p < 0.05). At the 2-year postoperative follow-up, 14 LMH patients (15.1%) were categorized as HMH. Two LMH patients (2.2%), and 3 HMH patients (7.7%) transitioned to a PCS score ≥ 75th percentile for age- and sex-matched US norms (p < 0.01).

CONCLUSIONS

While patients with poor mental and physical health, according to their MCS and PCS scores, have higher medical comorbidity and unemployment rates, they still demonstrate significant improvements in HRQOL measurements postoperatively. Both LMH and HMH patient groups demonstrated similar improvements in most HRQOL domains, except that the LMH patients had difficulties in obtaining improvements in the PCS domain.

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Frank J. Schwab, Ashish Patel, Christopher I. Shaffrey, Justin S. Smith, Jean-Pierre Farcy, Oheneba Boachie-Adjei, Richard A. Hostin, Robert A. Hart, Behrooz A. Akbarnia, Douglas C. Burton, Shay Bess and Virginie Lafage

in SS (9.5° ± 9° vs 8.1° ± 10.1°, respectively, p = 0.59), or postoperative SS (32.4° ± 10.6° vs 35.5° ± 11.3°, respectively, p = 0.30). Discussion Sagittal spinopelvic malalignment is a major cause of pain and loss of function associated with ASD. 1 , 13 , 21 Surgical restoration of optimal sagittal alignment is indicated for symptomatic patients and has demonstrated superior clinical and radiographic outcomes compared with nonoperative management. 5 , 32 Previous studies have shown that realignment of SVA and PT is critical to optimize clinical outcomes

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Shayan Fakurnejad, Justin K. Scheer, Virginie Lafage, Justin S. Smith, Vedat Deviren, Richard Hostin, Gregory M. Mundis Jr., Douglas C. Burton, Eric Klineberg, Munish Gupta, Khaled Kebaish, Christopher I. Shaffrey, Shay Bess, Frank Schwab, Christopher P. Ames and The International Spine Study Group

substantial or complete correction of an SVA significantly improved the rates of reaching MCID for the ODI and PCS scores and the SCB for the ODI score. Blondel et al. set substantial curve correction as a 66% or greater improvement from preoperative SVA. However, it is unclear how many of the patients in that study underwent a 3CO, and the authors examined only the SVA. The SVA is often considered the most influential radiographic parameter for HRQOL measures, but because total sagittal alignment is the ultimate goal of 3COs, it is crucial to correlate clinical outcomes

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Christopher P. Ames, Justin S. Smith, Justin K. Scheer, Christopher I. Shaffrey, Virginie Lafage, Vedat Deviren, Bertrand Moal, Themistocles Protopsaltis, Praveen V. Mummaneni, Gregory M. Mundis Jr., Richard Hostin, Eric Klineberg, Douglas C. Burton, Robert Hart, Shay Bess, Frank J. Schwab and the International Spine Study Group

, Bess S , Hart RA , : The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery . Neurosurgery 71 : 662 – 669 , 2012 59 Tokala DP , Lam KS , Freeman BJ , Webb JK : C7 decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis . Eur Spine J 16 : 1471 – 1478 , 2007 60 Uchida K , Nakajima H , Sato R , Yayama T , Mwaka ES , Kobayashi S , : Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome

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Justin S. Smith, Manish Singh, Eric Klineberg, Christopher I. Shaffrey, Virginie Lafage, Frank J. Schwab, Themistocles Protopsaltis, David Ibrahimi, Justin K. Scheer, Gregory Mundis Jr., Munish C. Gupta, Richard Hostin, Vedat Deviren, Khaled Kebaish, Robert Hart, Douglas C. Burton, Shay Bess and Christopher P. Ames

, including that of Lafage et al. 18 Although the role of SVA has been established, more recently it has become clear that global alignment is not fully accounted for by SVA alone. 1 The role of the pelvis as a key regulator of spinal alignment and as a source of compensation has led to an expanded view of sagittal alignment. 10 , 18 , 20 , 21 The term “sagittal spinopelvic alignment” captures not only assessment of SVA but also key pelvic parameters, including pelvic incidence, pelvic tilt, and sacral slope ( Fig. 1 ). Pelvic incidence is a fixed parameter that

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Ferran Pellisé, Miquel Serra-Burriel, Justin S. Smith, Sleiman Haddad, Michael P. Kelly, Alba Vila-Casademunt, Francisco Javier Sánchez Pérez-Grueso, Shay Bess, Jeffrey L. Gum, Douglas C. Burton, Emre Acaroğlu, Frank Kleinstück, Virginie Lafage, Ibrahim Obeid, Frank Schwab, Christopher I. Shaffrey, Ahmet Alanay, Christopher Ames, the International Spine Study Group and the European Spine Study Group

= posterior lumbar interbody fusion; Q. = question; SVA = sagittal vertical axis; TLIF = transforaminal interbody fusion; TL/L = thoracolumbar/lumbar. The preoperative MC model demonstrated that lowest instrumented vertebra (LIV)—more specifically, extension to the pelvis—was the most important predictor of an MC in the first 2 years after surgery. Walking ability, age, and sagittal deformity (global sagittal alignment, lordosis gap, and T1 sagittal tilt) were the most relevant predictors. The postoperative model found the same factors to be relevant, plus surgical time and

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Samantha R. Horn, Peter G. Passias, Cheongeun Oh, Virginie Lafage, Renaud Lafage, Justin S. Smith, Breton Line, Neel Anand, Frank A. Segreto, Cole A. Bortz, Justin K. Scheer, Robert K. Eastlack, Vedat Deviren, Praveen V. Mummaneni, Alan H. Daniels, Paul Park, Pierce D. Nunley, Han Jo Kim, Eric O. Klineberg, Douglas C. Burton, Robert A. Hart, Frank J. Schwab, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames and the International Spine Study Group

line through the sacral midpoint to the center of the 2 femoral heads). FIG. 1. Schematic of the measured sagittal alignment parameters for the cervical ( left ) and global spinopelvic ( right ) spinal regions. CBVA = chin-brow vertical angle; cSVA = cervical sagittal vertical axis; C2–7 CL = cervical lordosis; TK = thoracic kyphosis; LL = lumbar lordosis; SVA = sagittal vertical axis; PT = pelvic tilt; PI = pelvic incidence. Figure is available in color online only. Defining a Poor Outcome A poor outcome was defined as having all 3 of the following categories met: 1

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examined include presence of interbody fusion, rod diameter, rod material, age and preop sagittal alignment. Methods: A retrospective review of a multicenter, prospective ASD database was conducted. Inclusion criteria: age=18yr, ASD, no revisions between >6wk and <2yrs postop. Spinal pelvic parameters, thoracic kyphosis (TK:T2-T12) and lumbar lordosis (LL:L1-S1) were measured overall and within and outside of the instrumented segments. Changes for SVA, PT, PI-LL, TK, and LL between 6wks-2yrs postop were calculated. Of these pts, the amount of thoracic loss and TL