Long-term benefits of appropriately corrected sagittal alignment in reconstructive surgery for adult spinal deformity: evaluation of clinical outcomes and mechanical failures

Chong-Suh Lee MD, PhD, Jin-Sung Park MD, Yunjin Nam MD, Youn-Taek Choi MD, and Se-Jun Park MD, PhD
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  • Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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OBJECTIVE

It has been well documented that optimal sagittal alignment is highly correlated with good clinical outcomes in adult spinal deformity (ASD) surgery. However, it remains to be determined whether the clinical benefit of appropriately corrected sagittal alignment can be maintained in the long term. Therefore, the aim of this study was to investigate whether appropriately corrected sagittal alignment continues to offer benefits over time with regard to clinical outcomes and mechanical failure.

METHODS

Patients older than 50 years who underwent ≥ 4-level fusion for ASD and were followed up for ≥ 5 years were included in this study. Appropriateness of sagittal alignment correction was defined as pelvic incidence minus lumbar lordosis ≤ 10°, pelvic tilt ≤ 25°, and sagittal vertical axis ≤ 50 mm. Two groups were created based on this appropriateness: group A (appropriate) and group IA (inappropriate). Clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Scoliosis Research Society Outcomes Questionnaire–22 (SRS-22). The development of mechanical failures, such as rod fracture and proximal junctional kyphosis (PJK), was compared between the two groups.

RESULTS

The study included 90 patients with a follow-up duration of 90.3 months. There were 30 patients in group A and 60 patients in group IA. The clinical outcomes at 2 years were significantly better in group A than in group IA in terms of the VAS scores, ODI scores, and all domains of SRS-22. At the final follow-up visit, back VAS and ODI scores were still lower in group A than they were in group IA, but the VAS score for leg pain did not differ between the groups. The SRS-22 score at the final follow-up showed that only the pain and self-image/appearance domains and the total sum were significantly higher in group A than in group IA. The incidence of rod fracture and PJK did not differ between the two groups. The rate of revision surgery for rod fracture or PJK was also similar between the two groups.

CONCLUSIONS

The clinical benefits from appropriate correction of sagittal alignment continued for a mean of 90.3 months. However, the intergroup difference in clinical outcomes between groups A and IA decreased over time. The development of rod fracture or PJK was not affected by the appropriateness of sagittal alignment.

ABBREVIATIONS ASD = adult spinal deformity; group A = group with appropriate sagittal alignment; group IA = group with inappropriate sagittal alignment; HRQOL = health-related quality of life; LL = lumbar lordosis; ODI = Oswestry Disability Index; PI = pelvic incidence; PI-LL = mismatch between PI and LL; PJK = proximal junctional kyphosis; PT = pelvic tilt; SRS = Scoliosis Research Society; SRS-22 = SRS Outcomes Questionnaire–22; SS = sacral slope; SVA = sagittal vertical axis; TK = thoracic kyphosis; UIV = upper instrumented vertebra; VAS = visual analog scale.

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Contributor Notes

Correspondence Se-Jun Park: Samsung Medical Center, Seoul, South Korea. sejunos@gmail.com.

INCLUDE WHEN CITING Published online December 18, 2020; DOI: 10.3171/2020.7.SPINE201108.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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