Be Prepared: Preoperative Coronal Malalignment Often Leads to More Extensive Surgery Than Sagittal Malalignment During Adult Spinal Deformity Surgery

Zuckerman, Scott L.; Lai, Christopher; Shen, Yong; Kerolus, Mena G.; Ha, Alex; Buchanan, Ian A.; Lee, Nathan J.; Leung, Eric; Cerpa, Meghan; Lehman, Ronald A.; Lenke, Lawrence G.

doi:10.14245/ns.2142384.192

Cited by 7 publications

(11 citation statements)

References 26 publications

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“…Regarding pseudarthrosis and PJK, OD-L5 may be a superior coronal parameter to ORB-L5 and C7-L5. Past literature found an association between ORB-CVA 8 and C7-CVA 5,9,10 with clinical outcomes, which ORB-L5 and C7-L5 did not replicate. Though easier to measure, the cranial plumb line parameters may lack the power of CVAs to predict clinical outcomes, except for OD-L5 as it correlated with pseudarthrosis and PJK.…”

Section: Discussionmentioning

confidence: 65%

“…1 and 2). Other radiographic parameters included the OD-CVA, 16 ORB-CVA, 8 and C7-CVA, 5,9,10 preoperative sagittal vertical axis (SVA), postoperative SVA change (ΔSVA), maximum coronal cobb angle (Max Cobb), PO, LLD, and lumbosacral fractional curve (LSFC). They were measured preoperatively, immediately postoperatively, and at the final postoperative follow-up.…”

Section: Study Outcome Variablesmentioning

confidence: 99%

“…Previously, the coronal plane was less emphasized in ASD studies; 3 however, recent studies have found that coronal malalignment (CM)—defined as lateral deviation of the C7 plumb line with substantial displacement from the midline of the pelvis for more than 20 mm—contributes to worse outcomes and disability 3–6 . Well-established measures for CM include the C7 coronal vertical axis (C7-CVA), pelvic obliquity (PO), leg-length discrepancy (LLD), and orbital coronal vertical axis (ORB-CVA) 5,7–10 . CM is associated with sagittal plane deformities, sagittal malalignment, and unsatisfactory outcomes 11 .…”

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confidence: 99%

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Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery

Shen,

Sardar,

Greisberg

et al. 2023

Spine

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Study Design. Asymptomatic cohort: prospective, cross-sectional, multi-center. Symptomatic: retrospective, multi-surgeon, single-center. Objective. To assess the association between cranial coronal alignment and adult spinal deformity (ASD) surgical risk and outcomes. Summary of Background Data. ASD leads to decreased quality of life. Studies have shown that coronal malignment (CM) is associated with worse surgical outcomes. Methods. 468 adult participants were prospectively enrolled in the asymptomatic cohort. 172 symptomatic ASD patients with 2-year follow-ups were retrospectively enrolled in the symptomatic cohort. Three cranial plumb line parameters: the positions of the plumb lines from the midpoint between the medial orbital rims (ORB-L5), the odontoid (OD-L5), and the C7 centroid (C7-L5) relative to the L5 pedicle, were measured. Each subject had plumb line medial (M), touching (T), or lateral (L) to either pedicle. The association between each group of patients and radiographic parameters, intraoperative variables, patient-reported outcomes (PROs), and clinical outcomes were analyzed. Results. In the asymptomatic cohort, OD-L5 was medial to or touching the L5 pedicle in 98.3% of volunteers. In the symptomatic patients, preoperative OD-L5-L exhibited higher mean age (56.2±14.0), odontoid-coronal vertical axis (OD-CVA) (5.5±3.3 cm), Oswestry Disability Index (ODI) score (40.6±18.4), pelvic fixation rate (56/62, 90.3%), OR time (528.4±144.6 min), median estimated blood loss (EBL) (1300cc), and durotomy rate (24/62, 38.7%). A similar pattern of higher CVA, preoperative ODI, intraoperative pelvic fixation rate, OR time, EBL, and durotomy rate was observed in ORB-L5-L and C7-L5-L patients. Final follow-up postoperative OD-L5-L was associated with higher rates of proximal junctional kyphosis (PJK) (13.0%) and pseudarthrosis (17.4%). Conclusion. Preoperative OD-L5, ORB-L5, and C7-L5 lateral to pedicles were associated with worse preoperative ODI and higher intraoperative complexity. Postoperative OD-L5-L was associated with higher rates of PJK and pseudarthrosis. Postoperative CM, approximated by cranial plumb line lateral to the L5 pedicles, was associated with sagittal plane complications.

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Section: Discussionmentioning

confidence: 65%

Section: Study Outcome Variablesmentioning

confidence: 99%

mentioning

confidence: 99%

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Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery

Shen,

Sardar,

Greisberg

et al. 2023

Spine

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Section: Introductionmentioning

confidence: 99%

“…The most common symptoms are back pain, neurological symptoms in the lower extremities, and radicular pain, which lead to serious problems in terms of function and quality of life in patients. [2][3][4][5][6][7] Surgical methods for ADLS are extremely variable and include simple neural decompression, selective short-level fusion, and multilevel fusion for deformity correction. [8] While there exists considerable controversy regarding the surgical methods, traditional open posterior decompression and posterior fixation with curve correction represent the classic surgical methods for treating ADLS.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcome of minimal invasive oblique lateral interbody fusion with percutaneous pedicle screw fixation in the treatment of adult degenerative scoliosis

et al. 2022

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Oblique lateral interbody fusion is performed for lumbar spinal restoration and stabilization, without extensive paraspinal muscle damage or massive bleeding. This study aimed to confirm the radiological and clinical outcomes of minimally invasive oblique lateral interbody fusion (OLIF) with percutaneous pedicle screw fixation (PPSF) as treatment for adult degenerative lumbar scoliosis. Medical records of 40 patients with degenerative lumbar spinal deformities who underwent selective OLIF and PPSF at our hospital between April 2018 and February 2021 were retrospectively reviewed. The study population comprised 7 male and 33 female patients aged 55–79 years. Standing radiography was performed, and the coronal cobb angle, distance between the C7 plumb line and central sacral vertical line, sagittal vertical axis, pelvic tilt, lumbar lordosis (LL), pelvic incidence (PI), and difference between PI and LL (PI-LL) were measured. Coronal scoliosis was defined as a lumbar coronal plane curve of > 15°. All patients achieved statistically significant improvements in coronal and sagittal alignment. The coronal cobb angle was corrected from 18.82° to 11.52°, and the central sacral vertical line was reduced from 18.30 mm to 15.47 mm. The sagittal vertical axis was significantly reduced from 45.95 mm to 32.72 mm. In contrast, the pelvic tilt and LL were minimally changed. For subgroup analyses, patients were divided into the convex and concave groups according to the direction of coronal curve correction. Vertebral body rotation was superior in the convex group than in the concave group. Furthermore, we checked for asymmetric facet degeneration at the upper instrumented vertebra (UIV) level at 1 year postoperatively. Of the 22 patients who underwent more than 3 level fusion surgery, 8 patients were confirmed the postoperative asymmetric facet degeneration in above UIV. Minor complications occurred in 16 patients, who recovered without any problems. Revision surgery was not performed in all cases. Minimally invasive OLIF with PPSF has a lower risk of complications and favorable surgical outcomes in patients with adult degenerative lumbar scoliosis. Access from the convex side is advantageous for the correction of the rotated vertebra. Extending the UIV level to the neutral vertebra can reduce the occurrence of postoperative asymmetric facet degeneration.

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Rod fractures after multi-rod constructs in adult spinal deformity patients fused to the sacrum/pelvis: where do they occur and why?

et al. 2022

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Be Prepared: Preoperative Coronal Malalignment Often Leads to More Extensive Surgery Than Sagittal Malalignment During Adult Spinal Deformity Surgery

Cited by 7 publications

References 26 publications

Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery

Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery

Surgical outcome of minimal invasive oblique lateral interbody fusion with percutaneous pedicle screw fixation in the treatment of adult degenerative scoliosis

Rod fractures after multi-rod constructs in adult spinal deformity patients fused to the sacrum/pelvis: where do they occur and why?

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