Clinical Outcomes of Corrective Fusion Surgery From the Thoracic Spine to the Pelvis for Adult Spinal Deformity at 1, 2, and 5 years Postoperatively

Arima, Hideyuki; Hasegawa, Tomohiko; Yamato, Yu; Yoshida, Go; Banno, Tomohiro; Oe, Shin; Mihara, Yuki; Ide, Koichiro; Watanabe, Yasuhide; Nakai, Keiichi; Kurosu, Kenta; Matsuyama, Yukihiro

doi:10.1097/brs.0000000000004347

Cited by 5 publications

(6 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ported [4]. The surgery aims to correct and prevent the progression of the deformity, re lieve pain, and decompress the associated stenotic spinal canal [5].…”

Section: Methodsmentioning

confidence: 99%

“…ASD is a complex disease that causes low back pain, activity of daily life (ADL) disturbance, and spinal balance problems in the elderly population [2,3]. When conservative treatment is not effective, surgical intervention is indicated, and its efficacy has been reported [4]. The surgery aims to correct and prevent the progression of the deformity, relieve pain, and decompress the associated stenotic spinal canal [5].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Minimal Clinically Important Differences in Gait and Balance Ability in Patients Who Underwent Corrective Long Spinal Fusion for Adult Spinal Deformity

Sakaguchi,

Meena,

Tanaka

et al. 2023

JCM

View full text Add to dashboard Cite

Study Design: Retrospective observational study. Background: The risk of a femoral neck fracture due to a fall after adult spinal deformity surgery has been reported. One of the most significant factors among walking and balance tests in post-operative ASD patients was the timed up-and-go test (TUG). This study aims to calculate the minimal clinically important difference (MCID) in balance tests after ASD surgery. Methods: Forty-eight patients, 4 males and 44 females, were included by exclusion criteria in 66 consecutive patients who underwent corrective surgery as a treatment for ASD at our institution from June 2017 to February 2022. The inclusion criteria for this study were age ≥50 years; and no history of high-energy trauma. The exclusion criteria were dementia, severe deformity of the lower extremities, severe knee or hip osteoarthritis, history of central nervous system disorders, cancer, and motor severe paralysis leading to gait disorders. The surgeries were performed in two stages, first, the oblique lumber interbody fusion (OLIF) L1 to L5 (or S1), and second, the posterior corrective fusion basically from T10 to pelvis. For outcome assessment, 10 m walk velocity, TUG, ODI, and spinopelvic parameters were used. Results: Ten meter walk velocity of pre-operation and post-operation were 1.0 ± 0.3 m/s and 1.2 ± 0.2 m/s, respectively (p < 0.01). The TUG of pre-operation and post-operation were 12.1 ± 3.7 s and 9.7 ± 2.2 s, respectively (p < 0.01). The ODI improved from 38.6 ± 12.8% to 24.2 ± 15.9% after surgery (p < 0.01). All post-operative parameters except PI obtained statistically significant improvement after surgery. Conclusions: This is the first report of MCID of the 10 m walk velocity and TUG after ASD surgery. Ten meter walk velocity and the TUG improved after surgery; their improvement values were correlated with the ODI. MCID using the anchor-based approach for 10 m walk velocity and the TUG were 0.10 m/s and 2.0 s, respectively. These MCID values may be useful for rehabilitation after ASD surgery.

show abstract

“…ported [4]. The surgery aims to correct and prevent the progression of the deformity, re lieve pain, and decompress the associated stenotic spinal canal [5].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimal Clinically Important Differences in Gait and Balance Ability in Patients Who Underwent Corrective Long Spinal Fusion for Adult Spinal Deformity

Sakaguchi,

Meena,

Tanaka

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…22 Extensive corrective fusion for ASD may result in mechanical complications in the mid to long term, which then requires unexpected revision surgery. 23 The cost-effectiveness impact of unexpected revision surgery in extensive corrective fusion for ASD has rarely been reported in the past. Therefore, in this study, we aimed to determine how unexpected revision surgery affects the cost-effectiveness of extensive corrective fusion in patients with ASD.…”

Section: Medical Expenses and Cost-effectiveness Of Asd Surgerymentioning

confidence: 99%

Cost-Effectiveness of Corrective Fusion Surgeries for Adult Spinal Deformities: Does Unexpected Revision Surgery Affect Cost-Effectiveness?

Arima,

Hasegawa,

Yamato

et al. 2024

Spine Surg Relat Res

Self Cite

View full text Add to dashboard Cite

Introduction Previous research has demonstrated that mid- to long-term health-related quality of life following corrective fusion surgery for adult spinal deformity (ASD) can be improved by appropriate revision surgery. In this study, we aim to compare the cost-effectiveness of corrective fusion surgery for ASD with and without unexpected revision surgery 5 years postoperatively. Methods In total, 79 patients with ASD (mean age, 68.7 years) who underwent corrective fusion surgery between 2013 and 2015 were included in this study. Cost-effectiveness was evaluated based on the cost of obtaining 1 quality-adjusted life year (QALY). Patients were divided into two groups according to the presence or absence of unexpected revision surgery following corrective fusion and were subjected for comparison. Results As per our study findings, 26 (33%) of the 79 ASD patients underwent unexpected revision surgery during the first 5 years following surgery. Although there was no significant difference in terms of inpatient medical costs at the time of initial surgery for 5 years after surgery between the two groups (no-revision group, revision group; inpatient medical costs at the time of initial surgery: USD 69,854 vs. USD 72,685, P=0.344), the total medical expenses up to 5 years after surgery were found to be higher in the revision group (USD 72,704 vs. USD 104,287, P<0.001). The medical expenses required to improve 1 QALY 5 years after surgery were USD 178,476 in the no-revision group, whereas it was USD 222,081 in the revision group. Conclusions Although the total medical expenses were higher in the revision group, no significant difference was observed in the cumulative QALY improvement between the revision and no-revision groups. Moreover, the medical expenses required to improve 1 QALY were higher in the revision group, with a difference of approximately 20%.

show abstract

“…[1][2][3] ASD surgery has been shown to correct spinal malalignment, restore functional outcomes, and reduce pain. [4][5][6][7] Despite the major improvements in quality of life, the risk of mechanical complications is high. 8 Proximal junctional kyphosis (PJK) is a mechanical complication defined as focal kyphosis of 10°and an increase in kyphosis by 10°two levels above the upper instrumented vertebral (UIV) level.…”

mentioning

confidence: 99%

“…With an aging global population, the prevalence of symptomatic adult spinal deformity (ASD) is increasing 1–3. ASD surgery has been shown to correct spinal malalignment, restore functional outcomes, and reduce pain 4–7. Despite the major improvements in quality of life, the risk of mechanical complications is high 8.…”

mentioning

confidence: 99%

Cranially Directed Upper Instrumented Vertebrae Screw Angles are Associated with Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery

Chen

Longo

Chanbour

et al. 2022

Spine

View full text Add to dashboard Cite

Study Design. A retrospective cohort study. Objective. To evaluate the impact of the upper instrumented vertebral (UIV) screw angle in adult spinal deformity (ASD) surgery on: (1) proximal junctional kyphosis/failure (PJK/F), (2) mechanical complications and radiographic measurements, and (3) patient-reported outcome measures (PROMs). Summary of Background Data. The effect of UIV screw angle in ASD surgery on patient outcomes remains understudied. Materials and Methods. A single-institution, retrospective study was undertaken from 2011 to 2017. UIV screw angle was trichotomized into positive: cranially directed screws relative to the superior endplate (2°≤θ), neutral: parallel to the superior endplate (−2°<θ<2°), and negative: caudally directed screws relative to the superior endplate (−2°≥θ). The primary outcome was PJK/F. Secondary outcomes included remaining mechanical complications, reoperation, and PROMs: Oswestry Disability Index, Numeric Rating Scale (NRS) back/leg, and EuroQol. Regression controlled for age, body mass index, postoperative sagittal vertical axis (SVA), and pelvic incidence lumbar-lordosis mismatch. Results. Among 145 patients undergoing ASD surgery, UIV screw angles were 35 (24.1%) cranially directed, 24 (16.6%) neutral, and 86 (59.3%) caudally directed. PJK occurred in 47(32.4%) patients. Positive screws were independently associated with increased PJK [odds ratio (OR)=4.88; 95% CI, 1.85–13.5, P=0.002] and PJF (OR=3.06; 95% CI, 1.32–12.30, P=0.015). Among 108 (74.5%) patients with lower thoracic UIV, PJK occurred in 38 (35.1%). Cranially directed screws were independently associated with an increased odds of PJK (OR=5.56; 95% CI, 1.86–17.90, P=0.003) with a threshold of 0.2° (area under the curve =0.65; 95% CI, 0.54–0.76, P<0.001), above which the risk of PJK significantly increased. No association was found between positive screw angle and PJF (OR=3.13; 95% CI, 0.91–11.40, P=0.073). Because of the low number of patients with an upper thoracic UIV (N=37, 25.5%), no meaningful conclusions could be drawn from this subgroup. There was no association between UIV screw angle and remaining mechanical complications, reoperations, postoperative SVA and T1-pelvic angle, or PROMs. Conclusions. Cranially directed UIV screw angles increased the odds of PJK in patients with lower thoracic UIV. Meticulous attention should be paid to the lower thoracic UIV screw angle to mitigate the risk of PJK in ASD.

show abstract

Clinical Outcomes of Corrective Fusion Surgery From the Thoracic Spine to the Pelvis for Adult Spinal Deformity at 1, 2, and 5 years Postoperatively

Cited by 5 publications

References 31 publications

Minimal Clinically Important Differences in Gait and Balance Ability in Patients Who Underwent Corrective Long Spinal Fusion for Adult Spinal Deformity

Minimal Clinically Important Differences in Gait and Balance Ability in Patients Who Underwent Corrective Long Spinal Fusion for Adult Spinal Deformity

Cost-Effectiveness of Corrective Fusion Surgeries for Adult Spinal Deformities: Does Unexpected Revision Surgery Affect Cost-Effectiveness?

Cranially Directed Upper Instrumented Vertebrae Screw Angles are Associated with Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery

Contact Info

Product

Resources

About