Prediction of mechanical complications in adult spinal deformity surgery—the GAP score versus the Schwab classification

Jacobs, Eva; Royen, Barend J. van; Kuijk, Sander M. J. van; Merk, Johannes; Stadhouder, Agnita; Rhijn, Lodewijk W. van; Willems, Paul

doi:10.1016/j.spinee.2018.11.013

Cited by 60 publications

(45 citation statements)

References 27 publications

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“…Several parameters were reported to be associated with mechanical complications, including TK, SVA, and SS [16][17][18][19]. The PI-LL in SRS-Schwab classi cation can be used to quantify spinopelvic harmony, which is also thought to be an important vital factor for predicting mechanical complication and is usually used to predict better postoperative health-related quality of life [20,21]. However, this kind of classi cation is based on linear absolute numerical parameters, which cannot include the whole spectrum of PI.…”

Section: Discussionmentioning

confidence: 99%

Which Sagittal Evaluation System Can Effectively Predict Mechanical Complications in the Treatment of Elderly Patients With Adult Degenerative Scoliosis? Roussouly Classification or Global Alignment and Proportion (GAP) Score

Sun

et al. 2021

Preprint

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Background: To achieve the proper sagittal alignment, previous studies have developed different assessment systems for degenerative spinal deformity which could help us in making treatment strategies. The purpose of our study is to evaluate whether Roussouly classification or GAP score is more appropriate in the prediction of mechanical complications after surgical treatment of ADS.Methods: The ADS patients who received long segmental fusion in the treatment during the period from December 2016 to December 2018 were evaluated in this study. The basic information of the patients and all radiologic measurements, which were included in GAP score and Roussouly classification, were collected for analysis. Patients were divided into two groups according to occurrence or absence of mechanical complications for comparison. The correlation between evaluation systems and mechanical complications could be analyzed in logistic regression model via stepwise backward elimination based on the Wald statistics. ROC curve was used to determine the predictability of the evaluation systems in the occurrence of mechanical complications and calculate their cut-off value. A two-tailed P value < 0.05 was statistically significant for all statistical tests.Results: A total of 80 cases were included in this study. The results of logistic regression showed: GAP score (P = 0.008) and GAP categories (P = 0.007) were positively correlated with mechanical complications; Roussouly score was negatively correlated with mechanical complications (P=0.034); GAP score was positively correlated with PJK (P = 0.021); Roussouly score was negatively correlated with implant-related complications (P = 0.018); GAP categories were correlated with implant loosening (P = 0.023). Results of ROC showed that GAP score was most effective in predicting PJK (AUC = 0.863) and PJF (AUC = 0.724); GAP categories (AUC = 0.561) was more effective than GAP score (AUC = 0.555) in predicting implant-related complications.Conclusions: Roussouly-type matching could not accurately predict the risk of mechanical complications. In contrast, GAP score was most effective in predicting PJK and PJF. The GAP score was better than Roussouly classification in predicting mechanical complications.

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Section: Discussionmentioning

confidence: 99%

Which Sagittal Evaluation System Can Effectively Predict Mechanical Complications in the Treatment of Elderly Patients With Adult Degenerative Scoliosis? Roussouly Classification or Global Alignment and Proportion (GAP) Score

Sun

et al. 2021

Preprint

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“…33) In the GAP, the optimal sagittal alignment is based on four factors deviating from their ideal curves and these factors are proportionally related to the PI. 34) Therefore, future studies should describe the SSB by measuring a single variable, such as the GAP score, rather than listing several different variables.…”

Section: Discussionmentioning

confidence: 99%

Relationships between Spinal Sarcopenia and Spinal Sagittal Balance in Older Women

Kim

Lee

Park

et al. 2019

Ann Geriatr Med Res

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Background: Spinal sarcopenia is receiving renewed attention as a cause of spinal sagittal imbalance. However, the relationships between spinal sarcopenia and spinal sagittal balance (SSB) have not been thoroughly investigated. We evaluated the relationships between SSB parameters and sarcopenic indices with lumbar paraspinal muscle (LPM) quantity and strength in healthy older adults. Methods: Twenty-four healthy community-dwelling older women were enrolled. Demographic variables, conventional sarcopenic indices, isometric back muscle strength, and SSB parameters, as well as results of functional examinations and lumbar spine computed tomography scan with LPM cross-sectional area (CSA) and density assessments, were examined. The independent effect on the sum of the total LPM CSA was determined using multivariable regression analysis adjusted for age, appendicular skeletal muscle mass, gait speed, handgrip strength, back extensor strength, and pelvic tilt (PT) angle. Results: PT angle was significantly correlated with the sum of the total LPM CSA and mean LPM density (r=-0.502, p=0.015 and r=0.504, p=0.014, respectively). Furthermore, PT angle was an independent factor for the sum of the total LPM CSA (β=-0.610, p=0.021) in the multivariate regression models (R 2 =0.320). Conclusion: Our data suggest that PT angle was significantly correlated with LPM CSA in healthy older women. To our knowledge, this is the first report to investigate the relationships of sarcopenic indices and spinal muscle degeneration with SSB.

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“…The most common mechanical complications in patients with ASD are proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). 44 Others causes of revision surgery are pseudarthrosis, rod fracture, and loss of correction. 45 PJK is a concern in ASD surgery regardless of the approach used, and its prevalence is 20% to 40%.…”

Section: Complicationsmentioning

confidence: 99%

Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment

Godzik

Pereira

Hemphill

et al. 2020

Global Spine Journal

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Study Design: Review of the literature. Objectives: Anterior column realignment (ACR) is a powerful but relatively new minimally invasive technique for deformity correction. The purpose of this study is to provide a literature review of the ACR surgical technique, reported outcomes, and future directions. Methods: A review of the literature was performed regarding the ACR technique. A review of patients at our single center who underwent ACR was performed, with illustrative cases selected to demonstrate basic and nuanced aspects of the technique. Results: Clinical and cadaveric studies report increases in segmental lordosis in the lumbar spine by 73%, approximately 10° to 33°, depending on the degree of posterior osteotomy and lordosis of the hyperlordosis interbody spacer. These corrections have been found to be associated with a similar risk profile compared with traditional surgical options, including a 30% to 43% risk of proximal junctional kyphosis in early studies. Conclusions: ACR represents a powerful technique in the minimally invasive spinal surgeon’s toolbox for treatment of complex adult spinal deformity. The technique is capable of significant sagittal plane correction; however, future research is necessary to ascertain the safety profile and long-term durability of ACR.

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Prediction of mechanical complications in adult spinal deformity surgery—the GAP score versus the Schwab classification

Cited by 60 publications

References 27 publications

Which Sagittal Evaluation System Can Effectively Predict Mechanical Complications in the Treatment of Elderly Patients With Adult Degenerative Scoliosis? Roussouly Classification or Global Alignment and Proportion (GAP) Score

Which Sagittal Evaluation System Can Effectively Predict Mechanical Complications in the Treatment of Elderly Patients With Adult Degenerative Scoliosis? Roussouly Classification or Global Alignment and Proportion (GAP) Score

Relationships between Spinal Sarcopenia and Spinal Sagittal Balance in Older Women

Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment

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