Which Is More Predictive Value for Mechanical Complications: Fixed Thoracolumbar Alignment (T1 Pelvic Angle) Versus Dynamic Global Balance Parameter (Odontoid-Hip Axis Angle)

Abstract

Objective: In this study, we investigate about relationship between postoperative global sagittal imbalance and occurrence of mechanical complications after adult spinal deformity (ASD) surgery. In global sagittal balance parameters, odontoid-hip axis (OD-HA) angle and T1 pelvic angle (TPA) were analyzed.Methods: Between January 2009 and December 2016, 199 consecutive patients (26 males and 173 females) with ASD underwent corrective fusion of more than 4 levels and were followed up for more than 2 years. Immediate postoperative and postoperative 2 years whole spine x-rays were checked for evaluating immediate postoperative OD-HA, TPA, and other parameters. In clinical outcomes, back and leg pain visual analogue scale, Scoliosis Research Society-22 spinal deformity questionnaire (SRS-22), Oswestry Disability Index (ODI), 36- item Short Form Health Survey (SF-36) were evaluated.Results: Based on the occurrence of mechanical complications, a comparative analysis was performed for each parameter. In univariable analysis, mechanical complications were significantly much more occurred in OD-HA abnormal group (odds ratio [OR], 3.296; p < 0.001; area under the curve [AUC] = 0.645). In multivariable analysis, the result was much more related (OR, 2.924; p = 0.001; AUC = 0.727). In contrast, there was no significant difference between normal and the occurrence of mechanical complications in TPA. In clinical outcomes (normal vs. abnormal), the differences of SRS-22 (0.88 ± 0.73 vs. 0.68 ± 0.64, p = 0.042), ODI (-24.72 ± 20.16 vs. -19.01 ± 19.95, p = 0.046), SF-36 physical composite score (19.33 ± 18.55 vs. 12.90 ± 16.73, p = 0.011) were significantly improved in OD-HA normal group.Conclusion: The goal of ASD surgery is to improve patient life quality through correction. In our study, TPA was associated with spinopelvic parameter and OD-HA angle was associated with health-related quality of life and complications. OD-HA angle is predictable factor for mechanical complications after ASD surgery.

Reciprocal Changes Following Cervical Realignment Surgery

“…[2][3][4][5][6][7] The sagittal alignment regarding spinopelvic parameters and reciprocal changes in the thoracolumbar spine has been well documented. [8][9][10][11][12] The essential function of global spinal alignment (GSA) is the maintenance of global balance, an upright posture, and a horizontal gaze. 13 Thus, in the setting of thoracolumbar spinal deformity, cervical alignment is the final piece affected by GSA through compensatory mechanisms to maintain a horizontal gaze.…”

“…When a patient loses an adequate lumbar lordosis (LL), compensatory mechanisms are recruited to maintain an upright posture; cervical hyperlordosis, thoracic kyphosis (TK), pelvic retroversion, and knee flexion [ 2 - 7 ]. The sagittal alignment regarding spinopelvic parameters and reciprocal changes in the thoracolumbar spine has been well documented [ 8 - 12 ].…”

Preoperative Malnutrition-Associated Spinal Malalignment with Patient-Reported Outcome Measures in Adult Spinal Deformity Surgery: A 2-Year Follow-Up Study

“…Higher BMI, older age, osteoporosis, and radiographic parameters are risk factors [16][17][18] . Rod breakage may cause severe pain and loss of correction, frequently requiring revision surgery 19) .…”

Comparative Efficacy of Clinical Interventions for Sacroiliac Joint Pain: Systematic Review and Network Meta-analysis With Preliminary Design of Treatment Algorithm

“…SIJ pain may be strongly correlated with SIJ pathologies, such as SIJ instability or adjacent segment disease. 7,8 Many free-ending nerve fibers and mechanoreceptors from the SIJ joint have been observed, 9,10 and high levels of dermatome in the SIJ can also make the clinical presentation of pain uncertain. This could also cause SIJ pain to be underdiagnosed, 11 thus leading to premature bias in treatment decision-making.…”