RT Journal Article
SR Electronic
T1 Improved Surgical Correction Relative to Patient-Specific Ideal Spinopelvic Alignment Reduces Pelvic Nonresponse for Severely Malaligned Adult Spinal Deformity Patients
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 530
OP 539
DO 10.14444/8254
VO 16
IS 3
A1 Passias, Peter G.
A1 Bortz, Cole
A1 Alas, Haddy
A1 Moattari, Kevin
A1 Brown, Avery
A1 Pierce, Katherine E.
A1 Manning, Jordan
A1 Ayres, Ethan W.
A1 Varlotta, Christopher
A1 Wang, Erik
A1 Williamson, Tyler K.
A1 Imbo, Bailey
A1 Joujon-Roche, Rachel
A1 Tretiakov, Peter
A1 Krol, Oscar
A1 Janjua, Burhan
A1 Sciubba, Daniel
A1 Diebo, Bassel G.
A1 Protopsaltis, Themistocles
A1 Buckland, Aaron J.
A1 Schwab, Frank J.
A1 Lafage, Renaud
A1 Lafage, Virginie
YR 2022
UL https://www.ijssurgery.com/content/16/3/530.abstract
AB Background Persistent pelvic compensation following adult spinal deformity (ASD) corrective surgery may impair quality of life and result in persistent pathologic lower extremity compensation. Ideal age-specific alignment targets have been proposed to improve surgical outcomes, though it is unclear whether reaching these ideal targets reduces rates of pelvic nonresponse following surgery. Our aim was to assess the relationship between pelvic nonresponse, age-specific alignment, and lower-limb compensation following surgery for ASD.Methods Single-center retrospective cohort study. ASD patients were grouped: those who did not improve in Scoliosis Research Society-Schwab pelvic tilt (PT) modifier (pelvic nonresponders [PNR]), and those who improved (pelvic responders [PR]). Groups were propensity score matched for preoperative PT and assessed for differences in spinal and lower extremity alignment. Rates of pelvic nonresponse were compared across patient groups who were undercorrected, overcorrected, or matched age-specific postoperative alignment targets.Results A total of 146 surgical ASD patients, 47.9% of whom showed pelvic nonresponse following surgery, were included. After propensity score matching, PNR (N = 29) and PR (N = 29) patients did not differ in demographics, preoperative alignment, or levels fused; however, PNR patients have less preoperative knee flexion (9° vs 14°, P = 0.043). PNR patients had inferior postoperative pelvic incidence and lumbar lordosis (PI-LL) alignment (17° vs 3°) and greater pelvic shift (53 vs 31 mm). PNR and PR patients did not differ in rates of reaching ideal age-specific postoperative alignment for sagittal vertical axis (SVA) or PI-LL, though patients who matched ideal PT had lower rates of PNR (25.0% vs 75.0%). For patients with moderate and severe preoperative SVA, more aggressive correction relative to either ideal postoperative PT or PI-LL was associated with significantly lower rates of pelvic nonresponse (all P < 0.05).Conclusions For patients with moderate to severe baseline truncal inclination, more aggressive surgical correction relative to ideal age-specific PI-LL was associated with lower rates of pelvic nonresponse. Postoperative alignment targets may need to be adjusted to optimize alignment outcomes for patients with substantial preoperative sagittal deformity.Clinical Relevance These findings increase our understanding of the poor outcomes that occur despite ideal realignment. Surgical correction of severe global sagittal deformity should be prioritized to mitigate these occurrences.Level of Evidence 3.