Full-Body Analysis of Adult Spinal Deformity Patients' Age-Adjusted Alignment at 1 Year.

Full-Body Analysis of Adult Spinal Deformity Patients' Age-Adjusted Alignment at 1 Year.

World Neurosurg. 2018 Mar 16;:

Authors: Passias PG, Horn SR, Frangella NJ, Poorman GW, Vasquez-Montes D, Diebo BG, Bortz CA, Segreto FA, Moon JY, Zhou PL, Vira S, Sure A, Beaubrun B, Tishelman JC, Ramchandran S, Jalai CM, Bronson W, Wang C, Lafage V, Buckland AJ, Errico TJ

Abstract
BACKGROUND: Prior studies have built a foundation for understanding compensation in adult spinal deformity (ASD) patients using full-body stereographic assessments. These mechanisms, in relation to age-adjusted alignment targets, have yet to be fully studied. The aim of this study is to assess lower limb compensatory mechanisms of patients failing to meet age-adjusted alignment goals.
METHODS: ASD patients >40 y/o with full body baseline and follow-up radiographs were included. Patients were stratified by age (40-65y, >65y) and spino-pelvic correction. Lower limb compensation parameters (pelvic shift (PS), hip extension (SFA), knee flexion (KA), ankle flexion (AA), and global sagittal angle (GSA)) for patients that matched and failed to match age-adjusted alignment targets were compared using ANOVA and t-test analysis.
RESULTS: 108 patients were included. At 1 year, ankle flexion increased with age in the "match" PT and PI-LL cohorts (PT: AA: 5.6 to 7.8, P=.041; PI-LL: 4.9 to 8.8, P=.026). Knee flexion, ankle flexion and global sagittal angle increased with age in the "match" SVA cohort (KA: 3.8 to 13.1, P=.002; AA: 5.8 to 10.2, P= .008; GSA: 3.9 to 7.8, P<.001), as did knee flexion and global sagittal angle in the "match" TPA group (KA: 1.8 to 8.7, P=.020;; GSA: 2.6 to 5.7, P=.004).
CONCLUSIONS: Greater compensation captured by knee flexion and global sagittal angle was associated with age progression in the "match" SVA and TPA cohorts. Additionally, older SVA, PT and PI-LL "match" cohorts utilized increased ankle flexion, suggesting that ideal post-operative alignment of aged ASD individuals involves increased compensation.

PMID: 29555609 [PubMed - as supplied by publisher]

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