A Novel Tool for Deformity Surgery Planning: Determining the Magnitude of Lordotic Correction Required to Achieve a Desired Sagittal Vertical Axis.

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A Novel Tool for Deformity Surgery Planning: Determining the Magnitude of Lordotic Correction Required to Achieve a Desired Sagittal Vertical Axis.

World Neurosurg. 2017 May 24;:

Authors: Goldschmidt E, Angriman F, Agarwal N, Zhou J, Chen K, Tempel ZJ, Gerszten PC, Kanter AS, Okonkwo DO, Passias P, Scheer J, Protopsaltis T, Lafage V, Lafage R, Schwab F, Bess S, Ames C, Smith JS, Shaffrey CI, Miller E, Jain A, Neuman B, Sciubba DM, Burton D, Hamilton DK, International Spine Study Group (ISSG)

Abstract
OBJECT: We sought to create a model capable of predicting the magnitude of pelvic incidence-lumbar lordosis (PI-LL) correction necessary to achieve a desired change in sagittal vertical axis (SVA).
METHODS: Retrospective review of a prospectively maintained multicenter adult spinal deformity database collected by the International Spine Study Group between 2009 and 2014. The independent variable of interest was the degree of correction achieved in the PI-LL mismatch at 6-weeks post-surgery. Primary outcome was the change in global sagittal alignment at 6 weeks and 1 year after surgery. We used a linear mixed-effects model to determine the extent to which corrections in the PI-LL relationship affected post-operative changes in SVA.
RESULTS: A total of 1053 adult patients were identified. Of these, 590 were managed surgically. 87 surgically managed patients were excluded due to incomplete or missing PI-LL measurements on follow-up; the remaining 503 of these patients were selected for inclusion. For each degree of improvement in the PI-LL mismatch at 6 weeks, the SVA decreased by 2.18 mm (95% CI:-2.56, -1.79, p<0.01) and 1.67 mm (95% CI:-2.07, - 1.27, p<0.01) at 6 weeks and 12 months, respectively. A high SVA measurement (>50 mm) at 1-year post-surgery was negatively associated with health-related quality of life as measured by the SRS-12 outcomes assessment.
CONCLUSION: We describe a novel model that illustrates how surgical correction of the PI-LL relationship affects post-operative changes in SVA. This may enable surgeons to determine pre-operatively the amount of lumbar lordosis necessary to achieve a desired change in SVA.

PMID: 28552696 [PubMed - as supplied by publisher]

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