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

Ezequiel Goldschmidt, Federico Angriman, Nitin Agarwal, James Zhou, Katherine Chen, Zachary J. Tempel, Peter C. Gerszten, Adam S. Kanter, David O. Okonkwo, Peter Passias, Justin Scheer, Themistocles Protopsaltis, Virginie Lafage, Renaud Lafage, Frank Schwab, Shay Bess, Christopher Ames, Justin S. Smith, Christopher I. Shaffrey, Emily MillerAmit Jain, Brian J Neuman, Daniel Sciubba, Douglas Burton, D. Kojo Hamilton

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: 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: A retrospective review was conducted 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 6 weeks after surgery. Primary outcome was the change in global sagittal alignment 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 postoperative changes in SVA. Results: A total of 1053 adult patients were identified. Of these patients, 590 were managed surgically. Eighty-seven surgically managed patients were excluded because of incomplete or missing PI-LL measurements on follow-up; the remaining 503 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% confidence interval, -2.56, -1.79; P < 0.01) and 1.67 mm (95% confidence interval, -2.07, -1.27; P < 0.01) at 6 weeks and 12 months, respectively. A high SVA measurement (>50 mm) 1 year after surgery was negatively associated with health-related quality of life as measured by the Scoliosis Research Society 22 outcomes assessment. Conclusions: We describe a novel model that shows how surgical correction of the PI-LL relationship affects postoperative changes in SVA. This model may enable surgeons to determine preoperatively the amount of LL necessary to achieve a desired change in SVA.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Feb 13 2017

Keywords

  • Lumbar lordosis
  • Pelvic incidence
  • Sagittal vertical axis
  • Spinal alignment

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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