Alterations in Magnitude and Shape of Thoracic Kyphosis Following Surgical Correction for Adult Spinal Deformity

Renaud Lafage; Junho Song; Bassel Diebo; Alan H. Daniels; Peter G. Passias; Christopher P. Ames; Shay Bess; Robert Eastlack; Munish C. Gupta; Richard Hostin; Khaled Kebaish; Han Jo Kim; Eric Klineberg; Gregory M. Mundis; Justin S. Smith; Christopher Shaffrey; Frank Schwab; Virginie Lafage; Douglas Burton

doi:10.1177/21925682231218003

Alterations in Magnitude and Shape of Thoracic Kyphosis Following Surgical Correction for Adult Spinal Deformity

Renaud Lafage, Junho Song, Bassel Diebo, Alan H. Daniels, Peter G. Passias, Christopher P. Ames, Shay Bess, Robert Eastlack, Munish C. Gupta, Richard Hostin, Khaled Kebaish, Han Jo Kim, Eric Klineberg, Gregory M. Mundis, Justin S. Smith, Christopher Shaffrey, Frank Schwab, Virginie Lafage, Douglas Burton

Research output: Contribution to journal › Article › peer-review

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Abstract

Study Design: Retrospective review of prospective multicenter data. Objectives: This study aimed to investigate the shape of TK before and after fusion in ASD patients treated with long fusion. Methods: ASD patients undergoing posterior spinal fusions including at least T5 to L1 without prior fusion extending to the thoracic spine were included. Patients were categorized based on the preoperative T1-T12 kyphosis into: Hypo-TK (if < 30°), Normal-TK, and Hyper-TK (if > 70°). Regional kyphosis at T10-L1 (Distal), T5-T10 (Middle), and T1-T5 (Proximal) and their relative contributions to total kyphosis were compared between groups, and the pre-to postoperative changes were investigated using paired t test. Results: In total, 329 patients were included in this analysis (mean age: 57 ± 16 years, 79.6% female). Preoperative T1-T12 TK for the entire cohort was 40.9 ± 2° (32% Hypo-TK, 11% Hyper-TK, 57% Normal-TK). The Hypo-TK group had the smallest distal TK (5.9 vs 17.1 & 26.0), and middle TK (8.0 vs 25.3 & 45.4), but the percentage of contribution to total kyphosis was not significantly different (Distal: 24.1% vs 34.1% vs 32.8%; Middle: 46.6% vs 53.9% vs 56.8%, all P >.1). Postoperatively, T1-12 TK increased significantly (40.9 ± 2.0° vs 57.8 ± 17.6°). Each group had a decrease in distal kyphosis (Hypo-TK 2.6 ± 10.4°; Normal-TK 8.9 ± 11.5°; Hyper-TK 14.9 ± 12°, all P <.05). The middle kyphosis significantly decreased for Hyper-TK (11.8 ± 12.4) and increased for both Normal-TK and Hypo-TK (3.8 ± 11° and 14.2 ± 11°). Proximal TK increased significantly for all groups by 14-18°. Deterioration from Normal-TK to Hyper-TK postoperatively was associated with lower rate of patient satisfaction (59.6% vs 77.3%, P =.032). Conclusions: Posterior spinal fusion for ASD alters the magnitude and shape of thoracic kyphosis. While 60% of patients had a normal TK at baseline, 30% of those patients developed iatrogenic hyperkyphosis postoperatively. Patients with baseline hypokyphosis were more likely to be corrected to normal TK than hyperkyphotic patients. Future research should investigate TK restoration in ASD and its impact on clinical outcomes and complications.

Original language	English
Journal	Global Spine Journal
DOIs	https://doi.org/10.1177/21925682231218003
State	Accepted/In press - 2023

Keywords

adult spinal deformity
adult spinal deformity
posterior spinal fusion
proximal junctional kyphosis
proximal junctional kyphosis
scoliosis
thoracic kyphosis

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10.1177/21925682231218003

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Lafage, R., Song, J., Diebo, B., Daniels, A. H., Passias, P. G., Ames, C. P., Bess, S., Eastlack, R., Gupta, M. C., Hostin, R., Kebaish, K., Kim, H. J., Klineberg, E., Mundis, G. M., Smith, J. S., Shaffrey, C., Schwab, F., Lafage, V., & Burton, D. (Accepted/In press). Alterations in Magnitude and Shape of Thoracic Kyphosis Following Surgical Correction for Adult Spinal Deformity. Global Spine Journal. https://doi.org/10.1177/21925682231218003

@article{f08912ceadff4b378fe5268de6d7d0e6,

title = "Alterations in Magnitude and Shape of Thoracic Kyphosis Following Surgical Correction for Adult Spinal Deformity",

abstract = "Study Design: Retrospective review of prospective multicenter data. Objectives: This study aimed to investigate the shape of TK before and after fusion in ASD patients treated with long fusion. Methods: ASD patients undergoing posterior spinal fusions including at least T5 to L1 without prior fusion extending to the thoracic spine were included. Patients were categorized based on the preoperative T1-T12 kyphosis into: Hypo-TK (if < 30°), Normal-TK, and Hyper-TK (if > 70°). Regional kyphosis at T10-L1 (Distal), T5-T10 (Middle), and T1-T5 (Proximal) and their relative contributions to total kyphosis were compared between groups, and the pre-to postoperative changes were investigated using paired t test. Results: In total, 329 patients were included in this analysis (mean age: 57 ± 16 years, 79.6% female). Preoperative T1-T12 TK for the entire cohort was 40.9 ± 2° (32% Hypo-TK, 11% Hyper-TK, 57% Normal-TK). The Hypo-TK group had the smallest distal TK (5.9 vs 17.1 & 26.0), and middle TK (8.0 vs 25.3 & 45.4), but the percentage of contribution to total kyphosis was not significantly different (Distal: 24.1% vs 34.1% vs 32.8%; Middle: 46.6% vs 53.9% vs 56.8%, all P >.1). Postoperatively, T1-12 TK increased significantly (40.9 ± 2.0° vs 57.8 ± 17.6°). Each group had a decrease in distal kyphosis (Hypo-TK 2.6 ± 10.4°; Normal-TK 8.9 ± 11.5°; Hyper-TK 14.9 ± 12°, all P <.05). The middle kyphosis significantly decreased for Hyper-TK (11.8 ± 12.4) and increased for both Normal-TK and Hypo-TK (3.8 ± 11° and 14.2 ± 11°). Proximal TK increased significantly for all groups by 14-18°. Deterioration from Normal-TK to Hyper-TK postoperatively was associated with lower rate of patient satisfaction (59.6% vs 77.3%, P =.032). Conclusions: Posterior spinal fusion for ASD alters the magnitude and shape of thoracic kyphosis. While 60% of patients had a normal TK at baseline, 30% of those patients developed iatrogenic hyperkyphosis postoperatively. Patients with baseline hypokyphosis were more likely to be corrected to normal TK than hyperkyphotic patients. Future research should investigate TK restoration in ASD and its impact on clinical outcomes and complications.",

keywords = "adult spinal deformity, adult spinal deformity, posterior spinal fusion, proximal junctional kyphosis, proximal junctional kyphosis, scoliosis, thoracic kyphosis",

author = "Renaud Lafage and Junho Song and Bassel Diebo and Daniels, {Alan H.} and Passias, {Peter G.} and Ames, {Christopher P.} and Shay Bess and Robert Eastlack and Gupta, {Munish C.} and Richard Hostin and Khaled Kebaish and Kim, {Han Jo} and Eric Klineberg and Mundis, {Gregory M.} and Smith, {Justin S.} and Christopher Shaffrey and Frank Schwab and Virginie Lafage and Douglas Burton",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023.",

year = "2023",

doi = "10.1177/21925682231218003",

language = "English",

journal = "Global Spine Journal",

issn = "2192-5682",

}

Lafage, R, Song, J, Diebo, B, Daniels, AH, Passias, PG, Ames, CP, Bess, S, Eastlack, R, Gupta, MC, Hostin, R, Kebaish, K, Kim, HJ, Klineberg, E, Mundis, GM, Smith, JS, Shaffrey, C, Schwab, F, Lafage, V & Burton, D 2023, 'Alterations in Magnitude and Shape of Thoracic Kyphosis Following Surgical Correction for Adult Spinal Deformity', Global Spine Journal. https://doi.org/10.1177/21925682231218003

TY - JOUR

T1 - Alterations in Magnitude and Shape of Thoracic Kyphosis Following Surgical Correction for Adult Spinal Deformity

AU - Lafage, Renaud

AU - Song, Junho

AU - Diebo, Bassel

AU - Daniels, Alan H.

AU - Passias, Peter G.

AU - Ames, Christopher P.

AU - Bess, Shay

AU - Eastlack, Robert

AU - Gupta, Munish C.

AU - Hostin, Richard

AU - Kebaish, Khaled

AU - Kim, Han Jo

AU - Klineberg, Eric

AU - Mundis, Gregory M.

AU - Smith, Justin S.

AU - Shaffrey, Christopher

AU - Schwab, Frank

AU - Lafage, Virginie

AU - Burton, Douglas

PY - 2023

Y1 - 2023

N2 - Study Design: Retrospective review of prospective multicenter data. Objectives: This study aimed to investigate the shape of TK before and after fusion in ASD patients treated with long fusion. Methods: ASD patients undergoing posterior spinal fusions including at least T5 to L1 without prior fusion extending to the thoracic spine were included. Patients were categorized based on the preoperative T1-T12 kyphosis into: Hypo-TK (if < 30°), Normal-TK, and Hyper-TK (if > 70°). Regional kyphosis at T10-L1 (Distal), T5-T10 (Middle), and T1-T5 (Proximal) and their relative contributions to total kyphosis were compared between groups, and the pre-to postoperative changes were investigated using paired t test. Results: In total, 329 patients were included in this analysis (mean age: 57 ± 16 years, 79.6% female). Preoperative T1-T12 TK for the entire cohort was 40.9 ± 2° (32% Hypo-TK, 11% Hyper-TK, 57% Normal-TK). The Hypo-TK group had the smallest distal TK (5.9 vs 17.1 & 26.0), and middle TK (8.0 vs 25.3 & 45.4), but the percentage of contribution to total kyphosis was not significantly different (Distal: 24.1% vs 34.1% vs 32.8%; Middle: 46.6% vs 53.9% vs 56.8%, all P >.1). Postoperatively, T1-12 TK increased significantly (40.9 ± 2.0° vs 57.8 ± 17.6°). Each group had a decrease in distal kyphosis (Hypo-TK 2.6 ± 10.4°; Normal-TK 8.9 ± 11.5°; Hyper-TK 14.9 ± 12°, all P <.05). The middle kyphosis significantly decreased for Hyper-TK (11.8 ± 12.4) and increased for both Normal-TK and Hypo-TK (3.8 ± 11° and 14.2 ± 11°). Proximal TK increased significantly for all groups by 14-18°. Deterioration from Normal-TK to Hyper-TK postoperatively was associated with lower rate of patient satisfaction (59.6% vs 77.3%, P =.032). Conclusions: Posterior spinal fusion for ASD alters the magnitude and shape of thoracic kyphosis. While 60% of patients had a normal TK at baseline, 30% of those patients developed iatrogenic hyperkyphosis postoperatively. Patients with baseline hypokyphosis were more likely to be corrected to normal TK than hyperkyphotic patients. Future research should investigate TK restoration in ASD and its impact on clinical outcomes and complications.

AB - Study Design: Retrospective review of prospective multicenter data. Objectives: This study aimed to investigate the shape of TK before and after fusion in ASD patients treated with long fusion. Methods: ASD patients undergoing posterior spinal fusions including at least T5 to L1 without prior fusion extending to the thoracic spine were included. Patients were categorized based on the preoperative T1-T12 kyphosis into: Hypo-TK (if < 30°), Normal-TK, and Hyper-TK (if > 70°). Regional kyphosis at T10-L1 (Distal), T5-T10 (Middle), and T1-T5 (Proximal) and their relative contributions to total kyphosis were compared between groups, and the pre-to postoperative changes were investigated using paired t test. Results: In total, 329 patients were included in this analysis (mean age: 57 ± 16 years, 79.6% female). Preoperative T1-T12 TK for the entire cohort was 40.9 ± 2° (32% Hypo-TK, 11% Hyper-TK, 57% Normal-TK). The Hypo-TK group had the smallest distal TK (5.9 vs 17.1 & 26.0), and middle TK (8.0 vs 25.3 & 45.4), but the percentage of contribution to total kyphosis was not significantly different (Distal: 24.1% vs 34.1% vs 32.8%; Middle: 46.6% vs 53.9% vs 56.8%, all P >.1). Postoperatively, T1-12 TK increased significantly (40.9 ± 2.0° vs 57.8 ± 17.6°). Each group had a decrease in distal kyphosis (Hypo-TK 2.6 ± 10.4°; Normal-TK 8.9 ± 11.5°; Hyper-TK 14.9 ± 12°, all P <.05). The middle kyphosis significantly decreased for Hyper-TK (11.8 ± 12.4) and increased for both Normal-TK and Hypo-TK (3.8 ± 11° and 14.2 ± 11°). Proximal TK increased significantly for all groups by 14-18°. Deterioration from Normal-TK to Hyper-TK postoperatively was associated with lower rate of patient satisfaction (59.6% vs 77.3%, P =.032). Conclusions: Posterior spinal fusion for ASD alters the magnitude and shape of thoracic kyphosis. While 60% of patients had a normal TK at baseline, 30% of those patients developed iatrogenic hyperkyphosis postoperatively. Patients with baseline hypokyphosis were more likely to be corrected to normal TK than hyperkyphotic patients. Future research should investigate TK restoration in ASD and its impact on clinical outcomes and complications.

KW - adult spinal deformity

KW - posterior spinal fusion

KW - proximal junctional kyphosis

KW - scoliosis

KW - thoracic kyphosis

UR - http://www.scopus.com/inward/record.url?scp=85178435790&partnerID=8YFLogxK

U2 - 10.1177/21925682231218003

DO - 10.1177/21925682231218003

M3 - Article

C2 - 38031967

AN - SCOPUS:85178435790

SN - 2192-5682

JO - Global Spine Journal

JF - Global Spine Journal

ER -

Alterations in Magnitude and Shape of Thoracic Kyphosis Following Surgical Correction for Adult Spinal Deformity

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