TY - JOUR
T1 - How Good Are Surgeons at Achieving Their Preoperative Goal Sagittal Alignment Following Adult Deformity Surgery?
AU - on behalf of International Spine Study Group
AU - Smith, Justin S.
AU - Elias, Elias
AU - Sursal, Tolga
AU - Line, Breton
AU - Lafage, Virginie
AU - Lafage, Renaud
AU - Klineberg, Eric
AU - Kim, Han Jo
AU - Passias, Peter
AU - Nasser, Zeina
AU - Gum, Jeffrey L.
AU - Eastlack, Robert
AU - Daniels, Alan
AU - Mundis, Gregory
AU - Hostin, Richard
AU - Protopsaltis, Themistocles S.
AU - Soroceanu, Alex
AU - Hamilton, David Kojo
AU - Kelly, Michael P.
AU - Lewis, Stephen J.
AU - Gupta, Munish
AU - Schwab, Frank J.
AU - Burton, Douglas
AU - Ames, Christopher P.
AU - Lenke, Lawrence G.
AU - Shaffrey, Christopher I.
AU - Bess, Shay
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2024/9
Y1 - 2024/9
N2 - Study Design: Multicenter, prospective cohort Objectives: Malalignment following adult spine deformity (ASD) surgery can impact outcomes and increase mechanical complications. We assess whether preoperative goals for sagittal alignment following ASD surgery are achieved. Methods: ASD patients were prospectively enrolled based on 3 criteria: deformity severity (PI-LL ≥25°, TPA ≥30°, SVA ≥15 cm, TCobb≥70° or TLCobb≥50°), procedure complexity (≥12 levels fused, 3-CO or ACR) and/or age (>65 and ≥7 levels fused). The surgeon documented sagittal alignment goals prior to surgery. Goals were compared with achieved alignment on first follow-up standing radiographs. Results: The 266 enrolled patients had a mean age of 61.0 years (SD = 14.6) and 68% were women. Mean instrumented levels was 13.6 (SD = 3.8), and 23.2% had a 3-CO. Mean (SD) offsets (achieved-goal) were: SVA = −8.5 mm (45.6 mm), PI-LL = −4.6° (14.6°), TK = 7.2° (14.7°), reflecting tendencies to undercorrect SVA and PI-LL and increase TK. Goals were achieved for SVA, PI-LL, and TK in 74.4%, 71.4%, and 68.8% of patients, respectively, and was achieved for all 3 parameters in 37.2% of patients. Three factors were independently associated with achievement of all 3 alignment goals: use of PACs/equivalent for surgical planning (P <.001), lower baseline GCA (P =.009), and surgery not including a 3-CO (P =.037). Conclusions: Surgeons failed to achieve goal alignment of each sagittal parameter in ∼25-30% of ASD patients. Goal alignment for all 3 parameters was only achieved in 37.2% of patients. Those at greatest risk were patients with more severe deformity. Advancements are needed to enable more consistent translation of preoperative alignment goals to the operating room.
AB - Study Design: Multicenter, prospective cohort Objectives: Malalignment following adult spine deformity (ASD) surgery can impact outcomes and increase mechanical complications. We assess whether preoperative goals for sagittal alignment following ASD surgery are achieved. Methods: ASD patients were prospectively enrolled based on 3 criteria: deformity severity (PI-LL ≥25°, TPA ≥30°, SVA ≥15 cm, TCobb≥70° or TLCobb≥50°), procedure complexity (≥12 levels fused, 3-CO or ACR) and/or age (>65 and ≥7 levels fused). The surgeon documented sagittal alignment goals prior to surgery. Goals were compared with achieved alignment on first follow-up standing radiographs. Results: The 266 enrolled patients had a mean age of 61.0 years (SD = 14.6) and 68% were women. Mean instrumented levels was 13.6 (SD = 3.8), and 23.2% had a 3-CO. Mean (SD) offsets (achieved-goal) were: SVA = −8.5 mm (45.6 mm), PI-LL = −4.6° (14.6°), TK = 7.2° (14.7°), reflecting tendencies to undercorrect SVA and PI-LL and increase TK. Goals were achieved for SVA, PI-LL, and TK in 74.4%, 71.4%, and 68.8% of patients, respectively, and was achieved for all 3 parameters in 37.2% of patients. Three factors were independently associated with achievement of all 3 alignment goals: use of PACs/equivalent for surgical planning (P <.001), lower baseline GCA (P =.009), and surgery not including a 3-CO (P =.037). Conclusions: Surgeons failed to achieve goal alignment of each sagittal parameter in ∼25-30% of ASD patients. Goal alignment for all 3 parameters was only achieved in 37.2% of patients. Those at greatest risk were patients with more severe deformity. Advancements are needed to enable more consistent translation of preoperative alignment goals to the operating room.
KW - adult spinal deformity
KW - alignment prediction
KW - kyphosis
KW - sagittal alignment
KW - scoliosis
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85150196080&partnerID=8YFLogxK
U2 - 10.1177/21925682231161304
DO - 10.1177/21925682231161304
M3 - Article
C2 - 36821516
AN - SCOPUS:85150196080
SN - 2192-5682
VL - 14
SP - 1924
EP - 1936
JO - Global Spine Journal
JF - Global Spine Journal
IS - 7
ER -