TY - JOUR
T1 - Revision-Free Loss of Sagittal Correction Greater Than Three Years after Adult Spinal Deformity Surgery
T2 - Who and Why?
AU - Lovecchio, Francis
AU - Lafage, Renaud
AU - Kim, Han Jo
AU - Bess, Shay
AU - Ames, Christopher
AU - Gupta, Munish
AU - Passias, Peter
AU - Klineberg, Eric
AU - Mundis, Gregory
AU - Burton, Douglas
AU - Smith, Justin S.
AU - Shaffrey, Christopher
AU - Schwab, Frank
AU - Lafage, Virginie
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/2/1
Y1 - 2024/2/1
N2 - Study Design. Multicenter retrospective cohort study. Objective. To investigate risk factors for loss of correction within the instrumented lumbar spine after adult spinal deformity surgery. Summary of Background Data. The sustainability of adult spinal deformity surgery remains a health care challenge. Malalignment is a major reason for revision surgery. Patients and Methods. A total of 321 patients who underwent fusion of the lumbar spine (≥5 levels, LIV pelvis) with a revision-free follow-up of ≥3 years were identified. Patients were stratified by a change in pelvic incidence-lumbar lordosis from 6 weeks to 3 years postoperative as "maintained" versus "loss" >5°. Those with instrumentation failure (broken rod, screw pullout, etc.) were excluded before comparisons. Demographics, surgical data, and radiographic alignment were compared. Repeated measure analysis of variance was performed to evaluate the maintenance of the correction for L1-L4 and L4-S1. Multivariate logistic regression was conducted to identify independent surgical predictors of correction loss. Results. The cohort had a mean age of 64 years, a mean Body Mass Index of 28 kg/m2, and 80% females. Eighty-two patients (25.5%) lost >5° of pelvic incidence-lumbar lordosis correction (mean loss 10±5°). After the exclusion of patients with instrumentation failure, 52 losses were compared with 222 maintained. Demographics, osteotomies, 3CO, interbody fusion, use of bone morphogenetic protein, rod material, rod diameter, and fusion length were not significantly different. L1-S1 screw orientation angle was 1.3 ± 4.1 from early postoperative to 3 years (P = 0.031), but not appreciably different at L4-S1 (-0.1 ± 2.9 P = 0.97). Lack of a supplemental rod (odds ratio: 4.0, P = 0.005) and fusion length (odds ratio 2.2, P = 0.004) were associated with loss of correction. Conclusions. Approximately, a quarter of revision-free patients lose an average of 10° of their 6-week correction by 3 years. Lordosis is lost proximally through the instrumentation (i.e. tulip/shank angle shifts and/or rod bending). The use of supplemental rods and avoiding sagittal overcorrection may help mitigate this loss.
AB - Study Design. Multicenter retrospective cohort study. Objective. To investigate risk factors for loss of correction within the instrumented lumbar spine after adult spinal deformity surgery. Summary of Background Data. The sustainability of adult spinal deformity surgery remains a health care challenge. Malalignment is a major reason for revision surgery. Patients and Methods. A total of 321 patients who underwent fusion of the lumbar spine (≥5 levels, LIV pelvis) with a revision-free follow-up of ≥3 years were identified. Patients were stratified by a change in pelvic incidence-lumbar lordosis from 6 weeks to 3 years postoperative as "maintained" versus "loss" >5°. Those with instrumentation failure (broken rod, screw pullout, etc.) were excluded before comparisons. Demographics, surgical data, and radiographic alignment were compared. Repeated measure analysis of variance was performed to evaluate the maintenance of the correction for L1-L4 and L4-S1. Multivariate logistic regression was conducted to identify independent surgical predictors of correction loss. Results. The cohort had a mean age of 64 years, a mean Body Mass Index of 28 kg/m2, and 80% females. Eighty-two patients (25.5%) lost >5° of pelvic incidence-lumbar lordosis correction (mean loss 10±5°). After the exclusion of patients with instrumentation failure, 52 losses were compared with 222 maintained. Demographics, osteotomies, 3CO, interbody fusion, use of bone morphogenetic protein, rod material, rod diameter, and fusion length were not significantly different. L1-S1 screw orientation angle was 1.3 ± 4.1 from early postoperative to 3 years (P = 0.031), but not appreciably different at L4-S1 (-0.1 ± 2.9 P = 0.97). Lack of a supplemental rod (odds ratio: 4.0, P = 0.005) and fusion length (odds ratio 2.2, P = 0.004) were associated with loss of correction. Conclusions. Approximately, a quarter of revision-free patients lose an average of 10° of their 6-week correction by 3 years. Lordosis is lost proximally through the instrumentation (i.e. tulip/shank angle shifts and/or rod bending). The use of supplemental rods and avoiding sagittal overcorrection may help mitigate this loss.
KW - adult spine deformity
KW - construct
KW - interbody
KW - long-term
KW - lordosis
KW - revision
KW - sagittal alignment
KW - supplemental rod
UR - http://www.scopus.com/inward/record.url?scp=85183471692&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004852
DO - 10.1097/BRS.0000000000004852
M3 - Article
C2 - 37847773
AN - SCOPUS:85183471692
SN - 0362-2436
VL - 49
SP - 157
EP - 164
JO - Spine
JF - Spine
IS - 3
ER -