Browsing by Author "Singh, Manjot"

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    ItemOpen Access
    Lumbar Lordosis Redistribution and Segmental Correction in Adult Spinal Deformity (ASD): Does it Matter?
    (Spine, 2024-01) Diebo, Bassel G; Balmaceno-Criss, Mariah; Lafage, Renaud; Daher, Mohammad; Singh, Manjot; Hamilton, D Kojo; Smith, Justin S; Eastlack, Robert K; Fessler, Richard; Gum, Jeffrey L; Gupta, Munish C; Hostin, Richard; Kebaish, Khaled M; Lewis, Stephen; Line, Breton G; Nunley, Pierce D; Mundis, Gregory M; Passias, Peter G; Protopsaltis, Themistocles S; Turner, Jay; Buell, Thomas; Scheer, Justin K; Mullin, Jeffery; Soroceanu, Alex; Ames, Christopher P; Bess, Shay; Shaffrey, Christopher I; Lenke, Lawrence G; Schwab, Frank J; Lafage, Virginie; Burton, Douglas C; Daniels, Alan H; International Spine Study Group (ISSG)

    Study design

    Retrospective analysis of prospectively collected data.

    Objective

    Evaluate the impact of correcting to normative segmental lordosis values on post-operative outcomes.

    Background

    Restoring lumbar lordosis magnitude is crucial in adult spinal deformity surgery, but the optimal location and segmental distribution remains unclear.

    Methods

    Patients were grouped based on offset to normative segmental lordosis values, extracted from recent publications. Matched patients were within 10% of the cohort's mean offset, less than or over 10% were under- and over-corrected. Surgical technique, PROMs, and surgical complications were compared across groups at baseline and 2-year.

    Results

    510 patients with an average age of 64.6, mean CCI 2.08, and average follow-up of 25 months. L4-5 was least likely to be matched (19.1%), while L4-S1 was the most likely (24.3%). More patients were overcorrected at proximal levels (T10-L2; Undercorrected, U: 32.2% vs. Matched, M: 21.7% vs. Overcorrected, O: 46.1%) and undercorrected at distal levels (L4-S1: U: 39.0% vs. M: 24.3% vs. O: 36.8%). Postoperative ODI was comparable across correction groups at all spinal levels except at L4-S1 and T10-L2/L4-S1, where overcorrected patients and matched were better than undercorrected (U: 32.1 vs. M: 25.4 vs. O: 26.5, P=0.005; U: 36.2 vs. M: 24.2 vs. O: 26.8, P=0.001; respectively). Patients overcorrected at T10-L2 experienced higher rates of proximal junctional failure (PJF) (U: 16.0% vs. M: 15.6% vs. O: 32.8%, P<0.001) and had greater posterior inclination of the upper instrumented vertebra (UIV) (U: -9.2±9.4° vs. M: -9.6±9.1° vs. O: -12.2±10.0°, P<0.001), whereas undercorrection at these levels led to higher rates of revision for implant failure (U: 14.2% vs. M: 7.3% vs. O: 6.4%, P=0.025).

    Conclusions

    Patients undergoing fusion for adult spinal deformity suffer higher rates of PJF with overcorrection and increased rates of implant failure with undercorrection based on normative segmental lordosis.

    Level of evidence

    IV.
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    Restoring L4-S1 Lordosis Shape in Severe Sagittal Deformity: Impact of Correction Techniques on Alignment and Complication Profile.
    (World neurosurgery, 2024-06) Singh, Manjot; Balmaceno-Criss, Mariah; Daher, Mohammad; Lafage, Renaud; Hamilton, D Kojo; Smith, Justin S; Eastlack, Robert K; Fessler, Richard G; Gum, Jeffrey L; Gupta, Munish C; Hostin, Richard; Kebaish, Khaled M; Klineberg, Eric O; Lewis, Stephen J; Line, Breton G; Nunley, Pierce D; Mundis, Gregory M; Passias, Peter G; Protopsaltis, Themistocles S; Buell, Thomas; Ames, Christopher P; Mullin, Jeffrey P; Soroceanu, Alex; Scheer, Justin K; Lenke, Lawrence G; Bess, Shay; Shaffrey, Christopher I; Schwab, Frank J; Lafage, Virginie; Burton, Douglas C; Diebo, Bassel G; Daniels, Alan H; International Spine Study Group

    Background context

    Severe sagittal plane deformity with loss of L4-S1 lordosis is disabling and can be improved through various surgical techniques. However, data is limited on the differing ability of anterior lumbar interbody fusion (ALIF), pedicle subtraction osteotomy (PSO), and transforaminal lumbar interbody fusion (TLIF) to achieve alignment goals in severely malaligned patients.

    Purpose

    To examine surgical techniques aimed at restoring L4-S1 lordosis in severe adult spinal deformity (ASD).

    Design

    Retrospective review of prospectively collected data.

    Patient sample

    A total of 96 patients who underwent ALIF, PSO, and TLIF were included in this study.

    Outcome measures

    The following data were observed for all cases: patient demographics, spinopelvic parameters, complications, and PROMs.

    Methods

    Severe ASD patients with preoperative PI-LL >20°, L4-S1 lordosis <30°, and full body radiographs and patient-reported outcome measures (PROMs) at baseline and six-week postoperative visit were included. Patients were grouped into ALIF (1-2 level ALIF at L4-S1), PSO (L4/L5 PSO), and TLIF (1-2 level TLIF at L4-S1). Comparative analyses were performed on demographics, radiographic spinopelvic parameters, complications, and PROMs.

    Results

    Among the 96 included patients, 40 underwent ALIF, 27 underwent PSO, and 29 underwent TLIF. At baseline, cohorts had comparable age, sex, race, Edmonton frailty scores and radiographic spinopelvic parameters (p>0.05). However, PSO was performed more often in revision cases (p<0.001). Following surgery, L4-S1 lordosis correction (p=0.001) was comparable among ALIF and PSO patients and caudal lordotic apex migration (p=0.044) was highest among ALIF patients. PSO patients had higher intraoperative estimated blood loss (p<0.001) and motor deficits (p=0.049), and in-hospital ICU admission (p=0.022) and blood products given (p=0.004) but were otherwise comparable in terms of length of stay, blood transfusion given, and postoperative admission to rehab. Likewise, 90-day postoperative complication profiles and six-week PROMs were comparable as well.

    Conclusions

    ALIF can restore L4-S1 sagittal alignment as powerfully as PSO, with fewer intra-operative and in-hospital complications. When feasible, ALIF is a suitable alternative to PSO and likely superior to TLIF for correcting L4-S1 lordosis among patients with severe sagittal malalignment.
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    The Case for Operative Efficiency in Adult Spinal Deformity Surgery: Impact of Operative Time on Complications, Length of Stay, Alignment, Fusion Rates, and Patient Reported Outcomes.
    (Spine, 2023-11) Daniels, Alan H; Daher, Mohammad; Singh, Manjot; Balmaceno-Criss, Mariah; Lafage, Renaud; Diebo, Bassel G; Hamilton, David K; Smith, Justin S; Eastlack, Robert K; Fessler, Richard G; Gum, Jeffrey L; Gupta, Munish C; Hostin, Richard; Kebaish, Khaled M; Klineberg, Eric O; Lewis, Stephen J; Line, Breton G; Nunley, Pierce D; Mundis, Gregory M; Passias, Peter G; Protopsaltis, Themistocles S; Buell, Thomas; Scheer, Justin K; Mullin, Jeffrey P; Soroceanu, Alex; Ames, Christopher P; Lenke, Lawrence G; Bess, Shay; Shaffrey, Christopher I; Burton, Douglas C; Lafage, Virginie; Schwab, Frank J; International Spine Study Group

    Study design

    Retrospective review of prospectively collected data.

    Objective

    To analyze the impact of operative room (OR) time in adult spinal deformity (ASD) surgery on patient outcomes.

    Background

    It is currently unknown if OR time in ASD patients matched for deformity severity and surgical invasiveness is associated with patient outcomes.

    Methods

    ASD patients with baseline and 2-year postoperative radiographic and patient reported outcome measures (PROM) data, undergoing posterior only approach for long fusion (> L1- Ilium) were included. Patients were grouped into Short OR Time (<40 th percentile: <359 min) and Long OR Time (>60 th percentile: > 421 min). Groups were matched by age, baseline deformity severity, and surgical invasiveness. Demographics, radiographic, PROM data, fusion rate, and complications were compared between groups at baseline and 2-years follow-up.

    Results

    In total, 270 patients were included for analysis: mean OR time was 286 minutes in the Short OR group vs 510 minutes in the Long OR group ( P <0.001). Age, gender, percent of revision cases, surgical invasiveness, PI-LL, SVA and PT were comparable between groups ( P >0.05). Short OR had a slightly lower BMI than the short OR group ( P <0.001) and decompression was more prevalent in the long OR time ( P =0.042). Patients in the Long group had greater hospital length of stay (LOS) ( P =0.02); blood loss ( P <0.001); proportion requiring ICU ( P =0.003); higher minor complication rate ( P =0.001); with no significant differences for major complications or revision procedures ( P >0.5). Both groups had comparable radiographic fusion rates ( P =0.152) and achieved improvement in sagittal alignment measures, ODI and SF36 ( P <0.001).

    Conclusion

    Shorter OR time for ASD correction is associated with lower minor complication rate, lower EBL, fewer ICU admissions, and shorter hospital LOS without sacrificing alignment correction or PROMS. Maximizing operative efficiency by minimizing OR time in ASD surgery has the potential to benefit patients, surgeons, and hospital systems.