How Good Are Surgeons at Achieving Their Preoperative Goal Sagittal Alignment Following Adult Deformity Surgery?

dc.contributor.author

Smith, Justin S

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Elias, Elias

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Sursal, Tolga

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Line, Breton

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Lafage, Virginie

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Lafage, Renaud

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Klineberg, Eric

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Kim, Han Jo

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Passias, Peter

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Nasser, Zeina

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Gum, Jeffrey L

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Eastlack, Robert

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Daniels, Alan

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Mundis, Gregory

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Hostin, Richard

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Protopsaltis, Themistocles S

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Soroceanu, Alex

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Hamilton, David Kojo

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Kelly, Michael P

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Lewis, Stephen J

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Gupta, Munish

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Schwab, Frank J

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Burton, Douglas

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Ames, Christopher P

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Lenke, Lawrence G

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Shaffrey, Christopher I

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Bess, Shay

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International Spine Study Group

dc.date.accessioned

2023-06-15T16:29:56Z

dc.date.available

2023-06-15T16:29:56Z

dc.date.issued

2023-02

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2023-06-15T16:29:55Z

dc.description.abstract

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.
dc.identifier.issn

2192-5682

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2192-5690

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https://hdl.handle.net/10161/27972

dc.language

eng

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SAGE Publications

dc.relation.ispartof

Global spine journal

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10.1177/21925682231161304

dc.subject

International Spine Study Group

dc.title

How Good Are Surgeons at Achieving Their Preoperative Goal Sagittal Alignment Following Adult Deformity Surgery?

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

21925682231161304

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

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