Efficacy of Varying Surgical Approaches on Achieving Optimal Alignment in Adult Spinal Deformity Surgery.

dc.contributor.author

Passias, Peter G

dc.contributor.author

Ahmad, Waleed

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Williamson, Tyler K

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Lebovic, Jordan

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Kebaish, Khaled

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Lafage, Renaud

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Lafage, Virginie

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Line, Breton

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Schoenfeld, Andrew J

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Diebo, Bassel G

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Klineberg, Eric O

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Kim, Han Jo

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Ames, Christopher P

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Daniels, Alan H

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Smith, Justin S

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Shaffrey, Christopher I

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Burton, Douglas C

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Hart, Robert A

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Bess, Shay

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Schwab, Frank J

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Gupta, Munish C

dc.contributor.author

International Spine Study Group

dc.date.accessioned

2023-08-23T18:43:21Z

dc.date.available

2023-08-23T18:43:21Z

dc.date.issued

2023-07

dc.date.updated

2023-08-23T18:43:21Z

dc.description.abstract

Background

The Roussouly, SRS-Schwab, and GAP classifications define alignment by spinal shape and deformity severity. The efficacy of different surgical approaches and techniques to successfully achieve these goals is not well understood.

Purpose

Identify the impact of surgical approach and/or technique on meeting complex realignment goals in adult spinal deformity(ASD) corrective-surgery.

Study design/setting

Retrospective.

Methods

Included: ASD patients fused to pelvis with two-year(2Y) data. Patients were categorized by: 1)Roussouly: matching current and theoretical spinal shapes; 2)improving in SRS-Schwab modifiers(0, +, ++); 3)improving GAP Proportionality by 2Y. ANCOVA and multivariable logistic regression analyses controlling for age, levels fused, baseline deformity, and three-column osteotomy usage compared the effect of different surgical approaches, interbody and osteotomy use on meeting realignment goals.

Results

693 ASD patients were included. By surgical approach, 65.7% were posterior-only and 34.3% underwent anterior-posterior(AP) approach with 76% receiving an osteotomy(21.8% 3CO). By 2Y, 34% matched Roussouly, 58% improved in GAP, 45% in SRS-Schwab PT, 62% SVA, and 70% PI-LL. Combined approaches were most effective for improvement in PT(OR: 1.7,[1.1-2.5]) and GAP(OR: 2.2,[1.5-3.2]). Specifically, ALIFs below L3 demonstrated higher rates of improvement versus TLIFs in Roussouly(OR: 1.7, [1.1-2.5]) and GAP(OR: 1.9, [1.3-2.7]). Patients undergoing PSO at L3 or L4 were more likely to improve in PT(OR: 2.0,[1.0-5.2]) and PI-LL(OR: 3.8[1.4-9.8]). Clinically, patients undergoing combined approach demonstrated higher rates of meeting SCB in ODI by 2Y while minimizing rates of PJF, most often with an ALIF at L5-S1(ODI-SCB: OR: 1.4,[1.1-2.0];PJF: OR: 0.4,[0.2-0.8]).

Conclusions

Among patients undergoing ASD realignment, optimal lumbar shape and proportion can be achieved more often with a combined approach. While TLIFs incorporating a three-column osteotomy at L3 and L4 can restore lordosis and normalize pelvic compensation, ALIFs at L5-S1 were most likely to achieve complex realignment goals with an added clinical benefit and mitigation of junctional failure.
dc.identifier

00007632-990000000-00422

dc.identifier.issn

0362-2436

dc.identifier.issn

1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/28759

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

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10.1097/brs.0000000000004784

dc.subject

International Spine Study Group

dc.title

Efficacy of Varying Surgical Approaches on Achieving Optimal Alignment in Adult Spinal Deformity Surgery.

dc.type

Journal article

duke.contributor.orcid

Passias, Peter G|0000-0002-1479-4070|0000-0003-2635-2226

duke.contributor.orcid

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

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

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