A Novel Tool for Deformity Surgery Planning: Determining the Magnitude of Lordotic Correction Required to Achieve a Desired Sagittal Vertical Axis.

dc.contributor.author

Goldschmidt, Ezequiel

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Angriman, Federico

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Agarwal, Nitin

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Zhou, James

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Chen, Katherine

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Tempel, Zachary J

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Gerszten, Peter C

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Kanter, Adam S

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Okonkwo, David O

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Passias, Peter

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Scheer, Justin

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Protopsaltis, Themistocles

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Lafage, Virginie

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Lafage, Renaud

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Schwab, Frank

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Bess, Shay

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Ames, Christopher

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Smith, Justin S

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Shaffrey, Christopher I

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Miller, Emily

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Jain, Amit

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Neuman, Brian

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Sciubba, Daniel M

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Burton, Douglas

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Hamilton, D Kojo

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International Spine Study Group

dc.date.accessioned

2023-07-09T21:20:42Z

dc.date.available

2023-07-09T21:20:42Z

dc.date.issued

2017-08

dc.date.updated

2023-07-09T21:20:41Z

dc.description.abstract

Objective

We sought to create a model capable of predicting the magnitude of pelvic incidence-lumbar lordosis (PI-LL) correction necessary to achieve a desired change in sagittal vertical axis (SVA).

Methods

A retrospective review was conducted of a prospectively maintained multicenter adult spinal deformity database collected by the International Spine Study Group between 2009 and 2014. The independent variable of interest was the degree of correction achieved in the PI-LL mismatch 6 weeks after surgery. Primary outcome was the change in global sagittal alignment 6 weeks and 1 year after surgery. We used a linear mixed-effects model to determine the extent to which corrections in the PI-LL relationship affected postoperative changes in SVA.

Results

A total of 1053 adult patients were identified. Of these patients, 590 were managed surgically. Eighty-seven surgically managed patients were excluded because of incomplete or missing PI-LL measurements on follow-up; the remaining 503 patients were selected for inclusion. For each degree of improvement in the PI-LL mismatch at 6 weeks, the SVA decreased by 2.18 mm (95% confidence interval, -2.56, -1.79; P < 0.01) and 1.67 mm (95% confidence interval, -2.07, -1.27; P < 0.01) at 6 weeks and 12 months, respectively. A high SVA measurement (>50 mm) 1 year after surgery was negatively associated with health-related quality of life as measured by the Scoliosis Research Society 22 outcomes assessment.

Conclusions

We describe a novel model that shows how surgical correction of the PI-LL relationship affects postoperative changes in SVA. This model may enable surgeons to determine preoperatively the amount of LL necessary to achieve a desired change in SVA.
dc.identifier

S1878-8750(17)30785-4

dc.identifier.issn

1878-8750

dc.identifier.issn

1878-8769

dc.identifier.uri

https://hdl.handle.net/10161/28379

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

World neurosurgery

dc.relation.isversionof

10.1016/j.wneu.2017.05.086

dc.subject

International Spine Study Group

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Lumbar Vertebrae

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Humans

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Kyphosis

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Lordosis

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Postoperative Complications

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Disability Evaluation

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Retrospective Studies

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Follow-Up Studies

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Comorbidity

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Models, Anatomic

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Adult

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Aged

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Middle Aged

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Female

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Male

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Postural Balance

dc.title

A Novel Tool for Deformity Surgery Planning: Determining the Magnitude of Lordotic Correction Required to Achieve a Desired Sagittal Vertical Axis.

dc.type

Journal article

duke.contributor.orcid

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

pubs.begin-page

904

pubs.end-page

908.e1

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

104

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