Lightning Podiums: Adult Spinal Deformity - Room 801A

Presented by: R. Lafage

Author(s):

M. Gupta(1), R. Lafage(2), M. Kelly(1), C. Shaffrey(3), G. Mundis(4), R. Hostin(5), D. Burton(6), C. Ames(7), F. Schwab(2), H.J. Kim(2), E. Klineberg(8), S. Bess(9), J. Smith(3), V. Lafage(2), International Spine Study Group (ISSG)

(1) Washington University, Saint Louis, MO, United States
(2) Hospital for Special Surgery, New York, NY, United States
(3) University of Virginia, Charlottesville, VA, United States
(4) San Diego Center for Spinal Disorders, La Jolla, CA, United States
(5) Baylor Scoliosis Center, Plano, TX, United States
(6) University of Kansas Medical Center, Kansas City, KS, United States
(7) University of California, San Francisco, San Francisco, CA, United States
(8) University of California, Davis, Sacramento, CA, United States
(9) Denver International Spine Center, Denver, CO, United States

Abstract

Introduction: Sagittal plane correction of pts with adult spinal deformity is challenging to achieve and maintain. Aging adult patients tend to have an increasing kyphosis and a forward lean. The aim of this study was to investigate the effectiveness of the sagittal plane correction and durability at minimum 3 yr. follow up.

Purpose: To assess how sagittal plane correction in long fusions can change over 3-5 yrs in the unfused or fused portion of the spine and its influence on the outcome

Patient Sample: 115 ASD patients out of 248 pts

Outcome Measures: Radiographic parameters, ODI, SF-36, SRS-22

Methods: Observational cohort study in a multicenter adult spinal deformity database. Inclusion criteria: age 18 or greater, PI-LL mismatch >10, PT>20, SVA >5 cm and Cobb >20. Patients who required revision surgery after the initial surgery were excluded. Radiographic parameters between the upper thoracic (UT) and thoracolumbar (TL) groups and patient reported outcomes were studied for their temporal relationship. Minimum 3yr follow-up was required.

Results: 115 pts out of 248 pts met the criteria. Avg. age was 62 yrs. with 87 % females. Average BMI was 27. Majority of the pts underwent a primary surgery (74%). Avg. follow up was 46 months. The SRS-Schwab classes were N=26, T=2, L=58, D=29. The Avg. pre-op SVA was 7.5 cm, PI-LL was 19 and the PT was 25. 37 pts were fused to T3 or T4 and 44 were fused to T10 or T11. T7 was used to divide the UT and TL group. In the UT group the SVA, PT, TPA, PI-LL, and UIV-PA improved between baseline and each follow up. Thoracic kyphosis (TK) increased from baseline to each follow up. Between 6wks and last f/u roughly half the patients had TK increase or LL decrease greater than 5°. In the TL group the SVA, PI-LL, and UIV-PA improved from baseline and each f/u. PT improved only from baseline to 6wks. TPA improved between baseline, 6wks and 1yr. TK increases between baseline and each f/u. 25% of pts lost >5° in the lumbar lordosis. The ODI and SF-36 PCS did not change between baseline and 6wks but improved at 1yr and last f/u. The SRS-22 improved at 6wks, had greater improvement at 1yr and remained stable at last f/u.

Conclusions: Sagittal alignment was improved in all parameters at 6wks, 1 yr. and final follow-up. There was a gradual increase in thoracic kyphosis in all pts. Loss of correction was found in a subset of pts in the instrumented and non-instrumented part of the thoracic spine and through the instrumented portion of the lumbar spine. The majority of the improvement in HRQOL was seen at 1 yr. and remained stable at final follow-up.

Evolution Sagittal Alignment and HRQOL