Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, NY.
Spine (Phila Pa 1976). 2018 Mar 15;43(6):388-393. doi: 10.1097/BRS.0000000000002435.
Retrospective review of prospectively-collected database.
This study aims to compare 2-year clinical outcomes of patients who underwent surgical reconstructions based on their achievement to age-adjusted alignment ideals.
Recent research in sagittal plane has proposed age-adjusted alignment thresholds. However, the impact of these thresholds on postoperative health-related quality of life (HRQOL) is yet to be investigated.
Patients were included if they were more than 18-years old and underwent surgical correction of adult spinal deformity with a complete 2-year follow-up. Patients were stratified into three groups based on achievement of age-adjusted thresholds in pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis (SVA). First group included patients who reached the exact age-adjusted threshold ± 10 years (MATCHED), other two groups included patients who were over corrected (OVER), and under corrected (UNDER). Clinical outcomes including actual value and offset from age-adjusted Oswestry Disability Index, Short-Form-36 (SF-36) -physical component summary, and Scoliosis Research Society-22r (SRS-22r) were compared between groups at 2 years follow-up.
A total of 343 patients (mean, 57 yrs and 83% females) were included. Sagittal profile of the population was: PT = 23.6°, SVA = 65.8 mm, and PI-LL = 15.6°. At 2-year follow-up, there was significant improvement in all sagittal modifiers with 25.7%, 24.3%, and 33.1% of the patients matching their age alignment targets in terms of PT, PI-LL, and SVA, respectively. For PT and PI-LL, the three groups (MATCHED, OVER, and UNDER) had comparable values and offsets from age-adjusted patient reported outcome. However, for SVA groups, patients in UNDER had significantly worse HRQOL than the two other groups. Patients in PT, PI-LL, and SVA UNDER groups were significantly younger than the other groups, P < 0.05.
At 2 years after adult spinal deformity surgical treatment, only 24.3% to 33.1% of the patients reached age-adjusted alignment thresholds. Those under corrected in SVA demonstrated worse clinical outcomes. No significant improvements were found between matched and overcorrected patients, with overcorrection being an established risk for proximal junctional kyphosis. These results further emphasize the need for patient specific operative planning.
前瞻性收集数据库的回顾性研究。
本研究旨在比较基于达到年龄调整后的对线理想目标的患者的 2 年临床结果。
矢状面的最新研究提出了年龄调整后的对线阈值。然而，这些阈值对术后健康相关生活质量（HRQOL）的影响尚未得到研究。
纳入年龄超过 18 岁且接受过成人脊柱畸形手术矫正并完成 2 年完整随访的患者。根据骨盆倾斜（PT）、骨盆入射角减去腰椎前凸（PI-LL）和矢状垂直轴（SVA）的年龄调整阈值，患者被分为三组。第一组包括达到精确年龄调整阈值±10 年的患者（MATCHED），其他两组包括过矫正（OVER）和矫正不足（UNDER）的患者。在 2 年随访时，比较各组间实际值和与年龄调整后的 Oswestry 功能障碍指数（Oswestry Disability Index，ODI）、短格式 36 项健康调查量表（Short-Form-36，SF-36）-物理成分综合评分和脊柱侧凸研究学会 22r 评分（Scoliosis Research Society-22r，SRS-22r）的偏移量。
共纳入 343 例患者（平均年龄 57 岁，83%为女性）。人群的矢状面特征为：PT=23.6°，SVA=65.8mm，PI-LL=15.6°。在 2 年随访时，PT、PI-LL 和 SVA 的所有矢状面修正值均有显著改善，分别有 25.7%、24.3%和 33.1%的患者在 PT、PI-LL 和 SVA 方面达到了年龄调整后的对线目标。对于 PT 和 PI-LL，MATCHED、OVER 和 UNDER 三组的患者在与年龄调整后的患者报告结果的数值和偏移量方面具有可比性。然而，对于 SVA 组，UNDER 组的患者 HRQOL 明显差于其他两组。PT、PI-LL 和 SVA UNDER 组的患者明显比其他组年轻，P<0.05。
在成人脊柱畸形手术治疗后 2 年，只有 24.3%至 33.1%的患者达到了年龄调整后的对线阈值。SVA 矫正不足的患者临床结果较差。匹配和过矫正患者之间没有明显的改善，过矫正是近端交界性后凸的既定风险。这些结果进一步强调了需要针对患者进行手术规划。
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