Overcorrection in Sagittal Alignment Effect on Optimal Outcomes in Adult Spinal Deformity Patients

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
PD

Pooja R. Dave

Miami, Florida, United States
PT

Peter S. Tretiakov, BS

United States
GM

Giorgos D. Michalopoulos, MD

Minnesota, United States
DC

Daniel Chen, n/a

United States
TW

Tyler K. Williamson, MS

Medical Student/Clinical Researcher
University of the Incarnate Word SOM
San Antonio, Texas, United States
CB

Claudia Bennett-Caso

United States
NV

Neel Vallurupalli

United States
AC

Andrew Chen

United States
RL

Renaud Lafage, MS

Senior Biomedical engineer
Lenox Hill Hospital
new york, New York, United States
SO

Stephane Owusu-Sarpong, MD

Orthopedic Surgery Resident
NYU Langone Health, United States
JL

Jordan Lebovic, MD, MBA

Resident
NYU Langone Orthopedics
New York, New York, United States
SV

Shaleen Vira, MD

Assistant Professor, Orthopaedic Surgery & Neurosurgery
UT Southwestern Medical Center
Dallas, Texas, United States
MJ

M. Burhan Janjua

United States
AM

Angel Macagno

United States
TR

Timothy Roberts

Orthopaedic Spine Surgeon
Westbury, New York, United States
AS

Andrew Schoenfeld

United States
Virginie Lafage, PhD

AVP, Clinical Research
Lenox Hill | Northwell
Hospital for Special Surgery
New York, New York, United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Disclosure(s):

Peter G. Passias, MD: No relevant disclosure to display

Introduction: Age-adjusted sagittal spino-pelvic radiographic thresholds have been established and utilized by spine surgeons to assess post-operative success in ASD patients. But, recent studies have suggested that overcorrection can benefit some ASD patients without increasing the prevalence of PJK or PJF. Our research wanted to investigate how overcorrection of age-adjusted radiographic thresholds affects future rates of PJF or mechanical failure.

Purpose: To investigate what degree of overcorrection leads to PJF and mechanical failure with reoperation based on patient specific factors and degree of baseline deformity.

Methods: ASD patients, fused from thoracic vertebrae to pelvis, with 2 year (2Y) data were included. Frailty was calculated using Passias ASD-mFI. Good Outcome (GO) at two years was defined as: no major mechanical complications, reoperations, PJF, and thoracic decompensation (>15 degree change from baseline in unfused thoracic kyphosis) and [meeting either: (1) Substantial Clinical Benefit for Oswestry Disability Index (ODI) (change >18.8), or (2) ODI < 15 and Scoliosis Research Society Total>4.5]. (36007130) Poor outcomes (PO) was those that did not develop GO. Those that were over corrected (O) 1 standard deviation (SD1) (O1) in each parameter were evaluated.

Results: 302 ASD patients met inclusion(age 63±9yrs, 78% F, BMI 27±5kg/m2, CCI 1.9±1.7, ASD-mFI 7.2±4.7). BL radiographic deformity: mean PT 26º, PI 55º, PI-LL 21º, TPA 25º.
By 2Y, 62% developed PJK, 11% PJF, 19% TD, and 69% GO. PJK, PJF, and TD was associated with greater correction in SVA, PI-LL, and PT (p <.05).
O+ was significantly younger, had lower BMI, CCI, and frailty. O+ that were GO+ had significantly lower CCI and frailty.
PJF rates were twofold higher in O+ (p=.02). Implant malposition and operative complications were higher in PT O+ (p <.05). Reoperation due to implant failure had 2x higher rate of PILL being O+ (p=.06). Higher CCI was the most significant patient factor that lead to PJF and GO- (PJF OR: 1.4, GO- OR: 1.3, both p<.05). O+ had double the likelihood of development of GO- with higher CCI (p <.05). Age and BMI were significant predictors for the development of PO in O1 (Age OR: 1.1, BMI OR: 1.2, both p<.05). Threshold for CCI in O+ of less than 1 was associated with GO+, for TD: CCI < 2, and PJF: CCI < 3 (all p<.05). Frailty threshold was < 2.368 for GO (p <.05). Age threshold for PJK was < 65.3 (p <.05).

Conclusion: Overcorrecting is often necessary in adult spinal deformity to achieve good outcomes. Determination of patient specific factors and radiographic parameters can lead to better outcomes. Our study suggests that overcorrecting in PT has the greatest impact in achievement of this and should be carefully considered, especially in those that have greater comorbidities.