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Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone

Publication ,  Journal Article
Ailon, T; Scheer, JK; Lafage, V; Schwab, FJ; Klineberg, E; Sciubba, DM; Protopsaltis, TS; Zebala, L; Hostin, R; Obeid, I; Koski, T; Kelly, MP ...
Published in: Spine Deformity
July 1, 2016

Object Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons' ability to accurately predict postoperative alignment. Methods Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician. Surgeon training, practice characteristics, and use of surgical planning software was assessed. Participants predicted if the surgical plan would lead to adequate deformity correction and attempted to predict postoperative radiographic parameters including sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence to lumbar lordosis mismatch (PI-LL), thoracic kyphosis (TK). Results Seventeen surgeons participated: 71% within 0 to 10 years of practice; 88% devote >25% of their practice to deformity surgery. Surgeons accurately judged adequacy of the surgical plan to achieve correction to specific thresholds of SVA 69% ± 8%, PT 68% ± 9%, and PI-LL 68% ± 11% of the time. However, surgeons correctly predicted the actual postoperative radiographic parameters only 42% ± 6% of the time. They were more successful at predicting PT (61% ± 10%) than SVA (45% ± 8%), PI-LL (26% ± 11%), or TK change (35% ± 21%; p <.05). Improved performance correlated with greater focus on deformity but not number of years in practice or number of three-column osteotomies performed per year. Conclusion Surgeons failed to correctly predict the adequacy of the proposed surgical plan in approximately one third of presented cases. They were better at determining whether a surgical plan would achieve adequate correction than predicting specific postoperative alignment parameters. Pelvic tilt and SVA were predicted with the greatest accuracy.

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Published In

Spine Deformity

DOI

EISSN

2212-1358

ISSN

2212-134X

Publication Date

July 1, 2016

Volume

4

Issue

4

Start / End Page

323 / 329

Related Subject Headings

  • 4201 Allied health and rehabilitation science
  • 1103 Clinical Sciences
  • 0903 Biomedical Engineering
 

Citation

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Chicago
ICMJE
MLA
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Ailon, T., Scheer, J. K., Lafage, V., Schwab, F. J., Klineberg, E., Sciubba, D. M., … Ames, C. P. (2016). Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone. Spine Deformity, 4(4), 323–329. https://doi.org/10.1016/j.jspd.2016.02.003
Ailon, T., J. K. Scheer, V. Lafage, F. J. Schwab, E. Klineberg, D. M. Sciubba, T. S. Protopsaltis, et al. “Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone.” Spine Deformity 4, no. 4 (July 1, 2016): 323–29. https://doi.org/10.1016/j.jspd.2016.02.003.
Ailon T, Scheer JK, Lafage V, Schwab FJ, Klineberg E, Sciubba DM, et al. Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone. Spine Deformity. 2016 Jul 1;4(4):323–9.
Ailon, T., et al. “Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone.” Spine Deformity, vol. 4, no. 4, July 2016, pp. 323–29. Scopus, doi:10.1016/j.jspd.2016.02.003.
Ailon T, Scheer JK, Lafage V, Schwab FJ, Klineberg E, Sciubba DM, Protopsaltis TS, Zebala L, Hostin R, Obeid I, Koski T, Kelly MP, Bess S, Shaffrey CI, Smith JS, Ames CP. Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone. Spine Deformity. 2016 Jul 1;4(4):323–329.
Journal cover image

Published In

Spine Deformity

DOI

EISSN

2212-1358

ISSN

2212-134X

Publication Date

July 1, 2016

Volume

4

Issue

4

Start / End Page

323 / 329

Related Subject Headings

  • 4201 Allied health and rehabilitation science
  • 1103 Clinical Sciences
  • 0903 Biomedical Engineering