179 Patients Over Age 65 with Postoperative Malalignment are not as Disabled as Younger Patients
Sagittal Plane Deformity (SPD) is a significant driver of disability, pain, and dysfunction. Optimization of alignment parameters is an essential aspect of preoperative planning. Correction of SPD often requires complex osteotomies and can result in significant complication, especially in older patients. Minimally invasive surgery (MIS) techniques potentially offer the opportunity to provide deformity care to patients not able to tolerate open corrections. However, there is concern regarding the effectiveness of MIS for spinal alignment.
Inclusion criteria of age 18 or older, an MIS component as part of their index procedure, at least one of the following: PT > 20, SVA > 5, PI-LL > 10 or lumbar scoliosis > 20, and a minimum of 2 year follow-up. Patients were stratified into 3 age groups, <65, 65–74, and >74. In each strata patients were categorized as aligned (AL) or malaligned (MAL) postoperatively. MAL was defined as having PI-LL or SVA greater than normative data for each specific age group. Radiographic and clinical outcomes were compared within each strata. The younger two strata were further subanalyzed by matching patients by levels instrumented to create homogenous cohorts.
>185 patients identified in the database, 107 in <65 (74% MAL), 63 in 65–74 (67% MAL), and 15 in >74 (67% MAL). AL and MAL patients had similar preoperative radiographic parameters in all 3 groups. They also had similar preoperative disability, except in the <65 age group, MAL patients had significantly higher ODI (58.9 vs 43.1, P = 0.001).Matched patients <65 years demonstrated significantly worse back pain and ODI than MAL post operatively (ODI: 42.2 vs 21.3, P = 0.001). Those 65–74 and >74 demonstrated similar VAS and ODI scores, whether they were AL or MAL post op.
Postoperatively MAL patients demonstrated worse pain and disability compared to AL patients only if age <65. Those patients >65 had similar outcomes in both the AL and MAL groups, suggesting elderly patients may require less sagittal plane correction.
Fu, K-MG; Nunley, PD; Mundis, GM; Park, P; Nguyen, S; Marca, FL; Uribe, JS; Eastlack, R; Than, KD; Okonkwo, DO; Kanter, AS; Anand, N; Fessler, RG; Mummaneni, PV
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