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Multicenter validation of a formula predicting postoperative spinopelvic alignment.

Publication ,  Journal Article
Lafage, V; Bharucha, NJ; Schwab, F; Hart, RA; Burton, D; Boachie-Adjei, O; Smith, JS; Hostin, R; Shaffrey, C; Gupta, M; Akbarnia, BA; Bess, S
Published in: J Neurosurg Spine
January 2012

OBJECT: Sagittal spinopelvic imbalance is a major contributor to pain and disability for patients with adult spinal deformity (ASD). Preoperative planning is essential for pedicle subtraction osteotomy (PSO) candidates; however, current methods are often inaccurate because no formula to date predicts both postoperative sagittal balance and pelvic alignment. The authors of this study aimed to evaluate the accuracy of 2 novel formulas in predicting postoperative spinopelvic alignment after PSO. METHODS: This study is a multicenter retrospective consecutive PSO case series. Adults with spinal deformity (> 21 years old) who were treated with a single-level lumbar PSO for sagittal imbalance were evaluated. All patients underwent preoperative and a minimum of 6-month postoperative radiography. Two novel formulas were used to predict the postoperative spinopelvic alignment. The results predicted by the formulas were then compared with the actual postoperative radiographic values, and the formulas' ability to identify successful (sagittal vertical axis [SVA] ≤ 50 mm and pelvic tilt [PT] ≤ 25°) and unsuccessful (SVA > 50 mm or PT > 25°) outcomes was evaluated. RESULTS: Ninety-nine patients met inclusion criteria. The median absolute error between the predicted and actual PT was 4.1° (interquartile range 2.0°-6.4°). The median absolute error between the predicted and actual SVA was 27 mm (interquartile range 11-47 mm). Forty-one of 54 patients with a formula that predicted a successful outcome had a successful outcome as shown by radiography (positive predictive value = 0.76). Forty-four of 45 patients with a formula that predicted an unsuccessful outcome had an unsuccessful outcome as shown by radiography (negative predictive value = 0.98). CONCLUSIONS: The spinopelvic alignment formulas were accurate when predicting unsuccessful outcomes but less reliable when predicting successful outcomes. The preoperative surgical plan should be altered if an unsuccessful result is predicted. However, even after obtaining a predicted successful outcome, surgeons should ensure that the predicted values are not too close to unsuccessful values and should identify other variables that may affect alignment. In the near future, it is anticipated that the use of these formulas will lead to better surgical planning and improved outcomes for patients with complex ASD.

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Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

January 2012

Volume

16

Issue

1

Start / End Page

15 / 21

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spine
  • Spinal Fusion
  • Scoliosis
  • Retrospective Studies
  • Radiography
  • Predictive Value of Tests
  • Pelvis
  • Osteotomy
  • Orthopedics
 

Citation

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Lafage, V., Bharucha, N. J., Schwab, F., Hart, R. A., Burton, D., Boachie-Adjei, O., … Bess, S. (2012). Multicenter validation of a formula predicting postoperative spinopelvic alignment. J Neurosurg Spine, 16(1), 15–21. https://doi.org/10.3171/2011.8.SPINE11272
Lafage, Virginie, Neil J. Bharucha, Frank Schwab, Robert A. Hart, Douglas Burton, Oheneba Boachie-Adjei, Justin S. Smith, et al. “Multicenter validation of a formula predicting postoperative spinopelvic alignment.J Neurosurg Spine 16, no. 1 (January 2012): 15–21. https://doi.org/10.3171/2011.8.SPINE11272.
Lafage V, Bharucha NJ, Schwab F, Hart RA, Burton D, Boachie-Adjei O, et al. Multicenter validation of a formula predicting postoperative spinopelvic alignment. J Neurosurg Spine. 2012 Jan;16(1):15–21.
Lafage, Virginie, et al. “Multicenter validation of a formula predicting postoperative spinopelvic alignment.J Neurosurg Spine, vol. 16, no. 1, Jan. 2012, pp. 15–21. Pubmed, doi:10.3171/2011.8.SPINE11272.
Lafage V, Bharucha NJ, Schwab F, Hart RA, Burton D, Boachie-Adjei O, Smith JS, Hostin R, Shaffrey C, Gupta M, Akbarnia BA, Bess S. Multicenter validation of a formula predicting postoperative spinopelvic alignment. J Neurosurg Spine. 2012 Jan;16(1):15–21.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

January 2012

Volume

16

Issue

1

Start / End Page

15 / 21

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spine
  • Spinal Fusion
  • Scoliosis
  • Retrospective Studies
  • Radiography
  • Predictive Value of Tests
  • Pelvis
  • Osteotomy
  • Orthopedics