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The impact of age on surgical goals for spinopelvic alignment in minimally invasive surgery for adult spinal deformity.

Publication ,  Journal Article
Park, P; Fu, K-M; Mummaneni, PV; Uribe, JS; Wang, MY; Tran, S; Kanter, AS; Nunley, PD; Okonkwo, DO; Shaffrey, CI; Mundis, GM; Chou, D ...
Published in: J Neurosurg Spine
November 1, 2018

OBJECTIVEAchieving appropriate spinopelvic alignment in deformity surgery has been correlated with improvement in pain and disability. Minimally invasive surgery (MIS) techniques have been used to treat adult spinal deformity (ASD); however, there is concern for inadequate sagittal plane correction. Because age can influence the degree of sagittal correction required, the purpose of this study was to analyze whether obtaining optimal spinopelvic alignment is required in the elderly to obtain clinical improvement.METHODSA multicenter database of ASD patients was queried. Inclusion criteria were age ≥ 18 years; an MIS component as part of the index procedure; at least one of the following: pelvic tilt (PT) > 20°, sagittal vertical axis (SVA) > 50 mm, pelvic incidence to lumbar lordosis (PI-LL) mismatch > 10°, or coronal curve > 20°; and minimum follow-up of 2 years. Patients were stratified into younger (< 65 years) and older (≥ 65 years) cohorts. Within each cohort, patients were categorized into aligned (AL) or mal-aligned (MAL) subgroups based on postoperative radiographic measurements. Mal-alignment was defined as a PI-LL > 10° or SVA > 50 mm. Pre- and postoperative radiographic and clinical outcomes were compared.RESULTSOf the 185 patients, 107 were in the younger cohort and 78 in the older cohort. Based on postoperative radiographs, 36 (33.6%) of the younger patients were in the AL subgroup and 71 (66.4%) were in the MAL subgroup. The older patients were divided into 2 subgroups based on alignment; there were 26 (33.3%) patients in the AL and 52 (66.7%) in the MAL subgroups. Overall, patients within both younger and older cohorts significantly improved with regard to postoperative visual analog scale (VAS) scores for back and leg pain and Oswestry Disability Index (ODI) scores. In the younger cohort, there were no significant differences in postoperative VAS back and leg pain scores between the AL and MAL subgroups. However, the postoperative ODI score of 37.9 in the MAL subgroup was significantly worse than the ODI score of 28.5 in the AL subgroup (p = 0.019). In the older cohort, there were no significant differences in postoperative VAS back and leg pain score or ODI between the AL and MAL subgroups.CONCLUSIONSMIS techniques did not achieve optimal spinopelvic alignment in most cases. However, age appears to impact the degree of sagittal correction required. In older patients, optimal spinopelvic alignment thresholds did not need to be achieved to obtain similar symptomatic improvement. Conversely, in younger patients stricter adherence to optimal spinopelvic alignment thresholds may be needed.https://thejns.org/doi/abs/10.3171/2018.4.SPINE171153.

Duke Scholars

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Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

November 1, 2018

Volume

29

Issue

5

Start / End Page

560 / 564

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Thoracic Vertebrae
  • Spinal Fusion
  • Postoperative Complications
  • Orthopedics
  • Minimally Invasive Surgical Procedures
  • Middle Aged
  • Male
  • Lumbar Vertebrae
  • Lordosis
 

Citation

APA
Chicago
ICMJE
MLA
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Park, P., Fu, K.-M., Mummaneni, P. V., Uribe, J. S., Wang, M. Y., Tran, S., … International Spine Study Group. (2018). The impact of age on surgical goals for spinopelvic alignment in minimally invasive surgery for adult spinal deformity. J Neurosurg Spine, 29(5), 560–564. https://doi.org/10.3171/2018.4.SPINE171153
Park, Paul, Kai-Ming Fu, Praveen V. Mummaneni, Juan S. Uribe, Michael Y. Wang, Stacie Tran, Adam S. Kanter, et al. “The impact of age on surgical goals for spinopelvic alignment in minimally invasive surgery for adult spinal deformity.J Neurosurg Spine 29, no. 5 (November 1, 2018): 560–64. https://doi.org/10.3171/2018.4.SPINE171153.
Park P, Fu K-M, Mummaneni PV, Uribe JS, Wang MY, Tran S, et al. The impact of age on surgical goals for spinopelvic alignment in minimally invasive surgery for adult spinal deformity. J Neurosurg Spine. 2018 Nov 1;29(5):560–4.
Park, Paul, et al. “The impact of age on surgical goals for spinopelvic alignment in minimally invasive surgery for adult spinal deformity.J Neurosurg Spine, vol. 29, no. 5, Nov. 2018, pp. 560–64. Pubmed, doi:10.3171/2018.4.SPINE171153.
Park P, Fu K-M, Mummaneni PV, Uribe JS, Wang MY, Tran S, Kanter AS, Nunley PD, Okonkwo DO, Shaffrey CI, Mundis GM, Chou D, Eastlack R, Anand N, Than KD, Zavatsky JM, Fessler RG, International Spine Study Group. The impact of age on surgical goals for spinopelvic alignment in minimally invasive surgery for adult spinal deformity. J Neurosurg Spine. 2018 Nov 1;29(5):560–564.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

November 1, 2018

Volume

29

Issue

5

Start / End Page

560 / 564

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Thoracic Vertebrae
  • Spinal Fusion
  • Postoperative Complications
  • Orthopedics
  • Minimally Invasive Surgical Procedures
  • Middle Aged
  • Male
  • Lumbar Vertebrae
  • Lordosis