TY - JOUR
T1 - Full-Body Analysis of Adult Spinal Deformity Patients' Age-Adjusted Alignment at 1 Year
AU - Passias, Peter G.
AU - Horn, Samantha R.
AU - Frangella, Nicholas J.
AU - Poorman, Gregory W.
AU - Vasquez-Montes, Dennis
AU - Diebo, Bassel G.
AU - Bortz, Cole A.
AU - Segreto, Frank A.
AU - Moon, John Y.
AU - Zhou, Peter L.
AU - Vira, Shaleen
AU - Sure, Akhila
AU - Beaubrun, Bryan
AU - Tishelman, Jared C.
AU - Ramchandran, Subaraman
AU - Jalai, Cyrus M.
AU - Bronson, Wesley
AU - Wang, Charles
AU - Lafage, Virginie
AU - Buckland, Aaron J.
AU - Errico, Thomas J.
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/6
Y1 - 2018/6
N2 - Background: Previous studies have built a foundation for understanding compensation in patients with adult spinal deformity (ASD) by using full-body stereographic assessments. These mechanisms, in relation to age-adjusted alignment targets, have yet to be studied fully. The aim of this study was to assess lower-limb compensatory mechanisms of patients failing to meet age-adjusted alignment goals. Methods: Patients with ASD ≥40 years with full body baseline and follow-up radiographs were included. Patients were stratified by age (40–65 years, >65 years) and spinopelvic correction. Lower-limb compensation parameters (pelvic shift, hip extension, knee flexion [KA], ankle flexion [AA], and global sagittal angle [GSA]) for patients who matched and failed to match age-adjusted alignment targets were compared with analysis of variance and t-test analysis. Results: In total, 108 patients were included. At 1 year, AA increased with age in the “match” pelvic tilt (PT) and spinopelvic mismatch (PI-LL) cohorts (PT: AA, 5.6–7.8, P = 0.041; PI-LL: 4.9–8.8, P = 0.026). KA, AA, and GSA increased with age in the “match” sagittal vertical axis (SVA) cohort (KA: 3.8–13.1, P = 0.002; AA: 5.8–10.2, P = 0.008; GSA: 3.9–7.8, P < 0.001), as did KA and GSA in the “match” T1 pelvic angle group (KA: 1.8–8.7, P = 0.020; GSA: 2.6–5.7, P = 0.004). Conclusions: Greater compensation captured by KA and GSA was associated with age progression in the “match” SVA and T1 pelvic angle cohorts. In addition, older SVA, PT, and PI-LL “match” cohorts used increased AA, suggesting that ideal postoperative alignment of aged individuals with ASD involves increased compensation.
AB - Background: Previous studies have built a foundation for understanding compensation in patients with adult spinal deformity (ASD) by using full-body stereographic assessments. These mechanisms, in relation to age-adjusted alignment targets, have yet to be studied fully. The aim of this study was to assess lower-limb compensatory mechanisms of patients failing to meet age-adjusted alignment goals. Methods: Patients with ASD ≥40 years with full body baseline and follow-up radiographs were included. Patients were stratified by age (40–65 years, >65 years) and spinopelvic correction. Lower-limb compensation parameters (pelvic shift, hip extension, knee flexion [KA], ankle flexion [AA], and global sagittal angle [GSA]) for patients who matched and failed to match age-adjusted alignment targets were compared with analysis of variance and t-test analysis. Results: In total, 108 patients were included. At 1 year, AA increased with age in the “match” pelvic tilt (PT) and spinopelvic mismatch (PI-LL) cohorts (PT: AA, 5.6–7.8, P = 0.041; PI-LL: 4.9–8.8, P = 0.026). KA, AA, and GSA increased with age in the “match” sagittal vertical axis (SVA) cohort (KA: 3.8–13.1, P = 0.002; AA: 5.8–10.2, P = 0.008; GSA: 3.9–7.8, P < 0.001), as did KA and GSA in the “match” T1 pelvic angle group (KA: 1.8–8.7, P = 0.020; GSA: 2.6–5.7, P = 0.004). Conclusions: Greater compensation captured by KA and GSA was associated with age progression in the “match” SVA and T1 pelvic angle cohorts. In addition, older SVA, PT, and PI-LL “match” cohorts used increased AA, suggesting that ideal postoperative alignment of aged individuals with ASD involves increased compensation.
KW - Adult spinal deformity
KW - Age-adjusted alignment
KW - Compensation
KW - Pelvic tilt
KW - Radiographic alignment
KW - Sagittal vertical axis
KW - T1 pelvic angle
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U2 - 10.1016/j.wneu.2018.03.079
DO - 10.1016/j.wneu.2018.03.079
M3 - Article
C2 - 29555609
AN - SCOPUS:85045241192
SN - 1878-8750
VL - 114
SP - e775-e784
JO - World neurosurgery
JF - World neurosurgery
ER -