Should pelvic incidence influence realignment strategy? A detailed analysis in adult spinal deformity.

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Journal of neurosurgery. Spine Pub Date : 2024-09-06 Print Date: 2024-11-01 DOI:10.3171/2024.5.SPINE24106
Tyler K Williamson, Oluwatobi O Onafowokan, Andrew J Schoenfeld, Stephane Owusu-Sarpong, Jordan Lebovic, Jamshaid Mir, Ankita Das, Nathan Lorentz, Matthew Galetta, Pawel P Jankowski, Renaud Lafage, Virginie Lafage, Peter G Passias
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引用次数: 0

Abstract

Objective: The purpose of this study was to assess how various realignment strategies affect mechanical failure and clinical outcomes in pelvic incidence (PI)-stratified cohorts following adult spinal deformity (ASD) surgery.

Methods: Median and interquartile range statistics were calculated for demographics and surgical details. Further statistical analysis was used to define subsets within PI generating significantly different rates of mechanical failure. These subsets of PI were further analyzed as subcohorts for the outcomes and effects of realignment within each subcohort. Multivariate logistic regression analysis controlling for baseline frailty and lumbar lordosis (LL; L1-S1) analyzed the association of age-adjusted realignment and Global Alignment and Proportion (GAP) strategies with the incidence of mechanical failure and clinical improvement within PI-stratified groups.

Results: A parabolic relationship between PI and mechanical failure was noted, whereas patients with either < 51° (n = 174, 39.1% of cohort) or > 63° (n = 114, 25.6% of cohort) of PI generated higher rates of mechanical failure (18.0% and 20.0%, respectively) and lower rates of good outcome (80.3% and 77.6%, respectively) than those with moderate PI (51°-63°). Patients with lower PI more often met good outcome criteria when undercorrected in age-adjusted PI-LL mismatch and sagittal age-adjusted score, and those not meeting good outcome criteria were more likely to deteriorate in GAP relative LL from first to final follow-up (OR 13.4, 95% CI 1.3-139.2). In those with moderate PI, patients were more likely to meet good outcome when aligned on the GAP lordosis distribution index (LDI; OR 1.7, 95% CI 0.9-3.3). Patients with higher PI meeting good outcome were more likely to be overcorrected in sagittal vertical axis (OR 2.4, 95% CI 1.1-5.2) at first follow-up and less likely to be undercorrected in T1 pelvic angle (OR 0.4, 95% CI 0.2-0.9) by final follow-up. When assessing GAP alignment, patients were more likely to meet good outcome when aligned on GAP LDI (OR 3.5, 95% CI 1.4-8.9).

Conclusions: There was a parabolic relationship between PI and both mechanical failure and clinical improvement following deformity correction in this study. Understanding the associations between this fixed parameter and poor outcomes can aid the surgeon in strategical planning when seeking to realign ASD.

骨盆入径是否会影响矫正策略?成人脊柱畸形的详细分析。
研究目的本研究旨在评估成人脊柱畸形(ASD)手术后,各种复位策略如何影响骨盆发生率(PI)分层队列中的机械故障和临床结果:方法:计算人口统计学和手术细节的中位数和四分位数间距。通过进一步的统计分析,确定了PI中机械故障发生率明显不同的子集。将这些 PI 子群作为子队列进一步分析每个子队列中的结果和重新调整的影响。控制基线虚弱度和腰椎前凸(LL;L1-S1)的多变量逻辑回归分析分析了年龄调整后的对位和全局对位与比例(GAP)策略与PI分层组内机械故障发生率和临床改善的关系:PI与机械故障之间呈抛物线关系,与中度PI(51°-63°)患者相比,PI<51°(174人,占队列的39.1%)或>63°(114人,占队列的25.6%)患者的机械故障发生率更高(分别为18.0%和20.0%),良好预后发生率更低(分别为80.3%和77.6%)。PI较低的患者在年龄调整后的PI-LL不匹配和矢状面年龄调整评分矫正不足的情况下更容易达到良好预后标准,而未达到良好预后标准的患者从首次随访到最终随访的GAP相对LL更有可能恶化(OR 13.4,95% CI 1.3-139.2)。在中度 PI 患者中,当 GAP 脊柱前凸分布指数(LDI;OR 1.7,95% CI 0.9-3.3)一致时,患者更有可能达到良好结果。在首次随访时,PI 较高的患者更有可能在矢状垂直轴上矫正过度(OR 2.4,95% CI 1.1-5.2),而在最终随访时,T1 骨盆角矫正不足的可能性较小(OR 0.4,95% CI 0.2-0.9)。在评估GAP对齐情况时,GAP LDI对齐的患者更有可能达到良好结果(OR 3.5,95% CI 1.4-8.9):在这项研究中,PI与畸形矫正后的机械失败和临床改善之间存在抛物线关系。了解这一固定参数与不良预后之间的关系有助于外科医生在寻求 ASD 矫正时制定战略计划。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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