Defining modern iatrogenic flatback syndrome: examination of segmental lordosis in short lumbar fusion patients undergoing thoracolumbar deformity correction.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

European Spine Journal Pub Date : 2024-10-23 DOI:10.1007/s00586-024-08531-z

Bassel G Diebo, Manjot Singh, Mariah Balmaceno-Criss, Mohammad Daher, Lawrence G Lenke, Christopher P Ames, Douglas C Burton, Stephen M Lewis, Eric O Klineberg, Renaud Lafage, Robert K Eastlack, Munish C Gupta, Gregory M Mundis, Jeffrey L Gum, Kojo D Hamilton, Richard Hostin, Peter G Passias, Themistocles S Protopsaltis, Khaled M Kebaish, Han Jo Kim, Christopher I Shaffrey, Breton G Line, Praveen V Mummaneni, Pierce D Nunley, Justin S Smith, Jay Turner, Frank J Schwab, Juan S Uribe, Shay Bess, Virginie Lafage, Alan H Daniels

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引用次数: 0

Abstract

Purpose: Understanding the mechanism and extent of preoperative deformity in revision procedures may provide data to prevent future failures in lumbar spinal fusion patients.

Methods: ASD patients without prior spine surgery (PRIMARY) and with prior short (SHORT) and long (LONG) fusions were included. SHORT patients were stratified into modes of failure: implant, junctional, malalignment, and neurologic. Baseline demographics, spinopelvic alignment, offset from alignment targets, and patient-reported outcome measures (PROMs) were compared across PRIMARY and SHORT cohorts. Segmental lordosis analyses, assessing under-, match, or over-correction to segmental and global lordosis targets, were performed by SRS-Schwab coronal curve type and construct length.

Results: Among 785 patients, 430 (55%) were PRIMARY and 355 (45%) were revisions. Revision procedures included 181 (23%) LONG and 174 (22%) SHORT corrections. SHORT modes of failure included 27% implant, 40% junctional, 73% malalignment, and/or 28% neurologic. SHORT patients were older, frailer, and had worse baseline deformity (PT, PI-LL, SVA) and PROMs (NRS, ODI, VR-12, SRS-22) compared to primary patients (p < 0.001). Segmental lordosis analysis identified 93%, 88%, and 62% undercorrected patients at LL, L1-L4, and L4-S1, respectively. SHORT patients more often underwent 3-column osteotomies (30% vs. 12%, p < 0.001) and had higher ISSG Surgical Invasiveness Score (87.8 vs. 78.3, p = 0.006).

Conclusions: Nearly half of adult spinal deformity surgeries were revision fusions. Revision short fusions were associated with sagittal malalignment, often due to undercorrection of segmental lordosis goals, and frequently required more invasive procedures. Further initiatives to optimize alignment in lumbar fusions are needed to avoid costly and invasive deformity corrections.

Level of evidence: IV: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

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定义现代先天性平背综合征：检查接受胸腰椎畸形矫正术的短腰椎融合术患者的节段前凸。

目的：了解翻修手术中术前畸形的机制和程度可为预防腰椎融合术患者未来的失败提供数据：方法：纳入既往未接受过脊柱手术（初级）、既往接受过短（SHORT）和长（LONG）融合术的 ASD 患者。短融合术患者按失败模式分层：植入、连接、错位和神经系统。对 "第一 "组和 "第二 "组患者的基线人口统计学、脊柱骨盆对位、对位目标偏移和患者报告结果测量（PROMs）进行了比较。根据 SRS-Schwab 冠状曲线类型和结构长度进行节段前凸分析，评估与节段和整体前凸目标的校正不足、匹配或过度：在785名患者中，430人（55%）为初次手术，355人（45%）为翻修手术。翻修手术包括181例（23%）长矫正和174例（22%）短矫正。短矫正的失败模式包括：27%植入失败、40%连接失败、73%错位失败和/或28%神经失败。与初治患者相比，短治患者年龄更大、更虚弱、基线畸形（PT、PI-LL、SVA）和PROMs（NRS、ODI、VR-12、SRS-22）更差（P 结论：近一半的成年脊柱畸形患者接受了短治：近一半的成人脊柱畸形手术是翻修融合术。翻修短融合术与矢状位错位有关，通常是由于节段前凸目标矫正不足所致，而且经常需要更多的侵入性手术。需要进一步采取措施优化腰椎融合术的对位，以避免昂贵的侵入性畸形矫正：证据级别：IV：诊断性：具有一致参考标准和盲法的个体横断面研究。

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

European Spine Journal 医学-临床神经学

CiteScore

4.80

自引率

10.70%

发文量

373

审稿时长

2-4 weeks

期刊介绍： "European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts. Official publication of EUROSPINE, The Spine Society of Europe