Oluwatobi O Onafowokan, Oscar Krol, Virginie Lafage, Renaud Lafage, Justin S Smith, Breton Line, Shaleen Vira, Alan H Daniels, Bassel Diebo, Andrew J Schoenfeld, Jeffrey Gum, Khaled Kebaish, Khoi Than, Han Jo Kim, Richard Hostin, Munish Gupta, Robert Eastlack, Douglas Burton, Frank J Schwab, Christopher Shaffrey, Eric O Klineberg, Shay Bess, Peter G Passias
{"title":"全球对齐比例评分的哪些部分对成人脊柱畸形矫正手术的结果影响最大？","authors":"Oluwatobi O Onafowokan, Oscar Krol, Virginie Lafage, Renaud Lafage, Justin S Smith, Breton Line, Shaleen Vira, Alan H Daniels, Bassel Diebo, Andrew J Schoenfeld, Jeffrey Gum, Khaled Kebaish, Khoi Than, Han Jo Kim, Richard Hostin, Munish Gupta, Robert Eastlack, Douglas Burton, Frank J Schwab, Christopher Shaffrey, Eric O Klineberg, Shay Bess, Peter G Passias","doi":"10.1007/s00586-024-08540-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the impact of the Global Alignment and Proportion (GAP) score components on patient outcomes in Adult Spine Deformity (ASD) surgery.</p><p><strong>Methods: </strong>Patients included underwent assessment via the GAP score and its individual components: pelvic version (GAP PV), lumbar lordosis (GAP LL), lumbar distribution index (GAP LDI) and spinopelvic component (GAP SP). Multivariable analyses assessed the association between alignment in these components and clinical outcomes in ASD patients.</p><p><strong>Results: </strong>762 ASD patients met inclusion criteria. Alignment in GAP SP independently predicted meeting MCID for SR-22S and ODI and was associated with a lower likelihood of developing mechanical complications. Patients aligned in GAP SP were less likely to develop proximal junctional kyphosis (OR 0.42, 0.26-0.73, p = 0.01) and PJF (OR 0.3, 0.13-0.74, p = 0.01). Proportioned alignment in GAP SP with disproportioned alignment in GAP LDI contributed to an increased risk of PJK and PJF (OR 2.67, 95% CI 1.95-6.82, p = 0.045). There was no significant association of GAP SP proportionality and GAP RPV (OR 1.1, 0.86-2.15, p = 0.253) or GAP LL (OR 1.34, 0.78-4.23, p = 0.673) disproportionality with outcomes. Disproportioned alignment in GAP SP but proportioned alignment in both GAP LL and GAP LDI was associated with decreased likelihood of PJK (OR 0.53, 95% CI 0.39-0.94, p = 0.02) and PJF (OR 0.31, 95% CI 0.19-0.67, p = 0.001).</p><p><strong>Conclusion: </strong>The spinopelvic component of the GAP score is the most significant independent predictor of clinical outcomes. Its interaction with the other components of the GAP score also aids assessment of the risk for mechanical complications.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Which components of the global alignment proportionality score have the greatest impact on outcomes in adult spinal deformity corrective surgery?\",\"authors\":\"Oluwatobi O Onafowokan, Oscar Krol, Virginie Lafage, Renaud Lafage, Justin S Smith, Breton Line, Shaleen Vira, Alan H Daniels, Bassel Diebo, Andrew J Schoenfeld, Jeffrey Gum, Khaled Kebaish, Khoi Than, Han Jo Kim, Richard Hostin, Munish Gupta, Robert Eastlack, Douglas Burton, Frank J Schwab, Christopher Shaffrey, Eric O Klineberg, Shay Bess, Peter G Passias\",\"doi\":\"10.1007/s00586-024-08540-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To investigate the impact of the Global Alignment and Proportion (GAP) score components on patient outcomes in Adult Spine Deformity (ASD) surgery.</p><p><strong>Methods: </strong>Patients included underwent assessment via the GAP score and its individual components: pelvic version (GAP PV), lumbar lordosis (GAP LL), lumbar distribution index (GAP LDI) and spinopelvic component (GAP SP). Multivariable analyses assessed the association between alignment in these components and clinical outcomes in ASD patients.</p><p><strong>Results: </strong>762 ASD patients met inclusion criteria. Alignment in GAP SP independently predicted meeting MCID for SR-22S and ODI and was associated with a lower likelihood of developing mechanical complications. Patients aligned in GAP SP were less likely to develop proximal junctional kyphosis (OR 0.42, 0.26-0.73, p = 0.01) and PJF (OR 0.3, 0.13-0.74, p = 0.01). Proportioned alignment in GAP SP with disproportioned alignment in GAP LDI contributed to an increased risk of PJK and PJF (OR 2.67, 95% CI 1.95-6.82, p = 0.045). There was no significant association of GAP SP proportionality and GAP RPV (OR 1.1, 0.86-2.15, p = 0.253) or GAP LL (OR 1.34, 0.78-4.23, p = 0.673) disproportionality with outcomes. Disproportioned alignment in GAP SP but proportioned alignment in both GAP LL and GAP LDI was associated with decreased likelihood of PJK (OR 0.53, 95% CI 0.39-0.94, p = 0.02) and PJF (OR 0.31, 95% CI 0.19-0.67, p = 0.001).</p><p><strong>Conclusion: </strong>The spinopelvic component of the GAP score is the most significant independent predictor of clinical outcomes. Its interaction with the other components of the GAP score also aids assessment of the risk for mechanical complications.</p>\",\"PeriodicalId\":12323,\"journal\":{\"name\":\"European Spine Journal\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-11-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Spine Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00586-024-08540-y\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00586-024-08540-y","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：研究全球对齐与比例（GAP）评分对成人脊柱畸形（ASD）手术患者预后的影响：纳入的患者通过 GAP 评分及其各个组成部分进行评估：骨盆版本（GAP PV）、腰椎前凸（GAP LL）、腰椎分布指数（GAP LDI）和脊柱骨盆组成部分（GAP SP）。多变量分析评估了这些组件的排列与 ASD 患者临床预后之间的关系：762名ASD患者符合纳入标准。GAP SP对齐可独立预测SR-22S和ODI是否符合MCID，并与发生机械并发症的可能性较低有关。按GAP SP排列的患者发生近端交界性脊柱侧弯（OR 0.42, 0.26-0.73, p = 0.01）和PJF（OR 0.3, 0.13-0.74, p = 0.01）的可能性较低。GAP SP 中的比例排列与 GAP LDI 中的比例失调排列导致 PJK 和 PJF 风险增加（OR 2.67，95% CI 1.95-6.82，p = 0.045）。GAP SP比例失调和GAP RPV（OR 1.1，0.86-2.15，p = 0.253）或GAP LL（OR 1.34，0.78-4.23，p = 0.673）比例失调与结果无明显关联。GAP SP中的不成比例排列与PJK（OR 0.53，95% CI 0.39-0.94，p = 0.02）和PJF（OR 0.31，95% CI 0.19-0.67，p = 0.001）的可能性降低相关，但GAP LL和GAP LDI中的不成比例排列与PJK（OR 0.53，95% CI 0.39-0.94，p = 0.001）和PJF（OR 0.31，95% CI 0.19-0.67，p = 0.001）的可能性降低相关：结论：GAP评分中的脊柱骨盆部分是临床结果最重要的独立预测指标。结论：GAP评分中的脊柱部分是最重要的独立临床预后预测因子，它与GAP评分其他部分的相互作用也有助于评估机械并发症的风险。
Which components of the global alignment proportionality score have the greatest impact on outcomes in adult spinal deformity corrective surgery?
Purpose: To investigate the impact of the Global Alignment and Proportion (GAP) score components on patient outcomes in Adult Spine Deformity (ASD) surgery.
Methods: Patients included underwent assessment via the GAP score and its individual components: pelvic version (GAP PV), lumbar lordosis (GAP LL), lumbar distribution index (GAP LDI) and spinopelvic component (GAP SP). Multivariable analyses assessed the association between alignment in these components and clinical outcomes in ASD patients.
Results: 762 ASD patients met inclusion criteria. Alignment in GAP SP independently predicted meeting MCID for SR-22S and ODI and was associated with a lower likelihood of developing mechanical complications. Patients aligned in GAP SP were less likely to develop proximal junctional kyphosis (OR 0.42, 0.26-0.73, p = 0.01) and PJF (OR 0.3, 0.13-0.74, p = 0.01). Proportioned alignment in GAP SP with disproportioned alignment in GAP LDI contributed to an increased risk of PJK and PJF (OR 2.67, 95% CI 1.95-6.82, p = 0.045). There was no significant association of GAP SP proportionality and GAP RPV (OR 1.1, 0.86-2.15, p = 0.253) or GAP LL (OR 1.34, 0.78-4.23, p = 0.673) disproportionality with outcomes. Disproportioned alignment in GAP SP but proportioned alignment in both GAP LL and GAP LDI was associated with decreased likelihood of PJK (OR 0.53, 95% CI 0.39-0.94, p = 0.02) and PJF (OR 0.31, 95% CI 0.19-0.67, p = 0.001).
Conclusion: The spinopelvic component of the GAP score is the most significant independent predictor of clinical outcomes. Its interaction with the other components of the GAP score also aids assessment of the risk for mechanical complications.
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
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