Andrew K Chan, Shailen G Sampath, Praveen V Mummaneni, Paul Park, Juan S Uribe, Jay D Turner, Vivian P Le, Robert K Eastlack, Richard G Fessler, Khoi D Than, Kai-Ming Fu, Michael Y Wang, Adam S Kanter, David O Okonkwo, Pierce D Nunley, Neel Anand, Gregory M Mundis, Peter G Passias, Shay Bess, Christopher I Shaffrey, Dean Chou
{"title":"微创治疗成人脊柱畸形的侧腰椎椎间融合术后冠状位错位的发生率和预后。","authors":"Andrew K Chan, Shailen G Sampath, Praveen V Mummaneni, Paul Park, Juan S Uribe, Jay D Turner, Vivian P Le, Robert K Eastlack, Richard G Fessler, Khoi D Than, Kai-Ming Fu, Michael Y Wang, Adam S Kanter, David O Okonkwo, Pierce D Nunley, Neel Anand, Gregory M Mundis, Peter G Passias, Shay Bess, Christopher I Shaffrey, Dean Chou","doi":"10.1097/BRS.0000000000005191","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of prospective multicenter adult spinal deformity (ASD) database.</p><p><strong>Objective: </strong>To determine the prevalence and prognosis of postoperative coronal malalignment following LLIF for ASD with Qiu type A coronal alignment.</p><p><strong>Summary of background data: </strong>Qiu Type A coronal alignment is defined as coronal vertical axis (CVA) <30mm.1 There is concern that circumferential minimally invasive surgery (cMIS) with lateral lumbar interbody fusion (LLIF) is associated with postoperative coronal malalignment in ASD with preoperative Qiu type A patients.</p><p><strong>Methods: </strong>Qui type A patients undergoing cMIS with LLIF for ASD were included, with ASD defined with at least: maximum CC≥20°, SVA>5 cm, PI-LL≥10°, or PT>20°. Two year (2Y) clinical outcomes were compared for type A with 2Y CVA≥30 mm (MAL) versus <30 mm (ALIGN) and were adjusted for factors reaching P<0.05 on univariate comparisons (age, BMI, and ODI).</p><p><strong>Results: </strong>43 patients met inclusion criteria, of which 12 (27.9%) developed coronal malalignment and 31 (72.1%) remained coronally aligned at 2Y. At baseline, MAL were older (73.0 vs. 69.0, P=0.045), had a lower BMI (26.09 vs. 29.45, P=0.047), and were less disabled (ODI 42.83 vs. 51.69, P=0.016). Otherwise, the groups were well-matched for baseline characteristics. At 2Y, MAL had a greater 2Y SVA (mean 54.08 vs 19.00 mm, P=0.01). Clinically, MAL was associated with inferior 2Y SF-36 PCS (34.78 vs. 37.42, adj P=0.043) and 2Y SRS-22r function/activity domain (3.03 vs. 3.36, adj P=0.040), but otherwise similar in other patient-reported-outcome-metrics (adj P>0.05 for all). 2Y complications were similar between groups, including for reoperations and major and minor complications (adj P>0.05 for all).</p><p><strong>Conclusions: </strong>In Qui type A patients undergoing cMIS with LLIF for ASD, 27.9% develop coronal malalignment, which was associated with worse SF-36 PCS and SRS-22r function/activity. Despite radiographic malalignment, malalignment was not associated with higher 2-year complication rates including reoperations.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence and Prognosis of Coronal Malalignment Following Lateral Lumbar Interbody Fusion for Minimally Invasive Treatment of Adult Spinal Deformity.\",\"authors\":\"Andrew K Chan, Shailen G Sampath, Praveen V Mummaneni, Paul Park, Juan S Uribe, Jay D Turner, Vivian P Le, Robert K Eastlack, Richard G Fessler, Khoi D Than, Kai-Ming Fu, Michael Y Wang, Adam S Kanter, David O Okonkwo, Pierce D Nunley, Neel Anand, Gregory M Mundis, Peter G Passias, Shay Bess, Christopher I Shaffrey, Dean Chou\",\"doi\":\"10.1097/BRS.0000000000005191\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective analysis of prospective multicenter adult spinal deformity (ASD) database.</p><p><strong>Objective: </strong>To determine the prevalence and prognosis of postoperative coronal malalignment following LLIF for ASD with Qiu type A coronal alignment.</p><p><strong>Summary of background data: </strong>Qiu Type A coronal alignment is defined as coronal vertical axis (CVA) <30mm.1 There is concern that circumferential minimally invasive surgery (cMIS) with lateral lumbar interbody fusion (LLIF) is associated with postoperative coronal malalignment in ASD with preoperative Qiu type A patients.</p><p><strong>Methods: </strong>Qui type A patients undergoing cMIS with LLIF for ASD were included, with ASD defined with at least: maximum CC≥20°, SVA>5 cm, PI-LL≥10°, or PT>20°. Two year (2Y) clinical outcomes were compared for type A with 2Y CVA≥30 mm (MAL) versus <30 mm (ALIGN) and were adjusted for factors reaching P<0.05 on univariate comparisons (age, BMI, and ODI).</p><p><strong>Results: </strong>43 patients met inclusion criteria, of which 12 (27.9%) developed coronal malalignment and 31 (72.1%) remained coronally aligned at 2Y. At baseline, MAL were older (73.0 vs. 69.0, P=0.045), had a lower BMI (26.09 vs. 29.45, P=0.047), and were less disabled (ODI 42.83 vs. 51.69, P=0.016). Otherwise, the groups were well-matched for baseline characteristics. At 2Y, MAL had a greater 2Y SVA (mean 54.08 vs 19.00 mm, P=0.01). Clinically, MAL was associated with inferior 2Y SF-36 PCS (34.78 vs. 37.42, adj P=0.043) and 2Y SRS-22r function/activity domain (3.03 vs. 3.36, adj P=0.040), but otherwise similar in other patient-reported-outcome-metrics (adj P>0.05 for all). 2Y complications were similar between groups, including for reoperations and major and minor complications (adj P>0.05 for all).</p><p><strong>Conclusions: </strong>In Qui type A patients undergoing cMIS with LLIF for ASD, 27.9% develop coronal malalignment, which was associated with worse SF-36 PCS and SRS-22r function/activity. Despite radiographic malalignment, malalignment was not associated with higher 2-year complication rates including reoperations.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-11-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005191\",\"RegionNum\":2,\"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":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005191","RegionNum":2,"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
研究设计对前瞻性多中心成人脊柱畸形（ASD）数据库进行回顾性分析：目的：确定邱氏A型冠状对位ASD LLIF术后冠状错位的发生率和预后：邱氏A型冠状对位定义为冠状垂直轴（CVA）方法：纳入接受cMIS与LLIF治疗ASD的邱氏A型患者，ASD的定义至少包括：最大CC≥20°、SVA>5 cm、PI-LL≥10°或PT>20°。对 2 年 CVA≥30 mm（MAL）的 A 型患者与 2 年 CVA≥30 mm（MAL）的 A 型患者的两年（2Y）临床结果进行比较：43 名患者符合纳入标准，其中 12 人（27.9%）出现冠状位错位，31 人（72.1%）在 2 年后仍保持冠状位对齐。基线时，MAL 年龄较大（73.0 对 69.0，P=0.045），体重指数较低（26.09 对 29.45，P=0.047），残疾程度较轻（ODI 42.83 对 51.69，P=0.016）。除此之外，两组的基线特征完全匹配。2 年后，MAL 的 2 年 SVA 更大（平均 54.08 mm vs 19.00 mm，P=0.01）。在临床上，MAL 的 2Y SF-36 PCS（34.78 vs. 37.42，adj P=0.043）和 2Y SRS-22r 功能/活动域（3.03 vs. 3.36，adj P=0.040）较差，但在其他患者报告的结果指标方面相似（所有指标的adj P>0.05）。两组患者的2年并发症相似，包括再次手术以及主要和次要并发症（所有数据的校正P>0.05）：结论：在接受cMIS与LLIF治疗ASD的A型魁北克患者中，27.9%出现冠状位错位，这与SF-36 PCS和SRS-22r功能/活动能力下降有关。尽管存在放射学上的错位，但错位与较高的2年并发症（包括再次手术）发生率无关。
Prevalence and Prognosis of Coronal Malalignment Following Lateral Lumbar Interbody Fusion for Minimally Invasive Treatment of Adult Spinal Deformity.
Study design: Retrospective analysis of prospective multicenter adult spinal deformity (ASD) database.
Objective: To determine the prevalence and prognosis of postoperative coronal malalignment following LLIF for ASD with Qiu type A coronal alignment.
Summary of background data: Qiu Type A coronal alignment is defined as coronal vertical axis (CVA) <30mm.1 There is concern that circumferential minimally invasive surgery (cMIS) with lateral lumbar interbody fusion (LLIF) is associated with postoperative coronal malalignment in ASD with preoperative Qiu type A patients.
Methods: Qui type A patients undergoing cMIS with LLIF for ASD were included, with ASD defined with at least: maximum CC≥20°, SVA>5 cm, PI-LL≥10°, or PT>20°. Two year (2Y) clinical outcomes were compared for type A with 2Y CVA≥30 mm (MAL) versus <30 mm (ALIGN) and were adjusted for factors reaching P<0.05 on univariate comparisons (age, BMI, and ODI).
Results: 43 patients met inclusion criteria, of which 12 (27.9%) developed coronal malalignment and 31 (72.1%) remained coronally aligned at 2Y. At baseline, MAL were older (73.0 vs. 69.0, P=0.045), had a lower BMI (26.09 vs. 29.45, P=0.047), and were less disabled (ODI 42.83 vs. 51.69, P=0.016). Otherwise, the groups were well-matched for baseline characteristics. At 2Y, MAL had a greater 2Y SVA (mean 54.08 vs 19.00 mm, P=0.01). Clinically, MAL was associated with inferior 2Y SF-36 PCS (34.78 vs. 37.42, adj P=0.043) and 2Y SRS-22r function/activity domain (3.03 vs. 3.36, adj P=0.040), but otherwise similar in other patient-reported-outcome-metrics (adj P>0.05 for all). 2Y complications were similar between groups, including for reoperations and major and minor complications (adj P>0.05 for all).
Conclusions: In Qui type A patients undergoing cMIS with LLIF for ASD, 27.9% develop coronal malalignment, which was associated with worse SF-36 PCS and SRS-22r function/activity. Despite radiographic malalignment, malalignment was not associated with higher 2-year complication rates including reoperations.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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