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World Neurosurg. 2018 Jun;114:e775-e784. doi: 10.1016/j.wneu.2018.03.079. Epub 2018 Mar 16.

Full-Body Analysis of Adult Spinal Deformity Patients' Age-Adjusted Alignment at 1 Year.

Author information

1
Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York, USA. Electronic address: Peter.Passias@nyumc.org.
2
Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York, USA.
3
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, USA.
4
Department of Orthopaedics, Hospital for Special Surgery, New York, New York, USA.

Abstract

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.

KEYWORDS:

Adult spinal deformity; Age-adjusted alignment; Compensation; Pelvic tilt; Radiographic alignment; Sagittal vertical axis; T1 pelvic angle

PMID:
29555609
DOI:
10.1016/j.wneu.2018.03.079
[Indexed for MEDLINE]

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