Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone

Tamir Ailon, Justin K. Scheer, Virginie Lafage, Frank J. Schwab, Eric Otto Klineberg, Daniel M. Sciubba, Themistocles S. Protopsaltis, Lukas Zebala, Richard Hostin, Ibrahim Obeid, Tyler Koski, Michael P. Kelly, Shay Bess, Christopher I. Shaffrey, Justin S. Smith, Christopher P. Ames

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Object Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons' ability to accurately predict postoperative alignment. Methods Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician. Surgeon training, practice characteristics, and use of surgical planning software was assessed. Participants predicted if the surgical plan would lead to adequate deformity correction and attempted to predict postoperative radiographic parameters including sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence to lumbar lordosis mismatch (PI-LL), thoracic kyphosis (TK). Results Seventeen surgeons participated: 71% within 0 to 10 years of practice; 88% devote >25% of their practice to deformity surgery. Surgeons accurately judged adequacy of the surgical plan to achieve correction to specific thresholds of SVA 69% ± 8%, PT 68% ± 9%, and PI-LL 68% ± 11% of the time. However, surgeons correctly predicted the actual postoperative radiographic parameters only 42% ± 6% of the time. They were more successful at predicting PT (61% ± 10%) than SVA (45% ± 8%), PI-LL (26% ± 11%), or TK change (35% ± 21%; p <.05). Improved performance correlated with greater focus on deformity but not number of years in practice or number of three-column osteotomies performed per year. Conclusion Surgeons failed to correctly predict the adequacy of the proposed surgical plan in approximately one third of presented cases. They were better at determining whether a surgical plan would achieve adequate correction than predicting specific postoperative alignment parameters. Pelvic tilt and SVA were predicted with the greatest accuracy.

Original languageEnglish (US)
Pages (from-to)323-329
Number of pages7
JournalSpine Deformity
Volume4
Issue number4
DOIs
StatePublished - Jul 1 2016

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Lordosis
Kyphosis
Incidence
Thorax
Aptitude
Osteotomy
Surgeons
Software
Quality of Life
Physicians

Keywords

  • Adult scoliosis
  • Adult spinal deformity
  • Deformity correction
  • Spinal alignment
  • Surgical planning

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone. / Ailon, Tamir; Scheer, Justin K.; Lafage, Virginie; Schwab, Frank J.; Klineberg, Eric Otto; Sciubba, Daniel M.; Protopsaltis, Themistocles S.; Zebala, Lukas; Hostin, Richard; Obeid, Ibrahim; Koski, Tyler; Kelly, Michael P.; Bess, Shay; Shaffrey, Christopher I.; Smith, Justin S.; Ames, Christopher P.

In: Spine Deformity, Vol. 4, No. 4, 01.07.2016, p. 323-329.

Research output: Contribution to journalArticle

Ailon, T, Scheer, JK, Lafage, V, Schwab, FJ, Klineberg, EO, Sciubba, DM, Protopsaltis, TS, Zebala, L, Hostin, R, Obeid, I, Koski, T, Kelly, MP, Bess, S, Shaffrey, CI, Smith, JS & Ames, CP 2016, 'Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone', Spine Deformity, vol. 4, no. 4, pp. 323-329. https://doi.org/10.1016/j.jspd.2016.02.003
Ailon, Tamir ; Scheer, Justin K. ; Lafage, Virginie ; Schwab, Frank J. ; Klineberg, Eric Otto ; Sciubba, Daniel M. ; Protopsaltis, Themistocles S. ; Zebala, Lukas ; Hostin, Richard ; Obeid, Ibrahim ; Koski, Tyler ; Kelly, Michael P. ; Bess, Shay ; Shaffrey, Christopher I. ; Smith, Justin S. ; Ames, Christopher P. / Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone. In: Spine Deformity. 2016 ; Vol. 4, No. 4. pp. 323-329.
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abstract = "Object Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons' ability to accurately predict postoperative alignment. Methods Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician. Surgeon training, practice characteristics, and use of surgical planning software was assessed. Participants predicted if the surgical plan would lead to adequate deformity correction and attempted to predict postoperative radiographic parameters including sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence to lumbar lordosis mismatch (PI-LL), thoracic kyphosis (TK). Results Seventeen surgeons participated: 71{\%} within 0 to 10 years of practice; 88{\%} devote >25{\%} of their practice to deformity surgery. Surgeons accurately judged adequacy of the surgical plan to achieve correction to specific thresholds of SVA 69{\%} ± 8{\%}, PT 68{\%} ± 9{\%}, and PI-LL 68{\%} ± 11{\%} of the time. However, surgeons correctly predicted the actual postoperative radiographic parameters only 42{\%} ± 6{\%} of the time. They were more successful at predicting PT (61{\%} ± 10{\%}) than SVA (45{\%} ± 8{\%}), PI-LL (26{\%} ± 11{\%}), or TK change (35{\%} ± 21{\%}; p <.05). Improved performance correlated with greater focus on deformity but not number of years in practice or number of three-column osteotomies performed per year. Conclusion Surgeons failed to correctly predict the adequacy of the proposed surgical plan in approximately one third of presented cases. They were better at determining whether a surgical plan would achieve adequate correction than predicting specific postoperative alignment parameters. Pelvic tilt and SVA were predicted with the greatest accuracy.",
keywords = "Adult scoliosis, Adult spinal deformity, Deformity correction, Spinal alignment, Surgical planning",
author = "Tamir Ailon and Scheer, {Justin K.} and Virginie Lafage and Schwab, {Frank J.} and Klineberg, {Eric Otto} and Sciubba, {Daniel M.} and Protopsaltis, {Themistocles S.} and Lukas Zebala and Richard Hostin and Ibrahim Obeid and Tyler Koski and Kelly, {Michael P.} and Shay Bess and Shaffrey, {Christopher I.} and Smith, {Justin S.} and Ames, {Christopher P.}",
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T1 - Adult Spinal Deformity Surgeons Are Unable to Accurately Predict Postoperative Spinal Alignment Using Clinical Judgment Alone

AU - Ailon, Tamir

AU - Scheer, Justin K.

AU - Lafage, Virginie

AU - Schwab, Frank J.

AU - Klineberg, Eric Otto

AU - Sciubba, Daniel M.

AU - Protopsaltis, Themistocles S.

AU - Zebala, Lukas

AU - Hostin, Richard

AU - Obeid, Ibrahim

AU - Koski, Tyler

AU - Kelly, Michael P.

AU - Bess, Shay

AU - Shaffrey, Christopher I.

AU - Smith, Justin S.

AU - Ames, Christopher P.

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N2 - Object Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons' ability to accurately predict postoperative alignment. Methods Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician. Surgeon training, practice characteristics, and use of surgical planning software was assessed. Participants predicted if the surgical plan would lead to adequate deformity correction and attempted to predict postoperative radiographic parameters including sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence to lumbar lordosis mismatch (PI-LL), thoracic kyphosis (TK). Results Seventeen surgeons participated: 71% within 0 to 10 years of practice; 88% devote >25% of their practice to deformity surgery. Surgeons accurately judged adequacy of the surgical plan to achieve correction to specific thresholds of SVA 69% ± 8%, PT 68% ± 9%, and PI-LL 68% ± 11% of the time. However, surgeons correctly predicted the actual postoperative radiographic parameters only 42% ± 6% of the time. They were more successful at predicting PT (61% ± 10%) than SVA (45% ± 8%), PI-LL (26% ± 11%), or TK change (35% ± 21%; p <.05). Improved performance correlated with greater focus on deformity but not number of years in practice or number of three-column osteotomies performed per year. Conclusion Surgeons failed to correctly predict the adequacy of the proposed surgical plan in approximately one third of presented cases. They were better at determining whether a surgical plan would achieve adequate correction than predicting specific postoperative alignment parameters. Pelvic tilt and SVA were predicted with the greatest accuracy.

AB - Object Adult spinal deformity (ASD) surgery seeks to reduce disability and improve quality of life through restoration of spinal alignment. In particular, correction of sagittal malalignment is correlated with patient outcome. Inadequate correction of sagittal deformity is not infrequent. The present study assessed surgeons' ability to accurately predict postoperative alignment. Methods Seventeen cases were presented with preoperative radiographic measurements, and a summary of the operation as performed by the treating physician. Surgeon training, practice characteristics, and use of surgical planning software was assessed. Participants predicted if the surgical plan would lead to adequate deformity correction and attempted to predict postoperative radiographic parameters including sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence to lumbar lordosis mismatch (PI-LL), thoracic kyphosis (TK). Results Seventeen surgeons participated: 71% within 0 to 10 years of practice; 88% devote >25% of their practice to deformity surgery. Surgeons accurately judged adequacy of the surgical plan to achieve correction to specific thresholds of SVA 69% ± 8%, PT 68% ± 9%, and PI-LL 68% ± 11% of the time. However, surgeons correctly predicted the actual postoperative radiographic parameters only 42% ± 6% of the time. They were more successful at predicting PT (61% ± 10%) than SVA (45% ± 8%), PI-LL (26% ± 11%), or TK change (35% ± 21%; p <.05). Improved performance correlated with greater focus on deformity but not number of years in practice or number of three-column osteotomies performed per year. Conclusion Surgeons failed to correctly predict the adequacy of the proposed surgical plan in approximately one third of presented cases. They were better at determining whether a surgical plan would achieve adequate correction than predicting specific postoperative alignment parameters. Pelvic tilt and SVA were predicted with the greatest accuracy.

KW - Adult scoliosis

KW - Adult spinal deformity

KW - Deformity correction

KW - Spinal alignment

KW - Surgical planning

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