Outcomes of Surgical Treatment for 138 Patients with Severe Sagittal Deformity at a Minimum 2-Year Follow-up: A Case Series

on behalf of The International Spine Study Group

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


BACKGROUND: Operative treatment of adult spinal deformity (ASD) can be very challenging with high complication rates. It is well established that patients benefit from such treatment; however, the surgical outcomes for patients with severe sagittal deformity have not been reported. OBJECTIVE: To report the outcomes of patients undergoing surgical correction for severe sagittal deformity. METHODS: Retrospective review of a prospective, multicenter ASD database. Inclusion criteria: operative patients age ≥18, sagittal vertical axis (SVA) ≥15 cm, mismatch between pelvic incidence and lumbar lordosis (PI-LL) ≥30°, and/or lumbar kyphosis ≥5° with minimum 2 yr follow-up. Health-related quality of life (HRQOL) scores including minimal clinically important difference (MCID)/substantial clinical benefit (SCB), sagittal and coronal radiographic values, demographic, frailty, surgical, and complication data were collected. Comparisons between 2 yr postoperative and baseline HRQOL/radiographic data were made. P <. 05 was significant. RESULTS: A total of 138 patients were included from 502 operative patients (54.3% Female, Average (Avg) age 63.3 ± 11.5 yr). Avg operating room (OR) time 386.2 ± 136.5 min, estimated blood loss (EBL) 1829.8 ± 1474.6 cc. A total of 71(51.4%) had prior fusion. A total of 89.9% were posterior fusion only. Mean posterior levels fused 11.5 ± 4.1. A total of 44.9% had a 3-column osteotomy. All 2 yr postoperative radiographic parameters were significantly improved compared to baseline (P <. 001 for all). All 2yr HRQOL measures were significantly improved compared to baseline (P <. 004 for all). A total of 46.6% to 73.8% of patients met either MCID/SCB for all HRQOL. A total of 74.6% of patients had at least 1 complication, 11.6% had 4 or more complications, 33.3% had minimum 1 major complication, and 42(30.4%) had a postop revision. CONCLUSION: Patients with severe sagittal malalignment benefit from surgical correction at 2 yr postoperative both radiographically and clinically despite having a high complication rate.

Original languageEnglish (US)
Pages (from-to)94-103
Number of pages10
JournalOperative Neurosurgery
Issue number3
StatePublished - Sep 1 2021


  • Adult spinal deformity
  • Complications
  • MCID
  • Outcomes
  • Sagittal malalignment
  • SCB
  • Severe

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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