Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity

Virginie Lafage, Justin S. Smith, Shay Bess, Frank J. Schwab, Christopher P. Ames, Eric Otto Klineberg, Vincent Arlet, Richard Hostin, Douglas C. Burton, Christopher I. Shaffrey

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Purpose Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD). Methods Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO. Radiographic measures included: correction at the osteotomy site, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were assessed to determine if ideal SPA (SVA<4 cm, PT<25°) was achieved. Differences between the ideal (IDEAL) and failed (FAIL) SPA groups were evaluated. Results A total of 41 consecutive ASD patients treated with TCTO were evaluated. TCTO significantly decreased TK, maximum coronal Cobb angle, SVA and PT (P<0.05). Ideal SPA was achieved in 32 (78%) and failed in 9 (22%) patients. The IDEAL and FAIL groups had similar total fusion levels and similar focal, SVA and PT correction (P[0.05). FAIL group had larger pre- and post-operative SVA, PT and PI and a smaller LL than IDEAL (P<0.05). Conclusions Poor SPA occurred in 22% of TCTO patients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater preoperative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.

Original languageEnglish (US)
Pages (from-to)698-704
Number of pages7
JournalEuropean Spine Journal
Volume21
Issue number4
DOIs
StatePublished - Apr 2012

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Osteotomy
Thorax
Lordosis
Kyphosis
Incidence
Operative Surgical Procedures

Keywords

  • Osteotomy
  • Pedicle subtraction osteotomy
  • Sagittal vertical axis
  • Spinopelvic alignment
  • Thoracic
  • Vertebral column resection

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity. / Lafage, Virginie; Smith, Justin S.; Bess, Shay; Schwab, Frank J.; Ames, Christopher P.; Klineberg, Eric Otto; Arlet, Vincent; Hostin, Richard; Burton, Douglas C.; Shaffrey, Christopher I.

In: European Spine Journal, Vol. 21, No. 4, 04.2012, p. 698-704.

Research output: Contribution to journalArticle

Lafage, V, Smith, JS, Bess, S, Schwab, FJ, Ames, CP, Klineberg, EO, Arlet, V, Hostin, R, Burton, DC & Shaffrey, CI 2012, 'Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity', European Spine Journal, vol. 21, no. 4, pp. 698-704. https://doi.org/10.1007/s00586-011-1967-3
Lafage, Virginie ; Smith, Justin S. ; Bess, Shay ; Schwab, Frank J. ; Ames, Christopher P. ; Klineberg, Eric Otto ; Arlet, Vincent ; Hostin, Richard ; Burton, Douglas C. ; Shaffrey, Christopher I. / Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity. In: European Spine Journal. 2012 ; Vol. 21, No. 4. pp. 698-704.
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abstract = "Purpose Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD). Methods Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO. Radiographic measures included: correction at the osteotomy site, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were assessed to determine if ideal SPA (SVA<4 cm, PT<25°) was achieved. Differences between the ideal (IDEAL) and failed (FAIL) SPA groups were evaluated. Results A total of 41 consecutive ASD patients treated with TCTO were evaluated. TCTO significantly decreased TK, maximum coronal Cobb angle, SVA and PT (P<0.05). Ideal SPA was achieved in 32 (78{\%}) and failed in 9 (22{\%}) patients. The IDEAL and FAIL groups had similar total fusion levels and similar focal, SVA and PT correction (P[0.05). FAIL group had larger pre- and post-operative SVA, PT and PI and a smaller LL than IDEAL (P<0.05). Conclusions Poor SPA occurred in 22{\%} of TCTO patients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater preoperative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.",
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author = "Virginie Lafage and Smith, {Justin S.} and Shay Bess and Schwab, {Frank J.} and Ames, {Christopher P.} and Klineberg, {Eric Otto} and Vincent Arlet and Richard Hostin and Burton, {Douglas C.} and Shaffrey, {Christopher I.}",
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T1 - Sagittal spino-pelvic alignment failures following three column thoracic osteotomy for adult spinal deformity

AU - Lafage, Virginie

AU - Smith, Justin S.

AU - Bess, Shay

AU - Schwab, Frank J.

AU - Ames, Christopher P.

AU - Klineberg, Eric Otto

AU - Arlet, Vincent

AU - Hostin, Richard

AU - Burton, Douglas C.

AU - Shaffrey, Christopher I.

PY - 2012/4

Y1 - 2012/4

N2 - Purpose Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD). Methods Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO. Radiographic measures included: correction at the osteotomy site, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were assessed to determine if ideal SPA (SVA<4 cm, PT<25°) was achieved. Differences between the ideal (IDEAL) and failed (FAIL) SPA groups were evaluated. Results A total of 41 consecutive ASD patients treated with TCTO were evaluated. TCTO significantly decreased TK, maximum coronal Cobb angle, SVA and PT (P<0.05). Ideal SPA was achieved in 32 (78%) and failed in 9 (22%) patients. The IDEAL and FAIL groups had similar total fusion levels and similar focal, SVA and PT correction (P[0.05). FAIL group had larger pre- and post-operative SVA, PT and PI and a smaller LL than IDEAL (P<0.05). Conclusions Poor SPA occurred in 22% of TCTO patients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater preoperative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.

AB - Purpose Three column thoracic osteotomy (TCTO) is effective to correct rigid thoracic deformities, however, reasons for residual postoperative spinal deformity are poorly defined. Our objective was to evaluate risk factors for poor spino-pelvic alignment (SPA) following TCTO for adult spinal deformity (ASD). Methods Multicenter, retrospective radiographic analysis of ASD patients treated with TCTO. Radiographic measures included: correction at the osteotomy site, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence (PI). Final SVA and PT were assessed to determine if ideal SPA (SVA<4 cm, PT<25°) was achieved. Differences between the ideal (IDEAL) and failed (FAIL) SPA groups were evaluated. Results A total of 41 consecutive ASD patients treated with TCTO were evaluated. TCTO significantly decreased TK, maximum coronal Cobb angle, SVA and PT (P<0.05). Ideal SPA was achieved in 32 (78%) and failed in 9 (22%) patients. The IDEAL and FAIL groups had similar total fusion levels and similar focal, SVA and PT correction (P[0.05). FAIL group had larger pre- and post-operative SVA, PT and PI and a smaller LL than IDEAL (P<0.05). Conclusions Poor SPA occurred in 22% of TCTO patients despite similar operative procedures and deformity correction as patients in the IDEAL group. Greater preoperative PT and SVA predicted failed post-operative SPA. Alternative or additional correction procedures should be considered when planning TCTO for patients with large sagittal global malalignment, otherwise patients are at risk for suboptimal correction and poor outcomes.

KW - Osteotomy

KW - Pedicle subtraction osteotomy

KW - Sagittal vertical axis

KW - Spinopelvic alignment

KW - Thoracic

KW - Vertebral column resection

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U2 - 10.1007/s00586-011-1967-3

DO - 10.1007/s00586-011-1967-3

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