Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age?

Themistocles S. Protopsaltis, Alexandra Soroceanu, Jared C. Tishelman, Aaron J. Buckland, Gregory M. Mundis, Justin S. Smith, Alan Daniels, Lawrence G. Lenke, Han Jo Kim, Eric Otto Klineberg, Christopher P. Ames, Robert A. Hart, Shay Bess, Christopher I. Shaffrey, Frank J. Schwab, Virginie Lafage

Research output: Contribution to journalArticle

Abstract

Study Design. Retrospective analysis Objective. Determine whether deformity corrections should vary by pelvic incidence (PI). Summary of Background Data. Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for ASD surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific. Methods. A prospective database of consecutive ASD patients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and SF-36 Physical Component Score (PCS). Baseline relationships between TPA, age, PI and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values. Results. 903 ASD patients (mean 53.7y) and 111 normative subjects (mean 50.7y) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40-75, 75); and age: elderly(65y, n=375) middle age(45-65y, n=387) and young(18-45y, n=141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r=.42, p<.0001). ODI correlated with PCS(r=.71, p<.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age. Conclusions. Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI.Level of Evidence: 3.

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Jan 1 2019

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Incidence
Health Status
Linear Models
Databases
Lower Extremity
Spine
Regression Analysis

Keywords

  • adult spinal deformity
  • deformity correction
  • sagittal spinal alignment
  • surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Protopsaltis, T. S., Soroceanu, A., Tishelman, J. C., Buckland, A. J., Mundis, G. M., Smith, J. S., ... Lafage, V. (Accepted/In press). Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age? Spine. https://doi.org/10.1097/BRS.0000000000003237

Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age? / Protopsaltis, Themistocles S.; Soroceanu, Alexandra; Tishelman, Jared C.; Buckland, Aaron J.; Mundis, Gregory M.; Smith, Justin S.; Daniels, Alan; Lenke, Lawrence G.; Kim, Han Jo; Klineberg, Eric Otto; Ames, Christopher P.; Hart, Robert A.; Bess, Shay; Shaffrey, Christopher I.; Schwab, Frank J.; Lafage, Virginie.

In: Spine, 01.01.2019.

Research output: Contribution to journalArticle

Protopsaltis, TS, Soroceanu, A, Tishelman, JC, Buckland, AJ, Mundis, GM, Smith, JS, Daniels, A, Lenke, LG, Kim, HJ, Klineberg, EO, Ames, CP, Hart, RA, Bess, S, Shaffrey, CI, Schwab, FJ & Lafage, V 2019, 'Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age?', Spine. https://doi.org/10.1097/BRS.0000000000003237
Protopsaltis, Themistocles S. ; Soroceanu, Alexandra ; Tishelman, Jared C. ; Buckland, Aaron J. ; Mundis, Gregory M. ; Smith, Justin S. ; Daniels, Alan ; Lenke, Lawrence G. ; Kim, Han Jo ; Klineberg, Eric Otto ; Ames, Christopher P. ; Hart, Robert A. ; Bess, Shay ; Shaffrey, Christopher I. ; Schwab, Frank J. ; Lafage, Virginie. / Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age?. In: Spine. 2019.
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abstract = "Study Design. Retrospective analysis Objective. Determine whether deformity corrections should vary by pelvic incidence (PI). Summary of Background Data. Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for ASD surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific. Methods. A prospective database of consecutive ASD patients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and SF-36 Physical Component Score (PCS). Baseline relationships between TPA, age, PI and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values. Results. 903 ASD patients (mean 53.7y) and 111 normative subjects (mean 50.7y) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40-75, 75); and age: elderly(65y, n=375) middle age(45-65y, n=387) and young(18-45y, n=141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r=.42, p<.0001). ODI correlated with PCS(r=.71, p<.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age. Conclusions. Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI.Level of Evidence: 3.",
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author = "Protopsaltis, {Themistocles S.} and Alexandra Soroceanu and Tishelman, {Jared C.} and Buckland, {Aaron J.} and Mundis, {Gregory M.} and Smith, {Justin S.} and Alan Daniels and Lenke, {Lawrence G.} and Kim, {Han Jo} and Klineberg, {Eric Otto} and Ames, {Christopher P.} and Hart, {Robert A.} and Shay Bess and Shaffrey, {Christopher I.} and Schwab, {Frank J.} and Virginie Lafage",
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T1 - Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age?

AU - Protopsaltis, Themistocles S.

AU - Soroceanu, Alexandra

AU - Tishelman, Jared C.

AU - Buckland, Aaron J.

AU - Mundis, Gregory M.

AU - Smith, Justin S.

AU - Daniels, Alan

AU - Lenke, Lawrence G.

AU - Kim, Han Jo

AU - Klineberg, Eric Otto

AU - Ames, Christopher P.

AU - Hart, Robert A.

AU - Bess, Shay

AU - Shaffrey, Christopher I.

AU - Schwab, Frank J.

AU - Lafage, Virginie

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Study Design. Retrospective analysis Objective. Determine whether deformity corrections should vary by pelvic incidence (PI). Summary of Background Data. Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for ASD surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific. Methods. A prospective database of consecutive ASD patients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and SF-36 Physical Component Score (PCS). Baseline relationships between TPA, age, PI and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values. Results. 903 ASD patients (mean 53.7y) and 111 normative subjects (mean 50.7y) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40-75, 75); and age: elderly(65y, n=375) middle age(45-65y, n=387) and young(18-45y, n=141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r=.42, p<.0001). ODI correlated with PCS(r=.71, p<.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age. Conclusions. Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI.Level of Evidence: 3.

AB - Study Design. Retrospective analysis Objective. Determine whether deformity corrections should vary by pelvic incidence (PI). Summary of Background Data. Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for ASD surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific. Methods. A prospective database of consecutive ASD patients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and SF-36 Physical Component Score (PCS). Baseline relationships between TPA, age, PI and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values. Results. 903 ASD patients (mean 53.7y) and 111 normative subjects (mean 50.7y) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40-75, 75); and age: elderly(65y, n=375) middle age(45-65y, n=387) and young(18-45y, n=141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r=.42, p<.0001). ODI correlated with PCS(r=.71, p<.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age. Conclusions. Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI.Level of Evidence: 3.

KW - adult spinal deformity

KW - deformity correction

KW - sagittal spinal alignment

KW - surgery

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