Faculty Bibliography

STUDY DESIGN: Retrospective clinical and radiographic single-center study OBJECTIVE.: Assess simultaneous cervical spine and lower extremity compensatory changes with changes in thoracolumbar spinal alignment. SUMMARY OF BACKGROUND DATA: Full-body stereoradiographic imaging allows better understanding of reciprocal changes in cervical and lower extremity alignment in the setting of thoracolumbar malalignment. Few studies describe the simultaneous effect of alignment correction on these mechanisms. METHODS: Patients >/=18 years undergoing instrumented thoracolumbar fusion without previous cervical spine fusion, hip, knee or ankle arthroplasty were included. Spinopelvic, lower extremity and cervical alignment were assessed from full-body standing stereoradiographs using validated software. Patients were matched for pelvic incidence and stratified based on baseline T1-pelvic angle (TPA) as: TPA-Low <14 degrees , TPA-Moderate =14-22 degrees and TPA-High >22 degrees . Perioperative changes between baseline and first postoperative visit <6 months in lower extremity alignment (pelvic shift: P Shift, sacrofemoral angle: SFA, Knee Angle: KA, Ankle Angle: AA, global sagittal axis: GSA) and cervical alignment (C0-C2 angle, C2-slope, C2-C7 lordosis and C2-C7 SVA:cSVA) were correlated with change in magnitude of TPA and sagittal vertical axis (SVA) correction. RESULTS: After matching, 87 patients were assessed. Increasing baseline TPA severity associated with a progressive increase in all regional spinopelvic parameters except thoracic kyphosis, in addition to increased SFA, P Shift, KA, GSA, and C2-C7 lordosis. As TPA correction increased, there was a reciprocal reduction in SFA, KA, P Shift, GSA and C2-C7 lordosis. Change in SVA correlated most with change in GSA (r = 0.886), P Shift (r = 0.601), KA (r = 0.534) and C2-C7 lordosis (r = 0.467). Change in TPA correlated with change in SFA (r = 0.372) while SVA did not. CONCLUSIONS: Patients with thoracolumbar malalignment exhibit compensatory changes in cervical spine and lower extremity simultaneously in the form of cervical hyperlordosis, pelvic shift, knee flexion, and pelvic retroversion. These compensatory mechanisms resolve reciprocally in a linear fashion following optimal surgical correction. LEVEL OF EVIDENCE: 3.

BACKGROUND: Estimation of skeletal maturity, classically performed using Risser sign, plays a crucial role in the treatment of AIS. Recent data, however, has shown the simplified Tanner-Whitehouse (Sanders) classification, based on an anteriorposterior (AP) hand radiographs, to correlate more closely to the rapid growth phase and thus curve progression. This study evaluated the interobserver and intraobserver reliability of the Sanders and Risser classifications among clinicians at different levels of training. METHODS: Twenty AP scoliosis radiographs and 20 AP hand radiographs were randomized and distributed to 11 graders. The graders consisted of 3 orthopaedic residents, 3 spine fellows, 3 spine surgeons, and 1 radiologist. The graders were then asked to classify the radiographs according to the Sanders and Risser classifications. There were 3 rounds of grading, each done 3 weeks apart. The overall kappa coefficient was then calculated for each system to evaluate the interobserver and intraobserver reliability. RESULTS: For all graders the average kappa coefficient for the interobserver and intraobserver reliability of the Sanders classification was 0.54 and 0.62, respectively, and 0.46 and 0.49 for the Risser classification. With respect to spine attendings alone, the average kappa coefficient for the interobserver and intraobserver reliability of Sanders classification was 0.72 and 0.77, respectively, and 0.46 and 0.67 for the Risser classification. CONCLUSIONS: Our study demonstrated that the Sanders classification had moderate reliability with respect to physicians at various levels of training and had good reliability with respect to attending spine surgeons. Interestingly, the Risser staging was found to have less interobserver and intraobserver reliability overall. The Sanders classification is a reliable and reproducible system and should be in the armamentarium of surgeons who treat adolescent idiopathic scoliosis. LEVEL OF EVIDENCE: Level III.

STUDY DESIGN: This is a multicenter retrospective review of prospectively collected cases. OBJECTIVE: Our objective was to evaluate the relationship between patient satisfaction, HRQoL scores, complications, and radiographic measures at 2 years post-operative follow-up. SUMMARY OF BACKGROUND DATA: For patients receiving operative management for adult spine deformity (ASD), the relationship between health-related quality of life (HRQoL) measures, radiographic parameters, post-operative complications, and self-reported satisfaction remains unclear. METHODS: Data from 248 patients across 11 centers within the United States who underwent thoracolumbar fusion for ASD and had a minimum of 2 years follow-up was collected. Pre- and post-operative scores were obtained from the Scoliosis Research Society 22-item (SRS-22r), the Oswestry Disability Index (ODI), the 36-Item Short Form Health Survey (SF-36), and the Visual Analogue Scale (VAS). Sagittal vertical axis, coronal C7 plumbline, lumbar lordosis, pelvic tilt, T1 pelvic angle, and the difference between pelvic incidence and lumbar lordosis were assessed using post-operative radiographic films. Satisfaction (SAT) was assessed using the SRS-22r; patients were categorized as highly satisfied (HS) or less satisfied (LS). The correlation between SAT and HRQoL scores, radiographic parameters, and complications was determined. RESULTS: When compared to LS (n = 60) patients, HS (n = 188) patients demonstrated greater improvement in final ODI, SF-36 component scores, SRS-Total, and VAS back scores (p < 0.05). The correlations between SAT and the final follow-up and 2 year change from baseline values were moderate for MCS, PCS, and ODI or weak for HRQoL scores (p < 0.0001). The HS and LS groups were equal in pre- or final post-operative radiographic parameters. Occurrence of complications had no effect on satisfaction. CONCLUSION: Among operatively treated ASD patients, satisfaction was moderately correlated with some HRQoL measures, and not with radiographic changes or post-operative complications. Other factors, such as patient expectations and relationship with the surgeon, may be stronger drivers of patient satisfaction.

STUDY DESIGN: Single-center retrospective review. OBJECTIVE: This study evaluates the impact of increasing spinal deformity deviation from age-adjusted alignment ideals on lower extremity compensation. SUMMARY OF BACKGROUND DATA: Though current understanding of compensatory mechanisms in adult spinal deformity (ASD) is progressing due to full-body stereographic assessment, the impact of age-adjusted deformity targets on lower limb compensation remains unexamined. METHODS: ASD patients >/=18 years with biplanar full-body stereographic x-rays were included. Patients were stratified into age cohorts: <40y, 40-65y, >/=65y. Age-specific alignment goals (IDEAL) for pelvic tilt (PT), spino-pelvic mismatch (PI-LL), sagittal vertical axis (SVA), and T1 pelvic angle (TPA) were calculated for each patient using published formulas and compared to patients' real (ACTUAL) radiographic parameters. The difference between ACTUAL and IDEAL alignment (OFFSET) was calculated. ANOVA compared ACTUAL, IDEAL, and OFFSET between age groups, and OFFSET was correlated with lower-limb compensation (SFA: sacrofemoral angle, PS: pelvic shift, KA: knee angle, AA: ankle angle). RESULTS: 778 ASD patients (74.1% female) were included. ACTUAL and IDEAL alignments matched for PT (p = 0.37) in patients <40yrs, SVA (p = 0.12) in patients 40-65 yrs and PT, SVA and TPA (p > 0.05) in patients >/=65yrs. SVA and TPA OFFSETs decreased significantly with increasing age (p<0.001). Hip extension correlated with all OFFSETs in patients <40yrs (positively with PT, PI-LL, TPA; negatively with SVA). Knee flexion correlated with PI-LL, SVA, TPA, across all age groups with strongest correlations (0.52540yr) age groups. Posterior pelvic displacement correlated positively with all OFFSET groups, and was highest (0.526

PMID: 27974739

ISSN: 1528-1159

CID: 2363562