Under Correction of Sagittal Deformities Based on Age-adjusted Alignment Thresholds Leads to Worse Health-related Quality of Life whereas over Correction Provides No Additional Benefit

Justin K. Scheer, Renaud Lafage, Frank J. Schwab, Barthelemy Liabaud, Justin S. Smith, Gregory M. Mundis, Richard Hostin, Christopher I. Shaffrey, Douglas C. Burton, Robert Hart, Han J. Kim, Shay Bess, Munish Gupta, Virginie Lafage, Christopher P. Ames

Research output: Contribution to journalArticle

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Abstract

Study Design.Retrospective review of prospectively-collected database.Objective.This study aims to compare 2-year clinical outcomes of patients who underwent surgical reconstructions based on their achievement to age-adjusted alignment ideals.Summary of Background Data.Recent research in sagittal plane has proposed age-adjusted alignment thresholds. However, the impact of these thresholds on postoperative health-related quality of life (HRQOL) is yet to be investigated.Methods.Patients were included if they were more than 18-years old and underwent surgical correction of adult spinal deformity with a complete 2-year follow-up. Patients were stratified into three groups based on achievement of age-adjusted thresholds in pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis (SVA). First group included patients who reached the exact age-adjusted threshold ±10 years (MATCHED), other two groups included patients who were over corrected (OVER), and under corrected (UNDER). Clinical outcomes including actual value and offset from age-adjusted Oswestry Disability Index, Short-Form-36 (SF-36)-physical component summary, and Scoliosis Research Society-22r (SRS-22r) were compared between groups at 2 years follow-up.Results.A total of 343 patients (mean, 57 yrs and 83% females) were included. Sagittal profile of the population was: PT=23.6°, SVA=65.8mm, and PI-LL=15.6°. At 2-year follow-up, there was significant improvement in all sagittal modifiers with 25.7%, 24.3%, and 33.1% of the patients matching their age alignment targets in terms of PT, PI-LL, and SVA, respectively. For PT and PI-LL, the three groups (MATCHED, OVER, and UNDER) had comparable values and offsets from age-adjusted patient reported outcome. However, for SVA groups, patients in UNDER had significantly worse HRQOL than the two other groups. Patients in PT, PI-LL, and SVA UNDER groups were significantly younger than the other groups, P<0.05.Conclusion.At 2 years after adult spinal deformity surgical treatment, only 24.3% to 33.1% of the patients reached age-adjusted alignment thresholds. Those under corrected in SVA demonstrated worse clinical outcomes. No significant improvements were found between matched and overcorrected patients, with overcorrection being an established risk for proximal junctional kyphosis. These results further emphasize the need for patient specific operative planning.Level of Evidence.

Original languageEnglish (US)
Pages (from-to)388-393
Number of pages6
JournalSpine
Volume43
Issue number6
DOIs
StatePublished - Mar 15 2018
Externally publishedYes

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Quality of Life
Lordosis
Incidence
Kyphosis
Scoliosis
Research
Databases
Population

Keywords

  • adult spinal deformity
  • age
  • age-adjusted alignment
  • health-related quality of life
  • over correction
  • sagittal alignment
  • sagittal balance
  • sagittal malalignment
  • spinopelvic alignment
  • threshold

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Under Correction of Sagittal Deformities Based on Age-adjusted Alignment Thresholds Leads to Worse Health-related Quality of Life whereas over Correction Provides No Additional Benefit. / Scheer, Justin K.; Lafage, Renaud; Schwab, Frank J.; Liabaud, Barthelemy; Smith, Justin S.; Mundis, Gregory M.; Hostin, Richard; Shaffrey, Christopher I.; Burton, Douglas C.; Hart, Robert; Kim, Han J.; Bess, Shay; Gupta, Munish; Lafage, Virginie; Ames, Christopher P.

In: Spine, Vol. 43, No. 6, 15.03.2018, p. 388-393.

Research output: Contribution to journalArticle

Scheer, JK, Lafage, R, Schwab, FJ, Liabaud, B, Smith, JS, Mundis, GM, Hostin, R, Shaffrey, CI, Burton, DC, Hart, R, Kim, HJ, Bess, S, Gupta, M, Lafage, V & Ames, CP 2018, 'Under Correction of Sagittal Deformities Based on Age-adjusted Alignment Thresholds Leads to Worse Health-related Quality of Life whereas over Correction Provides No Additional Benefit', Spine, vol. 43, no. 6, pp. 388-393. https://doi.org/10.1097/BRS.0000000000002435
Scheer, Justin K. ; Lafage, Renaud ; Schwab, Frank J. ; Liabaud, Barthelemy ; Smith, Justin S. ; Mundis, Gregory M. ; Hostin, Richard ; Shaffrey, Christopher I. ; Burton, Douglas C. ; Hart, Robert ; Kim, Han J. ; Bess, Shay ; Gupta, Munish ; Lafage, Virginie ; Ames, Christopher P. / Under Correction of Sagittal Deformities Based on Age-adjusted Alignment Thresholds Leads to Worse Health-related Quality of Life whereas over Correction Provides No Additional Benefit. In: Spine. 2018 ; Vol. 43, No. 6. pp. 388-393.
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abstract = "Study Design.Retrospective review of prospectively-collected database.Objective.This study aims to compare 2-year clinical outcomes of patients who underwent surgical reconstructions based on their achievement to age-adjusted alignment ideals.Summary of Background Data.Recent research in sagittal plane has proposed age-adjusted alignment thresholds. However, the impact of these thresholds on postoperative health-related quality of life (HRQOL) is yet to be investigated.Methods.Patients were included if they were more than 18-years old and underwent surgical correction of adult spinal deformity with a complete 2-year follow-up. Patients were stratified into three groups based on achievement of age-adjusted thresholds in pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis (SVA). First group included patients who reached the exact age-adjusted threshold ±10 years (MATCHED), other two groups included patients who were over corrected (OVER), and under corrected (UNDER). Clinical outcomes including actual value and offset from age-adjusted Oswestry Disability Index, Short-Form-36 (SF-36)-physical component summary, and Scoliosis Research Society-22r (SRS-22r) were compared between groups at 2 years follow-up.Results.A total of 343 patients (mean, 57 yrs and 83{\%} females) were included. Sagittal profile of the population was: PT=23.6°, SVA=65.8mm, and PI-LL=15.6°. At 2-year follow-up, there was significant improvement in all sagittal modifiers with 25.7{\%}, 24.3{\%}, and 33.1{\%} of the patients matching their age alignment targets in terms of PT, PI-LL, and SVA, respectively. For PT and PI-LL, the three groups (MATCHED, OVER, and UNDER) had comparable values and offsets from age-adjusted patient reported outcome. However, for SVA groups, patients in UNDER had significantly worse HRQOL than the two other groups. Patients in PT, PI-LL, and SVA UNDER groups were significantly younger than the other groups, P<0.05.Conclusion.At 2 years after adult spinal deformity surgical treatment, only 24.3{\%} to 33.1{\%} of the patients reached age-adjusted alignment thresholds. Those under corrected in SVA demonstrated worse clinical outcomes. No significant improvements were found between matched and overcorrected patients, with overcorrection being an established risk for proximal junctional kyphosis. These results further emphasize the need for patient specific operative planning.Level of Evidence.",
keywords = "adult spinal deformity, age, age-adjusted alignment, health-related quality of life, over correction, sagittal alignment, sagittal balance, sagittal malalignment, spinopelvic alignment, threshold",
author = "Scheer, {Justin K.} and Renaud Lafage and Schwab, {Frank J.} and Barthelemy Liabaud and Smith, {Justin S.} and Mundis, {Gregory M.} and Richard Hostin and Shaffrey, {Christopher I.} and Burton, {Douglas C.} and Robert Hart and Kim, {Han J.} and Shay Bess and Munish Gupta and Virginie Lafage and Ames, {Christopher P.}",
year = "2018",
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language = "English (US)",
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TY - JOUR

T1 - Under Correction of Sagittal Deformities Based on Age-adjusted Alignment Thresholds Leads to Worse Health-related Quality of Life whereas over Correction Provides No Additional Benefit

AU - Scheer, Justin K.

AU - Lafage, Renaud

AU - Schwab, Frank J.

AU - Liabaud, Barthelemy

AU - Smith, Justin S.

AU - Mundis, Gregory M.

AU - Hostin, Richard

AU - Shaffrey, Christopher I.

AU - Burton, Douglas C.

AU - Hart, Robert

AU - Kim, Han J.

AU - Bess, Shay

AU - Gupta, Munish

AU - Lafage, Virginie

AU - Ames, Christopher P.

PY - 2018/3/15

Y1 - 2018/3/15

N2 - Study Design.Retrospective review of prospectively-collected database.Objective.This study aims to compare 2-year clinical outcomes of patients who underwent surgical reconstructions based on their achievement to age-adjusted alignment ideals.Summary of Background Data.Recent research in sagittal plane has proposed age-adjusted alignment thresholds. However, the impact of these thresholds on postoperative health-related quality of life (HRQOL) is yet to be investigated.Methods.Patients were included if they were more than 18-years old and underwent surgical correction of adult spinal deformity with a complete 2-year follow-up. Patients were stratified into three groups based on achievement of age-adjusted thresholds in pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis (SVA). First group included patients who reached the exact age-adjusted threshold ±10 years (MATCHED), other two groups included patients who were over corrected (OVER), and under corrected (UNDER). Clinical outcomes including actual value and offset from age-adjusted Oswestry Disability Index, Short-Form-36 (SF-36)-physical component summary, and Scoliosis Research Society-22r (SRS-22r) were compared between groups at 2 years follow-up.Results.A total of 343 patients (mean, 57 yrs and 83% females) were included. Sagittal profile of the population was: PT=23.6°, SVA=65.8mm, and PI-LL=15.6°. At 2-year follow-up, there was significant improvement in all sagittal modifiers with 25.7%, 24.3%, and 33.1% of the patients matching their age alignment targets in terms of PT, PI-LL, and SVA, respectively. For PT and PI-LL, the three groups (MATCHED, OVER, and UNDER) had comparable values and offsets from age-adjusted patient reported outcome. However, for SVA groups, patients in UNDER had significantly worse HRQOL than the two other groups. Patients in PT, PI-LL, and SVA UNDER groups were significantly younger than the other groups, P<0.05.Conclusion.At 2 years after adult spinal deformity surgical treatment, only 24.3% to 33.1% of the patients reached age-adjusted alignment thresholds. Those under corrected in SVA demonstrated worse clinical outcomes. No significant improvements were found between matched and overcorrected patients, with overcorrection being an established risk for proximal junctional kyphosis. These results further emphasize the need for patient specific operative planning.Level of Evidence.

AB - Study Design.Retrospective review of prospectively-collected database.Objective.This study aims to compare 2-year clinical outcomes of patients who underwent surgical reconstructions based on their achievement to age-adjusted alignment ideals.Summary of Background Data.Recent research in sagittal plane has proposed age-adjusted alignment thresholds. However, the impact of these thresholds on postoperative health-related quality of life (HRQOL) is yet to be investigated.Methods.Patients were included if they were more than 18-years old and underwent surgical correction of adult spinal deformity with a complete 2-year follow-up. Patients were stratified into three groups based on achievement of age-adjusted thresholds in pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis (SVA). First group included patients who reached the exact age-adjusted threshold ±10 years (MATCHED), other two groups included patients who were over corrected (OVER), and under corrected (UNDER). Clinical outcomes including actual value and offset from age-adjusted Oswestry Disability Index, Short-Form-36 (SF-36)-physical component summary, and Scoliosis Research Society-22r (SRS-22r) were compared between groups at 2 years follow-up.Results.A total of 343 patients (mean, 57 yrs and 83% females) were included. Sagittal profile of the population was: PT=23.6°, SVA=65.8mm, and PI-LL=15.6°. At 2-year follow-up, there was significant improvement in all sagittal modifiers with 25.7%, 24.3%, and 33.1% of the patients matching their age alignment targets in terms of PT, PI-LL, and SVA, respectively. For PT and PI-LL, the three groups (MATCHED, OVER, and UNDER) had comparable values and offsets from age-adjusted patient reported outcome. However, for SVA groups, patients in UNDER had significantly worse HRQOL than the two other groups. Patients in PT, PI-LL, and SVA UNDER groups were significantly younger than the other groups, P<0.05.Conclusion.At 2 years after adult spinal deformity surgical treatment, only 24.3% to 33.1% of the patients reached age-adjusted alignment thresholds. Those under corrected in SVA demonstrated worse clinical outcomes. No significant improvements were found between matched and overcorrected patients, with overcorrection being an established risk for proximal junctional kyphosis. These results further emphasize the need for patient specific operative planning.Level of Evidence.

KW - adult spinal deformity

KW - age

KW - age-adjusted alignment

KW - health-related quality of life

KW - over correction

KW - sagittal alignment

KW - sagittal balance

KW - sagittal malalignment

KW - spinopelvic alignment

KW - threshold

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DO - 10.1097/BRS.0000000000002435

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