Overcorrection in Sagittal Alignment Effect on Optimal Outcomes in Adult Spinal Deformity Patients

Wednesday, February 21, 2024

Presenting Author(s)

JM

Jamshaid Mir, MD

Research Fellow
NYU Langone Hospital
Paterson, NJ, US

Co-Author(s)

Nima Alan, MD

Neurosurgeon
UCSF
Phoenix, Arizona, United States
ZB

Zorica Buser, PhD

Director of Research
NYU Langone Medical Center, United States
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, NY, US
Ankita Das, n/a

Research Fellow
NYU Langone Health
Valhalla, NY, US
Pooja Dave, n/a

Research Fellow
NYU Langone Health
glen ellyn, Illinois, United States
MG

Michael Gerling, MD

Spine Surgeon
NYU Langone Medical Center, United States
BJ

Burhan Janjua, MD

Attending Surgeon
Mercy Health
Chicago, Illinois, United States
Pawel P. Jankowski, MD

Attending Surgeon
Hoag Neurosciences Institute
Irvine, CA, US
RL

Renaud Lafage, MS

Biomedical engineer
Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
NYC, New York, United States
VL

Virginie Lafage, MD

Scientist
Lenox Hill Hospital
New York, New York, United States
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
OO

Oluwatobi O. O. Onafowokan, BMBS, MSc

Research Fellow
NYU Langone Health
Paul Park, MD

Neurosurgeon
Semmes Murphey Clinic
MEMPHIS, Tennessee, United States
Peter G. Passias, MD

Attending Surgeon/PI
NYU Langone Health
New Canaan, CT, US
AS

Andrew Schoenfeld, MD MSc

Attending Surgeon
Brigham and Women's Hospital, United States
DS

Daniel Sciubba, M.D., M.B.A.

Senior vice president of Neurosurgery at Northwell Health
Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health
Great Neck, New York, United States
LT

Lee Tan, MD

Attending Surgeon
UCSF
Indianapolis, Indiana, United States
PT

Peter S. Tretiakov, n/a

Research Fellow
NYU Langone Health
petertretiakov@gmail.com, New York, United States

Disclosure(s):

Jamshaid Mir, MD: No financial relationships to disclose

Introduction: Recent studies have suggested that overcorrection in ASD can benefit some patients without increasing the prevalence of PJK or PJF. Our research aims to investigate overcorrection of age-adjusted radiographic thresholds.

Methods: ASD patients fused from at least L1-S1 with baseline(BL) to 2-year(2Y) data were included. Frailty was calculated using Passias mFI. Good Outcome (GO+) at 2Y was defined as: no major mechanical complications, reoperations, PJF, and thoracic decompensation (TD) (>15 degree change from baseline in unfused thoracic kyphosis) and [meeting either: (1) Substantial Clinical Benefit for Oswestry Disability Index (ODI) (change >18.8), or (2) ODI < 15 and Scoliosis Research Society Total>4.5]. Those that were overcorrected 1 standard deviation (O+) were evaluated.

Results: 302 ASD patients met inclusion(age 63±9yrs, 78% F, BMI 27±5kg/m2, CCI 1.9±1.7, ASD-mFI 7.2±4.7). BL radiographic deformity: mean PT 26º, PI 55º, PI-LL 21º, TPA 25º.
By 2Y, 62% developed PJK, 11% PJF, 19% TD, and 69% GO. PJK, PJF, and TD was associated with greater correction in SVA, PI-LL, and PT (p <.05).
O+ was significantly younger, had lower BMI, CCI, and frailty. O+ that were GO+ had significantly lower CCI and frailty.
PJF rates were twofold higher in O+ (p=.02). Implant malposition and operative complications were higher in PT O+ (p <.05). Reoperation due to implant failure had 2x higher rate of PILL being O+ (p=.06). Higher CCI was the most significant patient factor that lead to PJF and GO- (PJF OR: 1.4, GO- OR: 1.3, both p<.05). O+ had double the likelihood of development of GO- with higher CCI (p <.05). Age and BMI were significant predictors for the development of PO in O1 (Age OR: 1.1, BMI OR: 1.2, both p<.05). Threshold for CCI in O+ of less than 1 was associated with GO+, for TD: CCI < 2, and PJF: CCI < 3 (all p<.05). Frailty threshold was < 2.368 for GO (p <.05). Age threshold for PJK was < 65.3 (p <.05).

Conclusion : Overcorrecting is often necessary in ASD surgery to achieve good outcomes. Our study suggests that overcorrecting in PT has the greatest impact in not achieving good outcomes and should be carefully considered, especially in those with greater comorbidities.