Early Postoperative Sagittal Imbalance Following Instrumented Lumbosacral Spine Tumor Surgery: Initial Multi-Center Analysis of PI-LL Mismatch and Postoperative Complication Rates

Wednesday, February 21, 2024

Presenting Author(s)

CS

Christian Schroeder, ScM

Medical Student
Warren Alpert Medical School

Co-Author(s)

SB

Stefano Boriani, MD

Spine Surgeon
GSpine4 Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, United States
RC

Riccardo Cecchinato, MD

Orthopaedic Spine Surgeon
IRCCS Galeazzi-Sant’Ambrogio Hospital, United States
KC

Ki-Eun Chang, MD

Neurosurgery Fellow
Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
SK

Shreyas Kulkarni, BS

Medical Student
Warren Alpert Medical School of Brown University, United States
ZG

Ziya L. Gokaslan, MD

Chair of Neurosurgery
Warren Alpert Medical School of Brown University, United States
Owen P. Leary, BS (he/him/his)

Research Program Administrator
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
TN

Tim Niu, MD

Attending Neurosurgeon
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
AO

Adetokunbo A. Oyelese, MD PhD

Professor of Neurosurgery
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
JQ

Joaquin Q. Q. Camara-Quintana, MD

Assistant Professor of Neurosurgery
Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
JS

Jared S. Fridley, MD

Associate Professor of Neurosurgery
The Warren Alpert Medical School of Brown University, United States
Rahul A. Sastry, MD (he/him/his)

Neurosurgery Resident
Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
FS

Felicia Sun, MD

Neurosurgery Resident
Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States
ss

sohail syed, MD

Neurosurgery Fellow
Warren Alpert Medical School of Brown University, United States
AT

Albert Telfeian, MD phD

Professor of Neurosurgery
Warren Alpert Medical School of Brown University, United States
PS

Patti Z. Sullivan, MD

Professor of Neurosurgery
Warren Alpert Medical School of Brown University
Providence, Rhode Island, United States

Disclosure(s):

Christian Schroeder, ScM: No financial relationships to disclose

Introduction: Postoperative sagittal imbalance has been shown to predict postoperative construct failure and reoperation in patients undergoing surgery for spinal deformity and degenerative disease. Post operative PI-LL mismatch is a fundamental determinant of overall sagittal imbalance. However, PI-LL mismatch has not been comprehensively evaluated following spine tumor resection.

Methods: Assess post operative PI-LL mismatch as an individual predictor of reoperation and construct failure following lumbar or lumbosacral spine tumor resection with posterior instrumentation.

Results: Of the 50 patients included n= 27 (54%) had PI-LL mismatch ≥ 10º on first postoperative x-ray and n= 23 (46%) did not. The average age for the cohort was 52.2 years, with 23(46%) being male. Comparing the non-mismatched versus mismatched cohorts instrumentation crossed the lumbosacral junction in 7/23 versus 10/27 cases, and 4/23 and 11/27 patients in each group had metastatic (versus primary) tumors. Mean PI-LL difference was 5.1º vs 20.4º. For patients without and with PI mismatch 1/23 (4.3%) vs 9/27 (33%) of patients required reoperation respectively during the follow up interval due to construct complications.

Conclusion : Within our multi-institutional cohort of lumbar and lumbosacral spine tumor resection cases, we found a significant differences in reoperation or construct failure with respect to the previously studied PI-LL mismatch threshold of 10º. Future work should include a larger multicenter cohort and prospective studies examining sagittal imbalance and postoperative outcomes following spine tumor resection with instrumentation.