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320. Effect of supine alignment on postoperative sagittal alignment following ASD surgery
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S141−S157 STUDY DESIGN/SETTING: Prospective observational multicenter cohort of severe pediatric deformity patients treated surgically for minimum curves of 100˚ or planned vertebral column resection (VCR). PATIENT SAMPLE: Patients with a minimum spinal deformity curve of 100˚ or who were scheduled for a VCR procedure were prospectively enrolled at 17 sites. OUTCOME MEASURES: IOM alerts, radiographic parameters, surgical procedures, neurological status. METHODS: Patients with severe spinal deformity with minimum curves of 100˚; or planned VCR were followed for a minimum 2 years postoperative. We studied x-ray parameters, IOM changes, postop deficits and recovery at minimum 2 years. RESULTS: A total of 228 of the 312 patients enrolled had a minimum two years follow-up (QOLs and x-rays). Of these, 110 patients had a VCR and 1 a PSO. Two hundred twelve had a post-only approach and 16 a combined anterior/posterior. Two hundred twenty-eight patients had a total of 272 procedures including all stages; IOM alerts occurred in 102/272 procedures (38%). IOM alerts occurred in 98 pts (43%), with a total of 147 IOM alerts. An analysis was completed between a VCR, ant/post, coronal deformity angular ratio (C−DAR), the sagittal deformity angular ratio (S−DAR), and any IOM alert, SSEP, TCeMEP or both. Only S-DAR was predictive for any IOM alert (p<.0001). The common triggering events were 3 column osteotomies (N=34), correction maneuvers (N=30), hypotension (N=25), implant and instrumentation placement (N=20 and 19 respectively). Some alerts had multiple triggering events. A normal preoperative exam was present in 209 patients. A total of 190 patients remained neurologically normal postoperative; 19 had new deficits. At 2 years postop, 16/19 with new deficits returned to normal, 2 continued to have a deficit, and 1 was lost to follow-up. Analysis between ant/post, VCR, C-DAR and S-DAR indicated that S-DAR was associated (p=0.0035) with a new postoperative deficit. A total of 19 patients had a neurologic deficit preoperatively; postoperatively 6 improved to normal, 12 continued to have a deficit and 1 had a partial recovery. At 2 years, 13/19 with deficits preop totally recovered, 3 partially, 2 were the same, and 1 was lost to follow-up. CONCLUSIONS: Pediatric patients with severe deformity had a 43% incidence of IOM alerts but after addressing the alerts intraop, only 2 patients had new deficits at 2 years. Of the 19 patients with preoperative neurologic deficit, 16 patients improved or recovered. Neural monitoring should be mandatory in these cases. Sagittal DAR is associated with IOM alerts and new neurologic deficits. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.335
319. Minimally invasive surgery for neuromuscular scoliosis: a case control study of 140 consecutive patients Vishal Sarwahi, MD1, Jesse M. Galina, BS2, Romain Dayer, MD3, Sayyida S. Hasan, BS4, Aaron M. Atlas, BS4, Stephen Wendolowski4, Terry D. Amaral, MD5; 1 North Shore LIJ Health System, New Hyde Park, NY, US; 2 New Hyde Path, US; 3 Geneva University Hospitals, Pediatric Orthopedic Unit, Geneva, Geneva, Switzerland; 4 Cohen Children’s Medical Center, New Hyde Park, NY, US; 5 Northwell Health, Lake Success, NY, US BACKGROUND CONTEXT: Minimally invasive surgery (MIS) has been shown to have benefits in adolescent idiopathic scoliosis (AIS) and adult scoliosis with regards to estimated blood loss (EBL), transfusion rate, pain, narcotic usage and hospital stay. These benefits are ideal for neuromuscular scoliosis (NMS) patients, who generally have larger and stiffer curves which are at risk of progression, even with bracing. PURPOSE: The purpose of this study was to report a consecutive case series of NMS patients undergoing MIS or standard PSF. STUDY DESIGN/SETTING: Retrospective chart review. PATIENT SAMPLE: A total of 37 NMS patients treated with MIS and 103 NMS patients treated with PSF.
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OUTCOME MEASURES: Pre- and postoperative Cobb angle, pre- and postoperative kyphosis, pre- and postoperative pelvic obliquity, perioperative complications, surgery time, EBL, transfusion rates, ICU length of stay, hospital length of stay. METHODS: We retrospectively collected data of 37 consecutive patients with neuromuscular scoliosis treated with MIS using 1 incision and a muscle-splitting approach by 2 senior surgeons from 2013-2018. 103 NMS patients treated with standard PSF and pedicle screw constructs were retrospectively reviewed in comparison. RESULTS: In the MIS group, respectively the control group, the mean Cobb angle was corrected from 69.9˚ vs 67.7˚ to 29.4˚ vs 25.4˚ with a mean correction of 59% vs 63%, (p < 0.001). Mean pelvic obliquity decreased from 11.0˚ vs 12.3˚ to 5.9˚ vs 7.7˚ with a mean correction of 46% in the MIS group vs 37% in the control group, (p < 0.001). Intraoperative complications occurred in 1 MIS patient (dural breach), respectively in 7 control patients (3 pneumothorax, 4 hemorrhagic shocks). Ten Perioperative (30 days) complications occurred in 9 MIS patients (27%): 4 respiratory failures, 2 pneumonias, 1 granuloma, 1 ileus, 1 convulsion and 1 rod disconnected from the iliac connector. Thirty-one perioperative complications occurred in 24 control patients (30%): 6 UTIs, 2 pneumonias, 1 septic shock, 3 respiratory failures, 2 prolonged extubations, 6 atelectasis, 3 ileus, 2 abdominal compartment syndromes, 4 surgical site infections, and 2 wound dehiscences. In the MIS group, respectively the control group, mean ORT was 345 min vs 407 min; EBL was 573ml vs 1108ml, allogenic blood transfusion rate was 57% vs 87%, ICU LOS (days) was 4.5 vs 5.6 and hospital LOS was 11 vs 14.9. CONCLUSIONS: The use of MIS for patients with neuromuscular scoliosis results in a significant correction of spinal deformity, with a low EBL, a significantly lower rate of need for allogenic blood transfusion, and a shorter LOS. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.336
320. Effect of supine alignment on postoperative sagittal alignment following ASD surgery Jonathan Elysee1, Renaud Lafage, MSc1, Mathieu Bannwarth, MD1, Bryan Ang, BA1, Alex L. Huang1, Haddy Alas, BS2, Jessica Andres-Bergos, PhD1, Peter G. Passias, MD3, Han Jo Kim, MD1, Frank J. Schwab, MD1, Virginie Lafage, PhD1; 1 Hospital for Special Surgery, New York, NY, US; 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, US; 3 NY Spine Institute, NYU Langone Health, New York, NY, US BACKGROUND CONTEXT: Several guidelines for target-selection in the literature utilize pelvic incidence (PI) as a marker for lumbar correction. In practice, postoperative alignment is highly affected by preoperative data, including demographics and spinal flexibility. Preoperative supine radiographs allow for early visualization of patient alignment in the intraoperative position. Our objective was to determine the strongest predictor of postoperative alignment among PI, age and preoperative supine alignment using a retrospective, single center database of adult spinal deformity (ASD) patients. PURPOSE: Identify independent predictors of postoperative curvatures (LL and TK) using preoperative data only. STUDY DESIGN/SETTING: Retrospective review of a single-center database of ASD patients. PATIENT SAMPLE: A total of 99 surgically treated ASD patients with minimum 1 year follow-up. OUTCOME MEASURES: L1-S1 lordosis, T4-T12 kyphosis. METHODS: Pre- to postoperative analysis was conducted using paired t-test sampling. Patients were stratified by region of fusion postoperative: complete lumbar fusion (from L1 to S1) and/or complete thoracic fusion (from T4 to T12). Pearson’s r correlation analysis was performed on postoperative curvatures (LL and TK) with preoperative alignment in both
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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standing and supine positions. Correlation analysis was repeated for LL in patients with complete lumbar fusion and for TK in patients with complete thoracic fusion. Lastly, a multilinear stepwise regression was conducted to identify independent predictors of LL or TK post-op. RESULTS: A total of 99 patients were included in the analysis (63.2yo, 83.1%F, 27.3kg/m2, mean f/u 21 months§.9.8). Preoperative SRS classification demonstrated a moderate to severe sagittal and/or coronal deformity (PT modifier: 18.2% ++, SVA: 27.3% ++, PI-LL: 29.3% ++, SRS type: 29.3% N and 68.7% L or D). Sagittal alignment significantly improved between pre- and postoperative (all p < 0.001). Of these, 73 patients (73.7%) underwent a complete fusion of the lumbar spine and 50 (50.5%) underwent a complete thoracic fusion. A total of 20.6% underwent a 3CO, and no significant difference was found in postoperative alignment between patients with and without 3CO (PI-LL: -2.6˚ vs 1.8˚ p = 0.175). Correlation analysis demonstrated a significant association between preoperative and postoperative LL alignment (LL Standing: 0.608; LL Supine: 0.668; PI: 0.577 all p< 0.001) as well as between pre- and postoperative TK alignment (TK Standing: 0.549; TK Supine: 0.488). Analyses were repeated on patients who underwent a complete lumbar or thoracic fusion: results demonstrated stronger associations for LL correlations (0.691, 0.716 and 0.553) and similar TK correlations (0.454 and 0.530), respectively. Multilinear regression demonstrated that only LL Supine and PI were significant predictors of postoperative LL with an r-squared of 0.568, all p< 0.01 (patient age, LL standing and TK were not significant). Similarly, LL Supine, TK Supine and patient age were the only predictors of post-op TK (r-squared 0.490, all p < 0.01). CONCLUSIONS: Preoperative supine alignment is one of the best predictors of postoperative alignment at 1 year. When controlling for fusion location, results show an even greater importance of supine alignment, especially regarding thoracic alignment. Specific attention is required when performing thoracic fusion to avoid thoracic flattening FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.337
321. Evaluation of global alignment and proportion score in an independent adult spinal deformity database Munish C. Gupta, MD1, Caglar Yilgor, MD2, Hong Joo Moon, MD3, Thamrong Lertudomphonwanit, MD4, Ahmet Alanay, MD5, Michael P. Kelly, MD6, Lawrence G. Lenke, MD7, Keith H. Bridwell, MD1; 1 Washington University School of Medicine, St. Louis, MO, US; 2 Acibadem University School of Medicine, Istanbul, Turkey; 3 Republic of Seoul, Korea; 4 Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5 Acibadem University, School of Medicine, Istanbul, Ata¸sehir, Turkey; 6 Washington University, Saint Louis, MO, US; 7 New York, NY, US BACKGROUND CONTEXT: Sagittal spino-pelvic alignment has been associated with patient-reported outcome measures and mechanical complication rates. Linear numerical values of pelvic tilt and lumbar lordosis measurements with different pelvic incidences may be misleading. The use of “relative” measurements embedded in a weighted scoring of Global Alignment and Proportion (GAP) has been described. The purpose of our study was to evaluate the validity of the GAP score in an independent database. PURPOSE: The purpose of our study was to evaluate the validity of the GAP score in an independent database. STUDY DESIGN/SETTING: Retrospective review of an independent adult spinal deformity data base from a single center. PATIENT SAMPLE: Adult spinal deformity patients from a single center who had >5 level fusion to the pelvis between 2004-2014. OUTCOME MEASURES: Demographic, clinical, surgical and radiographic parameters. METHODS: ASD patients who underwent ≥5 levels fusion to the pelvis between 2004 to 2014 were included. Demographic, clinical, surgical and radiographic patient characteristics were recorded. Cochran-Armitage tests
were used to determine mechanical complication trends across GAP categories. Uni /multivariable logistic regression analyses were used to obtain crude and adjusted odds ratios of predictor (GAP categories) and the outcome (mechanical complication). The diagnostic performance of the GAP score was tested using the area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value and accuracy in predicting mechanical complications. RESULTS: A total of 338 out of 657 patients (295F, 43M) with a mean age of 58§9.6 met the inclusion criteria. Mean follow-up was 55 months (24-138). Every mechanical complication was included from minor proximal compression fracture and iliac screw disengagement. Most common complications were rod failure in 25.4% (86/338) patients, 23 patients (6.8%) implant complication at the L-S junction, PJF in 45 patients (13.3%) and PJK in 20 pts (5.9%). Mechanical complication in proportioned (GAP-P), moderately (GAP-MD) and severely disproportioned (GAP-SD) patients were 23.8%, 55.7% and 66.1%, respectively. AUC for the GAP score was 0.653 (95% CI, 0.59 to 0.71, p<0.001). GAP Score demonstrated 60.5% sensitivity, 76.2% specificity, 89.1% positive predictive value, 37.4% negative predictive value and 64.2% accuracy in predicting mechanical complications. Postoperative alignment of GAP-MD and GAP-SD resulted in 3.6 and 4.6 folds of more odds in incurring a mechanical complication compared to proportioned GAP. CONCLUSIONS: This study validates the efficacy of GAP Score in predicting mechanical complications in an independent database. A trend was observed in which lower GAP scores were associated with lower rates of mechanical complications. Both the crude and adjusted odds ratios were high, showing the extent of effectiveness of this predictive tool. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.584
322. Equilibrating SRS sagittal deformity grades with the PROMIS physical health domain in adult spinal deformity Peter G. Passias, MD1, Haddy Alas, BS2, Cole Bortz, BA3, Avery Brown, BS2, Katherine E. Pierce, BS3, Dennis Vasquez-Montes, MS, BA2, Bassel G. Diebo, MD4, Tina Raman, MD3, Themistocles S. Protopsaltis, MD2, Aaron J. Buckland, MBBS, FRACS2, Michael C. Gerling, MD5; 1 NY Spine Institute, NYU Langone Health, New York, NY, US; 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 3 New York, NY, US; 4 Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, US; 5 NYU Langone, Brooklyn, Brooklyn, NY, US BACKGROUND CONTEXT: The Patient-Reported Outcomes Measurement Information System (PROMIS) is a comprehensive self-report measurement tool with patient functions, symptoms, behaviors, and mental health outcomes. Little work has been done correlating PROMIS physical health domain metrics with established adult spinal deformity (ASD) classifications such as SRS-Schwab. PURPOSE: To correlate sagittal alignment components via the SRSSchwab classification system with established PROMIS domains in a cohort of ASD patients. STUDY DESIGN/SETTING: Retrospective review of a single-center stereoradiographic database. PATIENT SAMPLE: A total of 41 ASD patients with complete baseline radiographic and PROMIS data. OUTCOME MEASURES: PROMIS physical health domain metrics (Pain Intensity [PI], Physical Function [PF], Pain Interference [Interference]), SRS-Schwab modifiers (SVA, PI-LL, PT) METHODS: Surgical ASD patients (SVA≥5cm, PT≥25˚ or TK ≥60˚) ≥18 years old with available baseline (BL) radiographic and PROMIS data were isolated in the single-center comprehensive Spine Quality Database (Quality). Patients were classified according to SRS-Schwab deformity modifiers(0,+,++) for SVA, PI-LL and PT. Descriptives and univariate analyses compared population-weighted PROMIS scores for PI, PF and
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
319. Minimally invasive surgery for neuromuscular scoliosis: a case control study of 140 consecutive patients Vishal Sarwahi, MD1, Jesse M. Galina, BS2, Romain Dayer, MD3, Sayyida S. Hasan, BS4, Aaron M. Atlas, BS4, Stephen Wendolowski4, Terry D. Amaral, MD5; 1 North Shore LIJ Health System, New Hyde Park, NY, US; 2 New Hyde Path, US; 3 Geneva University Hospitals, Pediatric Orthopedic Unit, Geneva, Geneva, Switzerland; 4 Cohen Children’s Medical Center, New Hyde Park, NY, US; 5 Northwell Health, Lake Success, NY, US BACKGROUND CONTEXT: Minimally invasive surgery (MIS) has been shown to have benefits in adolescent idiopathic scoliosis (AIS) and adult scoliosis with regards to estimated blood loss (EBL), transfusion rate, pain, narcotic usage and hospital stay. These benefits are ideal for neuromuscular scoliosis (NMS) patients, who generally have larger and stiffer curves which are at risk of progression, even with bracing. PURPOSE: The purpose of this study was to report a consecutive case series of NMS patients undergoing MIS or standard PSF. STUDY DESIGN/SETTING: Retrospective chart review. PATIENT SAMPLE: A total of 37 NMS patients treated with MIS and 103 NMS patients treated with PSF.
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OUTCOME MEASURES: Pre- and postoperative Cobb angle, pre- and postoperative kyphosis, pre- and postoperative pelvic obliquity, perioperative complications, surgery time, EBL, transfusion rates, ICU length of stay, hospital length of stay. METHODS: We retrospectively collected data of 37 consecutive patients with neuromuscular scoliosis treated with MIS using 1 incision and a muscle-splitting approach by 2 senior surgeons from 2013-2018. 103 NMS patients treated with standard PSF and pedicle screw constructs were retrospectively reviewed in comparison. RESULTS: In the MIS group, respectively the control group, the mean Cobb angle was corrected from 69.9˚ vs 67.7˚ to 29.4˚ vs 25.4˚ with a mean correction of 59% vs 63%, (p < 0.001). Mean pelvic obliquity decreased from 11.0˚ vs 12.3˚ to 5.9˚ vs 7.7˚ with a mean correction of 46% in the MIS group vs 37% in the control group, (p < 0.001). Intraoperative complications occurred in 1 MIS patient (dural breach), respectively in 7 control patients (3 pneumothorax, 4 hemorrhagic shocks). Ten Perioperative (30 days) complications occurred in 9 MIS patients (27%): 4 respiratory failures, 2 pneumonias, 1 granuloma, 1 ileus, 1 convulsion and 1 rod disconnected from the iliac connector. Thirty-one perioperative complications occurred in 24 control patients (30%): 6 UTIs, 2 pneumonias, 1 septic shock, 3 respiratory failures, 2 prolonged extubations, 6 atelectasis, 3 ileus, 2 abdominal compartment syndromes, 4 surgical site infections, and 2 wound dehiscences. In the MIS group, respectively the control group, mean ORT was 345 min vs 407 min; EBL was 573ml vs 1108ml, allogenic blood transfusion rate was 57% vs 87%, ICU LOS (days) was 4.5 vs 5.6 and hospital LOS was 11 vs 14.9. CONCLUSIONS: The use of MIS for patients with neuromuscular scoliosis results in a significant correction of spinal deformity, with a low EBL, a significantly lower rate of need for allogenic blood transfusion, and a shorter LOS. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.336
320. Effect of supine alignment on postoperative sagittal alignment following ASD surgery Jonathan Elysee1, Renaud Lafage, MSc1, Mathieu Bannwarth, MD1, Bryan Ang, BA1, Alex L. Huang1, Haddy Alas, BS2, Jessica Andres-Bergos, PhD1, Peter G. Passias, MD3, Han Jo Kim, MD1, Frank J. Schwab, MD1, Virginie Lafage, PhD1; 1 Hospital for Special Surgery, New York, NY, US; 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, US; 3 NY Spine Institute, NYU Langone Health, New York, NY, US BACKGROUND CONTEXT: Several guidelines for target-selection in the literature utilize pelvic incidence (PI) as a marker for lumbar correction. In practice, postoperative alignment is highly affected by preoperative data, including demographics and spinal flexibility. Preoperative supine radiographs allow for early visualization of patient alignment in the intraoperative position. Our objective was to determine the strongest predictor of postoperative alignment among PI, age and preoperative supine alignment using a retrospective, single center database of adult spinal deformity (ASD) patients. PURPOSE: Identify independent predictors of postoperative curvatures (LL and TK) using preoperative data only. STUDY DESIGN/SETTING: Retrospective review of a single-center database of ASD patients. PATIENT SAMPLE: A total of 99 surgically treated ASD patients with minimum 1 year follow-up. OUTCOME MEASURES: L1-S1 lordosis, T4-T12 kyphosis. METHODS: Pre- to postoperative analysis was conducted using paired t-test sampling. Patients were stratified by region of fusion postoperative: complete lumbar fusion (from L1 to S1) and/or complete thoracic fusion (from T4 to T12). Pearson’s r correlation analysis was performed on postoperative curvatures (LL and TK) with preoperative alignment in both
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S141−S157
standing and supine positions. Correlation analysis was repeated for LL in patients with complete lumbar fusion and for TK in patients with complete thoracic fusion. Lastly, a multilinear stepwise regression was conducted to identify independent predictors of LL or TK post-op. RESULTS: A total of 99 patients were included in the analysis (63.2yo, 83.1%F, 27.3kg/m2, mean f/u 21 months§.9.8). Preoperative SRS classification demonstrated a moderate to severe sagittal and/or coronal deformity (PT modifier: 18.2% ++, SVA: 27.3% ++, PI-LL: 29.3% ++, SRS type: 29.3% N and 68.7% L or D). Sagittal alignment significantly improved between pre- and postoperative (all p < 0.001). Of these, 73 patients (73.7%) underwent a complete fusion of the lumbar spine and 50 (50.5%) underwent a complete thoracic fusion. A total of 20.6% underwent a 3CO, and no significant difference was found in postoperative alignment between patients with and without 3CO (PI-LL: -2.6˚ vs 1.8˚ p = 0.175). Correlation analysis demonstrated a significant association between preoperative and postoperative LL alignment (LL Standing: 0.608; LL Supine: 0.668; PI: 0.577 all p< 0.001) as well as between pre- and postoperative TK alignment (TK Standing: 0.549; TK Supine: 0.488). Analyses were repeated on patients who underwent a complete lumbar or thoracic fusion: results demonstrated stronger associations for LL correlations (0.691, 0.716 and 0.553) and similar TK correlations (0.454 and 0.530), respectively. Multilinear regression demonstrated that only LL Supine and PI were significant predictors of postoperative LL with an r-squared of 0.568, all p< 0.01 (patient age, LL standing and TK were not significant). Similarly, LL Supine, TK Supine and patient age were the only predictors of post-op TK (r-squared 0.490, all p < 0.01). CONCLUSIONS: Preoperative supine alignment is one of the best predictors of postoperative alignment at 1 year. When controlling for fusion location, results show an even greater importance of supine alignment, especially regarding thoracic alignment. Specific attention is required when performing thoracic fusion to avoid thoracic flattening FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.337
321. Evaluation of global alignment and proportion score in an independent adult spinal deformity database Munish C. Gupta, MD1, Caglar Yilgor, MD2, Hong Joo Moon, MD3, Thamrong Lertudomphonwanit, MD4, Ahmet Alanay, MD5, Michael P. Kelly, MD6, Lawrence G. Lenke, MD7, Keith H. Bridwell, MD1; 1 Washington University School of Medicine, St. Louis, MO, US; 2 Acibadem University School of Medicine, Istanbul, Turkey; 3 Republic of Seoul, Korea; 4 Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5 Acibadem University, School of Medicine, Istanbul, Ata¸sehir, Turkey; 6 Washington University, Saint Louis, MO, US; 7 New York, NY, US BACKGROUND CONTEXT: Sagittal spino-pelvic alignment has been associated with patient-reported outcome measures and mechanical complication rates. Linear numerical values of pelvic tilt and lumbar lordosis measurements with different pelvic incidences may be misleading. The use of “relative” measurements embedded in a weighted scoring of Global Alignment and Proportion (GAP) has been described. The purpose of our study was to evaluate the validity of the GAP score in an independent database. PURPOSE: The purpose of our study was to evaluate the validity of the GAP score in an independent database. STUDY DESIGN/SETTING: Retrospective review of an independent adult spinal deformity data base from a single center. PATIENT SAMPLE: Adult spinal deformity patients from a single center who had >5 level fusion to the pelvis between 2004-2014. OUTCOME MEASURES: Demographic, clinical, surgical and radiographic parameters. METHODS: ASD patients who underwent ≥5 levels fusion to the pelvis between 2004 to 2014 were included. Demographic, clinical, surgical and radiographic patient characteristics were recorded. Cochran-Armitage tests
were used to determine mechanical complication trends across GAP categories. Uni /multivariable logistic regression analyses were used to obtain crude and adjusted odds ratios of predictor (GAP categories) and the outcome (mechanical complication). The diagnostic performance of the GAP score was tested using the area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value and accuracy in predicting mechanical complications. RESULTS: A total of 338 out of 657 patients (295F, 43M) with a mean age of 58§9.6 met the inclusion criteria. Mean follow-up was 55 months (24-138). Every mechanical complication was included from minor proximal compression fracture and iliac screw disengagement. Most common complications were rod failure in 25.4% (86/338) patients, 23 patients (6.8%) implant complication at the L-S junction, PJF in 45 patients (13.3%) and PJK in 20 pts (5.9%). Mechanical complication in proportioned (GAP-P), moderately (GAP-MD) and severely disproportioned (GAP-SD) patients were 23.8%, 55.7% and 66.1%, respectively. AUC for the GAP score was 0.653 (95% CI, 0.59 to 0.71, p<0.001). GAP Score demonstrated 60.5% sensitivity, 76.2% specificity, 89.1% positive predictive value, 37.4% negative predictive value and 64.2% accuracy in predicting mechanical complications. Postoperative alignment of GAP-MD and GAP-SD resulted in 3.6 and 4.6 folds of more odds in incurring a mechanical complication compared to proportioned GAP. CONCLUSIONS: This study validates the efficacy of GAP Score in predicting mechanical complications in an independent database. A trend was observed in which lower GAP scores were associated with lower rates of mechanical complications. Both the crude and adjusted odds ratios were high, showing the extent of effectiveness of this predictive tool. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.584
322. Equilibrating SRS sagittal deformity grades with the PROMIS physical health domain in adult spinal deformity Peter G. Passias, MD1, Haddy Alas, BS2, Cole Bortz, BA3, Avery Brown, BS2, Katherine E. Pierce, BS3, Dennis Vasquez-Montes, MS, BA2, Bassel G. Diebo, MD4, Tina Raman, MD3, Themistocles S. Protopsaltis, MD2, Aaron J. Buckland, MBBS, FRACS2, Michael C. Gerling, MD5; 1 NY Spine Institute, NYU Langone Health, New York, NY, US; 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 3 New York, NY, US; 4 Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, US; 5 NYU Langone, Brooklyn, Brooklyn, NY, US BACKGROUND CONTEXT: The Patient-Reported Outcomes Measurement Information System (PROMIS) is a comprehensive self-report measurement tool with patient functions, symptoms, behaviors, and mental health outcomes. Little work has been done correlating PROMIS physical health domain metrics with established adult spinal deformity (ASD) classifications such as SRS-Schwab. PURPOSE: To correlate sagittal alignment components via the SRSSchwab classification system with established PROMIS domains in a cohort of ASD patients. STUDY DESIGN/SETTING: Retrospective review of a single-center stereoradiographic database. PATIENT SAMPLE: A total of 41 ASD patients with complete baseline radiographic and PROMIS data. OUTCOME MEASURES: PROMIS physical health domain metrics (Pain Intensity [PI], Physical Function [PF], Pain Interference [Interference]), SRS-Schwab modifiers (SVA, PI-LL, PT) METHODS: Surgical ASD patients (SVA≥5cm, PT≥25˚ or TK ≥60˚) ≥18 years old with available baseline (BL) radiographic and PROMIS data were isolated in the single-center comprehensive Spine Quality Database (Quality). Patients were classified according to SRS-Schwab deformity modifiers(0,+,++) for SVA, PI-LL and PT. Descriptives and univariate analyses compared population-weighted PROMIS scores for PI, PF and
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.