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P87. Strategies for prevention of pseudarthrosis in adult spinal deformity: cobalt chrome rod, 4-rod fixation, and oblique lumbar interbody fusion with sacropelvic fixation
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231 8
Center, Louisville, KY, US; Warren Alpert Medical School of BU/RI Hospital, Providence, RI, US; 9 Washington University, Saint Louis, MO, US; 10 University of Virginia, Charlottesville, VA, US; 11 University of Kansas Medical Center, Kansas City, KS, US; 12 Hospital for Special Surgery, New York, NY, US; 13 Johns Hopkins University, Baltimore, MD, US; 14 Brighton, CO, US BACKGROUND CONTEXT: Adult Spinal Deformity (ASD) surgery significantly improves disability in patients who are functionally limited. Few studies have been done examining the threshold at which surgery is unlikely to provide functional benefit in ASD patients. PURPOSE: To identify a preoperative threshold at which patients who are more active than this threshold are unlikely to have functional improvement following ASD surgery, and may experience functional decline. STUDY DESIGN/SETTING: Retrospective review of a multicenter database. PATIENT SAMPLE: A total of 592/760 (78%) eligible ASD patients (>5 levels fused) were identified in a multicenter database with minimum 2-year follow-up. OUTCOME MEASURES: Our primary outcome was baseline-2 year postoperative change in Scoliosis Research Society 22r (SRS-22r) Activity domain. METHODS: The SRS-22r was administered at preoperatively and at follow-up visits through 2-years. A baseline SRS-22r Activity score threshold was identified at which patients were more likely to decline than improve at 2-years postoperatively. Categorical variables were compared with chisquared test. Significance was set at 0.05. RESULTS: Mean age of patients was 59§14 years, 80% females. Patients had 11.2§4.3 levels fused; follow up of 3.8§0.9 years. A baseline SRS22r threshold of 3.8 was identified at which 44 (52%) patients above this threshold declined and 40 (48%) had improved activity at 2-year followup. In patients who declined, mean change was -0.6§0.43 points. Patients above this threshold were younger, had less severe deformity, and less back/leg pain (p<0.001). Most patients worse than this threshold reported SRS-22r Pain as the most severe domain (51%), while most patients better than this threshold reported the SRS-22r appearance as the worst domain (58%) (p<0.001). Patients above and below this threshold were equally likely to be satisfied with their surgery at 2 years (p=0.92). CONCLUSIONS: Baseline SRS-22r Activity score can be used to riskstratify ASD patients by likelihood of functional improvement postoperatively. Patients doing better than this threshold are just as likely to be satisfied as more disabled patients at 2 years, likely due to improvement in appearance, pain or mental health rather than activity level. In patients with SRS-22r activity above 3.8, the potential for minimal functional benefit should be included in the shared decision making process. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
S199
PURPOSE: The purpose of this study was to identify the methods for reducing the incidence of pseudarthrosis in the surgical treatment of ASD. STUDY DESIGN/SETTING: Retrospective, consecutive case review. PATIENT SAMPLE: A total of 186 consecutive patients with degenerative lumbar kyphosis (average age 70.8 years) who underwent a long-segment fixation with a minimum 2-year follow-up. OUTCOME MEASURES: Description and analysis of X-ray changes. METHODS: Subjects were classified into the pseudarthrosis group (n=39) and the non-pseudarthrosis group (n=147). For predicting the factors of pseudarthrosis, patient factors, radiologic parameters, and surgical factors which include rod materials (Titanium vs Cobalt Chrome), the use of 4-rod fixation and sacropelvic fixation, correction methods (pedicle subtraction osteotomy vs oblique lumbar interbody fusion), and the history of the previous spine surgery were analyzed. RESULTS: The overall pseudarthrosis rate was 21% (39/186). No significant differences in the incidence of pseudarthrosis regarding patient factors and preoperative radiological parameters were found between the two groups (p >0.05). Significant differences were observed in the postoperative sagittal vertical axis and thoracic kyphosis angle (p <0.05), but there were no significant differences during the last follow-up. Postoperative and last follow-up measurements showed significant differences in thoracolumbar junctional angles (p <0.05). As for surgical factors, the use of cobalt chrome rod (p =0.000), 4-rod fixation (p =0.001), sacropelvic fixation (p =0.045), and oblique lumbar interbody fusion (p =0.000) showed statistically lower incidence of pseudarthrosis than did the use of titanium rod, 2-rod fixation, non-sacropelvic fixation and PSO. CONCLUSIONS: Applications of cobalt chrome rod, 4-rod fixation, or oblique lumbar interbody fusion procedure with sacropelvic fixation will be promising methods for reducing pseudarthrosis in surgically treated ASD. FDA DEVICE/DRUG STATUS: Unavailable from authors at time of publication. https://doi.org/10.1016/j.spinee.2019.05.512
P88. Revision surgery for pseudarthrosis after surgical correction with pedicle subtraction osteotomy in adult spinal deformity: comparison of rod change only, anterior lumbar interbody fusion around pedicle subtraction osteotomy, and 4-rod constructs Jung-Hee Lee, MD, PhD1, Ki Young Lee, MD2, Won Ju Shin, MD1, Sang Kyu Im, MD3, Seong Jin Cho, MD4, Jin Soo Kim5; 1 Kyung Hee University Medical Center, Seoul, Republic of Korea; 2 Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Republic of Korea; 3 Seoul, Republic of Korea; 4 KyungHee Medical Center, Seoul, Republic of Korea; 5 Barosun Hospital, Seoul, Republic of Korea
https://doi.org/10.1016/j.spinee.2019.05.511 P87. Strategies for prevention of pseudarthrosis in adult spinal deformity: cobalt chrome rod, 4-rod fixation, and oblique lumbar interbody fusion with sacropelvic fixation Jung-Hee Lee, MD, PhD1, Ki Young Lee, MD2, Won Ju Shin, MD1, Sang Kyu Im, MD3, Seong Jin Cho, MD4, Jin Soo Kim5; 1 Kyung Hee University Medical Center, Seoul, Republic of Korea; 2 Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Republic of Korea; 3 Seoul, Republic of Korea; 4 KyungHee Medical Center, Seoul, Republic of Korea; 5 Barosun Hospital, Seoul, Republic of Korea BACKGROUND CONTEXT: Restoration of the sagittal alignment in adult spinal deformity (ASD) can produce excellent radiological and clinical outcomes, but pseudarthrosis is one of the most common complications with an incidence of 0% to 29%. Various surgical options are reported for reducing the incidence of pseudarthrosis, but these methods are controversial and have limitations.
BACKGROUND CONTEXT: Pseudarthrosis is the most common cause of revision surgery after sagittal correction with long posterior spinal fusion (PSF) in patients with ASD. Although revision surgery for pseudarthrosis after surgical correction of adult spinal deformity (ASD) remains challenging and without consensus, previous studies did not sufficiently compare the methods of revision surgery. PURPOSE: We aimed to determine the most useful of the following three methods of revision surgery: surgery for rod change only, anterior lumbar interbody fusion (ALIF) around pedicle subtraction osteotomy (PSO), and 4-rod constructs. STUDY DESIGN/SETTING: Retrospective, consecutive case review. PATIENT SAMPLE: A total of 79 patients (average age 70.5 years) who were diagnosed adult spinal deformity with sagittal imbalance and followed up for more than 5 years after surgical correction with pedicle subtraction osteotomy. OUTCOME MEASURES: Description and analysis of X-ray changes. METHODS: There were 42 revision surgeries for pseudarthrosis performed by one of three methods: rod change with 2-rod constructs (n=16),
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.
Center, Louisville, KY, US; Warren Alpert Medical School of BU/RI Hospital, Providence, RI, US; 9 Washington University, Saint Louis, MO, US; 10 University of Virginia, Charlottesville, VA, US; 11 University of Kansas Medical Center, Kansas City, KS, US; 12 Hospital for Special Surgery, New York, NY, US; 13 Johns Hopkins University, Baltimore, MD, US; 14 Brighton, CO, US BACKGROUND CONTEXT: Adult Spinal Deformity (ASD) surgery significantly improves disability in patients who are functionally limited. Few studies have been done examining the threshold at which surgery is unlikely to provide functional benefit in ASD patients. PURPOSE: To identify a preoperative threshold at which patients who are more active than this threshold are unlikely to have functional improvement following ASD surgery, and may experience functional decline. STUDY DESIGN/SETTING: Retrospective review of a multicenter database. PATIENT SAMPLE: A total of 592/760 (78%) eligible ASD patients (>5 levels fused) were identified in a multicenter database with minimum 2-year follow-up. OUTCOME MEASURES: Our primary outcome was baseline-2 year postoperative change in Scoliosis Research Society 22r (SRS-22r) Activity domain. METHODS: The SRS-22r was administered at preoperatively and at follow-up visits through 2-years. A baseline SRS-22r Activity score threshold was identified at which patients were more likely to decline than improve at 2-years postoperatively. Categorical variables were compared with chisquared test. Significance was set at 0.05. RESULTS: Mean age of patients was 59§14 years, 80% females. Patients had 11.2§4.3 levels fused; follow up of 3.8§0.9 years. A baseline SRS22r threshold of 3.8 was identified at which 44 (52%) patients above this threshold declined and 40 (48%) had improved activity at 2-year followup. In patients who declined, mean change was -0.6§0.43 points. Patients above this threshold were younger, had less severe deformity, and less back/leg pain (p<0.001). Most patients worse than this threshold reported SRS-22r Pain as the most severe domain (51%), while most patients better than this threshold reported the SRS-22r appearance as the worst domain (58%) (p<0.001). Patients above and below this threshold were equally likely to be satisfied with their surgery at 2 years (p=0.92). CONCLUSIONS: Baseline SRS-22r Activity score can be used to riskstratify ASD patients by likelihood of functional improvement postoperatively. Patients doing better than this threshold are just as likely to be satisfied as more disabled patients at 2 years, likely due to improvement in appearance, pain or mental health rather than activity level. In patients with SRS-22r activity above 3.8, the potential for minimal functional benefit should be included in the shared decision making process. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
S199
PURPOSE: The purpose of this study was to identify the methods for reducing the incidence of pseudarthrosis in the surgical treatment of ASD. STUDY DESIGN/SETTING: Retrospective, consecutive case review. PATIENT SAMPLE: A total of 186 consecutive patients with degenerative lumbar kyphosis (average age 70.8 years) who underwent a long-segment fixation with a minimum 2-year follow-up. OUTCOME MEASURES: Description and analysis of X-ray changes. METHODS: Subjects were classified into the pseudarthrosis group (n=39) and the non-pseudarthrosis group (n=147). For predicting the factors of pseudarthrosis, patient factors, radiologic parameters, and surgical factors which include rod materials (Titanium vs Cobalt Chrome), the use of 4-rod fixation and sacropelvic fixation, correction methods (pedicle subtraction osteotomy vs oblique lumbar interbody fusion), and the history of the previous spine surgery were analyzed. RESULTS: The overall pseudarthrosis rate was 21% (39/186). No significant differences in the incidence of pseudarthrosis regarding patient factors and preoperative radiological parameters were found between the two groups (p >0.05). Significant differences were observed in the postoperative sagittal vertical axis and thoracic kyphosis angle (p <0.05), but there were no significant differences during the last follow-up. Postoperative and last follow-up measurements showed significant differences in thoracolumbar junctional angles (p <0.05). As for surgical factors, the use of cobalt chrome rod (p =0.000), 4-rod fixation (p =0.001), sacropelvic fixation (p =0.045), and oblique lumbar interbody fusion (p =0.000) showed statistically lower incidence of pseudarthrosis than did the use of titanium rod, 2-rod fixation, non-sacropelvic fixation and PSO. CONCLUSIONS: Applications of cobalt chrome rod, 4-rod fixation, or oblique lumbar interbody fusion procedure with sacropelvic fixation will be promising methods for reducing pseudarthrosis in surgically treated ASD. FDA DEVICE/DRUG STATUS: Unavailable from authors at time of publication. https://doi.org/10.1016/j.spinee.2019.05.512
P88. Revision surgery for pseudarthrosis after surgical correction with pedicle subtraction osteotomy in adult spinal deformity: comparison of rod change only, anterior lumbar interbody fusion around pedicle subtraction osteotomy, and 4-rod constructs Jung-Hee Lee, MD, PhD1, Ki Young Lee, MD2, Won Ju Shin, MD1, Sang Kyu Im, MD3, Seong Jin Cho, MD4, Jin Soo Kim5; 1 Kyung Hee University Medical Center, Seoul, Republic of Korea; 2 Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Republic of Korea; 3 Seoul, Republic of Korea; 4 KyungHee Medical Center, Seoul, Republic of Korea; 5 Barosun Hospital, Seoul, Republic of Korea
https://doi.org/10.1016/j.spinee.2019.05.511 P87. Strategies for prevention of pseudarthrosis in adult spinal deformity: cobalt chrome rod, 4-rod fixation, and oblique lumbar interbody fusion with sacropelvic fixation Jung-Hee Lee, MD, PhD1, Ki Young Lee, MD2, Won Ju Shin, MD1, Sang Kyu Im, MD3, Seong Jin Cho, MD4, Jin Soo Kim5; 1 Kyung Hee University Medical Center, Seoul, Republic of Korea; 2 Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Republic of Korea; 3 Seoul, Republic of Korea; 4 KyungHee Medical Center, Seoul, Republic of Korea; 5 Barosun Hospital, Seoul, Republic of Korea BACKGROUND CONTEXT: Restoration of the sagittal alignment in adult spinal deformity (ASD) can produce excellent radiological and clinical outcomes, but pseudarthrosis is one of the most common complications with an incidence of 0% to 29%. Various surgical options are reported for reducing the incidence of pseudarthrosis, but these methods are controversial and have limitations.
BACKGROUND CONTEXT: Pseudarthrosis is the most common cause of revision surgery after sagittal correction with long posterior spinal fusion (PSF) in patients with ASD. Although revision surgery for pseudarthrosis after surgical correction of adult spinal deformity (ASD) remains challenging and without consensus, previous studies did not sufficiently compare the methods of revision surgery. PURPOSE: We aimed to determine the most useful of the following three methods of revision surgery: surgery for rod change only, anterior lumbar interbody fusion (ALIF) around pedicle subtraction osteotomy (PSO), and 4-rod constructs. STUDY DESIGN/SETTING: Retrospective, consecutive case review. PATIENT SAMPLE: A total of 79 patients (average age 70.5 years) who were diagnosed adult spinal deformity with sagittal imbalance and followed up for more than 5 years after surgical correction with pedicle subtraction osteotomy. OUTCOME MEASURES: Description and analysis of X-ray changes. METHODS: There were 42 revision surgeries for pseudarthrosis performed by one of three methods: rod change with 2-rod constructs (n=16),
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.