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What Are the Factors Influencing the Treatment Modality for Patients with Adult Spinal Deformity?
NASS 32nd Annual Meeting Proceedings / The Spine Journal 17 (2017) S176–S272 P141. What Are the Factors Influencing the Treatment Modality for Patients with Adult Spinal Deformity? Takashi Fujishiro, MD1, Louis Boissiere, MD2, Daniel Larrieu, Derek T. Cawley, MD3, Abdulmajeed Alzakri, MD4, Jean-Marc Vital, MD5, Olivier Gille, PhD6, Caglar Yilgor, MD6, Ahmet Alanay, MD7, Emre Acaroglu, MD8, Anouar Bourghli, Francisco J. Perez-Grueso, MD9, Ferran Pellise, MD, PhD10, Ibrahim Obeid, MD11, ESSG European Spine Study Group12; 1Spinal Unit 1, Bordeaux University Hospital, Bordeaux, France; 2Bordeaux University Hospital, France; 3Ireland; 4Bordeaux Gironde, France; 5Hôpital Pellegrin Tripode, Bordeaux, France; 6Groupe Hospitalier Pellegrin, Bordeaux, France; 7Acibadem University School of Medicine, Istanbul, Atas¸ehir, Turkey; 8Ankara, Turkey; 9H. De La Paz (Madrid), Madrid, Spain; 10Barcelona, Spain; 11Bordeaux, France; 12 European Spine Study Group, Barcelona, Spain BACKGROUND CONTEXT: The decision-making process for adult spinal deformity (ASD) correction is challenging, because the ASD population is highly heterogeneous. There have been a handful of studies investigating the factors influencing the treatment modality. However, spinopelvic radiographic parameters while correlated to HRQOL, have not been analyzed as decision-making factors. PURPOSE: To elucidate the decision-making factors for ASD treatment, including radiographic parameters that impact on HRQOL. STUDY DESIGN/SETTING: Retrospective review of a prospective multicentered database. PATIENT SAMPLE: We reviewed prospectively collected data of patients with ASD aged≥18 years, presenting at least one criteria: Cobb ≥20°; SVA ≥5 cm; TK ≥60° or PT ≥25°. Among them, a total of 989 patients with complete data were included in this study (134 surgical and 280 nonsurgical [mean age: 30.7 years] in the younger age group; 323 surgical and 252 nonsurgical [mean age 65.8 years] in the older age group). OUTCOME MEASURES: Demographic evaluation included age, gender, BMI, comorbidity, past spinal surgery, neurological symptoms and back/ leg pain. HRQOL measures included ODI, 2 scores in SF-36 and 5 domains in SRS-22. Analyzed radiographic parameters were coronal curve types, Cobb angle, apical translation and coronal decompensation in coronal plane, and PT, SVA, PI-LL mismatch, T1 sagittal tilt (T1ST), T1 pelvic angle (TPA), global tilt (GT), lumbar lordosis index (LLI), and relative spinopelvic alignment (RSA:=GT- ideal GT with ideal GT=0.48×PI–15, evaluating the amount of malalignment based on patients ideal GT) in sagittal plane. Subluxation both in coronal and sagittal plane was also assessed. METHODS: All demographic, HRQOL measures, and radiographic parameters were analyzed between the patients with surgical and nonsurgical treatment in stratified 2 age groups (younger ≤50 years; older>50 years). Forward stepwise logistic regression analyses were performed, including the variables with statistical differences to treatment modality at the p<.15 in univariate analyses. A p value <.05 was considered statistically significant. RESULTS: The multivariate analyses indicated that patients who elected for surgical management had significantly worse SRS-22 self-image score (OR: 2.2, 95% CI: 1.7–3.0, p<.001), greater apical translation (OR: 1.025, 95% CI: 1.012–1.039, p<.001, calculated per mm), and greater PI-LL mismatch (OR: 1.030, 95% CI: 1.008–1.053, p=.008) in the younger age group, and greater ODI score (OR: 1.019, 95% CI: 1.006–1.033, p=.005), and worse SRS-22 self-image score (OR: 2.2, 95% CI: 1.6–3.0, p<.001), smaller maximum coronal curve (OR: 1.032, 95% CI: 1.023–1.043, p<.001), and smaller LLI (OR: 2.0, 95% CI: 1.2–3.5, p=.010) in the older age group. CONCLUSIONS: The magnitude of spinal deformity was the most important factor for decision-making in the younger age group, whereas both spinal deformity magnitude and disability were the most important factors in the older age group. In both age groups, SRS-22 self-image score was significant, however, greater coronal deformity was a significant factor in deciding to undergo surgery only in the younger age group. Moreover, sagittal parameters, in particular the relationship between PI and LL in both age groups, were associated with the decision-making process.
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FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.08.142
P142. Evaluation of Revisions in Pediatric Cerebral Palsy Spinal Deformity Patients at 5-Years Munish C. Gupta, MD1, Mark Abel, MD2, Harry L. Shufflebarger, MD3, Paul D. Sponseller, MD4; 1Washington University School of Medicine, St. Louis, MO, USA; 2University of Virginia, Charlottesville, VA, USA; 3 Miami Children’s Hospital, Miami, FL, USA; 4Baltimore, MD, USA BACKGROUND CONTEXT: Surgical treatment of spinal deformity in cerebral palsy patients has been found to be very beneficial. Previous studies of surgery in these patients have shown a higher risk of revisions and failures than in AIS patients. Current surgical techniques and implants seem to have decreased both revisions and other complications. We studied the rate of revisions with modern surgical techniques at minimum 5 years. PURPOSE: The purpose of this study was to evaluate the revision rate, instrumentation durability and loss of correction of cerebral palsy patients 5 years after surgery for spinal deformity. STUDY DESIGN/SETTING: Observational cohort. PATIENT SAMPLE: Study included 79 pediatric cerebral palsy surgical patients. OUTCOME MEASURES: Radiographic parameters major Cobb angle, lordosis, HRQOL, revision surgeries. METHODS: Patients enrolled in a prospective, multicenter, cerebral palsy surgical registry from 2008–2011 with min 5-years follow-up were reviewed. Registry data and radiographs were reviewed; revisions were placed in categories: 1) implant prominence or misplacement 2) implant failure with/ without pseudoarthrosis 3) wound complication including infection 4) progression of deformity requiring revision and 5) other. RESULTS: Of 488 patients in the registry, 79/203 enrolled from 2008– 2011 have a minimum of 5 year follow-up. Average age was 13 (8–19) at surgery, 41 females/38 males. Seventy (89%) patients had posterior-only, 8 (10%) had anterior/posterior, and 1 had an anterior-only procedure. A total of 73 patients had primary coronal deformity, major Cobb average 85° (41– 135), postop 27° (5–81), 2 years 31° (3–69), 5 years 32° (8–80). Loss of correction was 3° at 2 years and 5° at 5 years. Six patients had primary sagittal plane deformity average of 77° preoperatively, 45° postoperatively, 42° 2 years, 41° 5 years. In all patients, preoperative lordosis was −35°, postop was −52°, 2-year was −53°, 5-year was −56°. There was no significant loss of correction in the coronal or sagittal plane. There were 3 revisions for implant prominence or misplacement, 3 for implant failure with nonunions, 7 for wound infections, and 2 for other complications. Between postop and 3 months there were 4 infections that required revision, 1 patient between 3 months - 1 yr, 1 patient between 2–5 years, and 1 patient >5yrs. No patients required revision for progressive deformity. There were no differences in the GMFCS grade between no revisions (G5=62, G4=3, G2=2, no grade=2) compared to revisions (G5=7, G4=3). The outcome scores for both groups were the same at postop, 2 years and 5 years (CPCHILD, HUI). CONCLUSIONS: Excellent correction in coronal and sagittal plane of cerebral palsy patients was achieved without any significant loss of correction at 5 years. Even though there was a 12.7% revision rate, the constructs overall were found to be durable at 5 years. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.08.143
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.
S239
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.08.142
P142. Evaluation of Revisions in Pediatric Cerebral Palsy Spinal Deformity Patients at 5-Years Munish C. Gupta, MD1, Mark Abel, MD2, Harry L. Shufflebarger, MD3, Paul D. Sponseller, MD4; 1Washington University School of Medicine, St. Louis, MO, USA; 2University of Virginia, Charlottesville, VA, USA; 3 Miami Children’s Hospital, Miami, FL, USA; 4Baltimore, MD, USA BACKGROUND CONTEXT: Surgical treatment of spinal deformity in cerebral palsy patients has been found to be very beneficial. Previous studies of surgery in these patients have shown a higher risk of revisions and failures than in AIS patients. Current surgical techniques and implants seem to have decreased both revisions and other complications. We studied the rate of revisions with modern surgical techniques at minimum 5 years. PURPOSE: The purpose of this study was to evaluate the revision rate, instrumentation durability and loss of correction of cerebral palsy patients 5 years after surgery for spinal deformity. STUDY DESIGN/SETTING: Observational cohort. PATIENT SAMPLE: Study included 79 pediatric cerebral palsy surgical patients. OUTCOME MEASURES: Radiographic parameters major Cobb angle, lordosis, HRQOL, revision surgeries. METHODS: Patients enrolled in a prospective, multicenter, cerebral palsy surgical registry from 2008–2011 with min 5-years follow-up were reviewed. Registry data and radiographs were reviewed; revisions were placed in categories: 1) implant prominence or misplacement 2) implant failure with/ without pseudoarthrosis 3) wound complication including infection 4) progression of deformity requiring revision and 5) other. RESULTS: Of 488 patients in the registry, 79/203 enrolled from 2008– 2011 have a minimum of 5 year follow-up. Average age was 13 (8–19) at surgery, 41 females/38 males. Seventy (89%) patients had posterior-only, 8 (10%) had anterior/posterior, and 1 had an anterior-only procedure. A total of 73 patients had primary coronal deformity, major Cobb average 85° (41– 135), postop 27° (5–81), 2 years 31° (3–69), 5 years 32° (8–80). Loss of correction was 3° at 2 years and 5° at 5 years. Six patients had primary sagittal plane deformity average of 77° preoperatively, 45° postoperatively, 42° 2 years, 41° 5 years. In all patients, preoperative lordosis was −35°, postop was −52°, 2-year was −53°, 5-year was −56°. There was no significant loss of correction in the coronal or sagittal plane. There were 3 revisions for implant prominence or misplacement, 3 for implant failure with nonunions, 7 for wound infections, and 2 for other complications. Between postop and 3 months there were 4 infections that required revision, 1 patient between 3 months - 1 yr, 1 patient between 2–5 years, and 1 patient >5yrs. No patients required revision for progressive deformity. There were no differences in the GMFCS grade between no revisions (G5=62, G4=3, G2=2, no grade=2) compared to revisions (G5=7, G4=3). The outcome scores for both groups were the same at postop, 2 years and 5 years (CPCHILD, HUI). CONCLUSIONS: Excellent correction in coronal and sagittal plane of cerebral palsy patients was achieved without any significant loss of correction at 5 years. Even though there was a 12.7% revision rate, the constructs overall were found to be durable at 5 years. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2017.08.143
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.