How Much Lumbar Lordosis does a Patient Need to Reach their Age-Adjusted Alignment Target? A Formulated Approach Predicting Successful Surgical Outcomes
STUDY DESIGN: Retrospective cohort study.
OBJECTIVES: Identify optimal lumbar lordosis in adult deformity correction to achieve age-adjusted targets and sustained alignment.
METHODS: Surgical adult spinal deformity patients reaching an age-adjusted ideal alignment at one year were identified. Multilinear regression analysis was used to identify the relationship between regional curvatures (LL and TK) that enabled achievement of a given global alignment (T1 pelvic angle, TPA) based on pelvic incidence (PI).
RESULTS: 347 patients out of 1048 available reached their age-adjusted TPA within 5° (60-year-old, 72% women, body mass index 29 ± 6.2). They had a significant improvement in all sagittal parameters (except PI) from pre-operative baseline to 1 year following surgery (P < .001). Multilinear regression predicting L1-S1 based on TK, TPA, and PI demonstrated excellent results (R2 = .85). Simplification of the coefficients of prediction combined with a conversion to an age-based formula led to the following: LL = PI - 0.3TK - 0.5Age + 10. Internal validation of the formula led to a mean error of -.4°, and an absolute error of 5.0°. Internal validation on patients with an age-adjusted alignment revealed similar accuracy across the entire age-adjusted TPA spectrum (ranges of LL errors: ME = .2° to 1.7°, AE = 4.0° to 5.3°).
CONCLUSION: This study provides a simple guideline to identify the amount of LL needed to reach a given alignment (i.e., age-adjusted target) based on PI and associated TK. Implementation of this predictive formula during pre-operative surgical planning may help to reduce unexpected sub-optimal post-operative alignment outcomes.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 2023 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
|---|---|
| Enthalten in: |
Global spine journal - 14(2023), 1 vom: 20. Jan., Seite 41-48 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
McCarthy, Michael H [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Adult spinal deformity |
|---|
| Anmerkungen: |
Date Revised 27.11.2023 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.1177/21925682221092003 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM339721073 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM339721073 | ||
| 003 | DE-627 | ||
| 005 | 20231226003529.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1177/21925682221092003 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1132.xml |
| 035 | |a (DE-627)NLM339721073 | ||
| 035 | |a (NLM)35442842 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a McCarthy, Michael H |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a How Much Lumbar Lordosis does a Patient Need to Reach their Age-Adjusted Alignment Target? A Formulated Approach Predicting Successful Surgical Outcomes |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 27.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a STUDY DESIGN: Retrospective cohort study | ||
| 520 | |a OBJECTIVES: Identify optimal lumbar lordosis in adult deformity correction to achieve age-adjusted targets and sustained alignment | ||
| 520 | |a METHODS: Surgical adult spinal deformity patients reaching an age-adjusted ideal alignment at one year were identified. Multilinear regression analysis was used to identify the relationship between regional curvatures (LL and TK) that enabled achievement of a given global alignment (T1 pelvic angle, TPA) based on pelvic incidence (PI) | ||
| 520 | |a RESULTS: 347 patients out of 1048 available reached their age-adjusted TPA within 5° (60-year-old, 72% women, body mass index 29 ± 6.2). They had a significant improvement in all sagittal parameters (except PI) from pre-operative baseline to 1 year following surgery (P < .001). Multilinear regression predicting L1-S1 based on TK, TPA, and PI demonstrated excellent results (R2 = .85). Simplification of the coefficients of prediction combined with a conversion to an age-based formula led to the following: LL = PI - 0.3TK - 0.5Age + 10. Internal validation of the formula led to a mean error of -.4°, and an absolute error of 5.0°. Internal validation on patients with an age-adjusted alignment revealed similar accuracy across the entire age-adjusted TPA spectrum (ranges of LL errors: ME = .2° to 1.7°, AE = 4.0° to 5.3°) | ||
| 520 | |a CONCLUSION: This study provides a simple guideline to identify the amount of LL needed to reach a given alignment (i.e., age-adjusted target) based on PI and associated TK. Implementation of this predictive formula during pre-operative surgical planning may help to reduce unexpected sub-optimal post-operative alignment outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a adult spinal deformity | |
| 650 | 4 | |a age-adjusted alignment targets | |
| 650 | 4 | |a lumbar lordosis | |
| 650 | 4 | |a pelvic incidence | |
| 650 | 4 | |a predictive formula | |
| 650 | 4 | |a regional alignment | |
| 650 | 4 | |a sagittal vertical axis | |
| 650 | 4 | |a thoracic kyphosis | |
| 700 | 1 | |a Lafage, Renaud |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Justin S |e verfasserin |4 aut | |
| 700 | 1 | |a Bess, Shay |e verfasserin |4 aut | |
| 700 | 1 | |a Ames, Christopher P |e verfasserin |4 aut | |
| 700 | 1 | |a Klineberg, Eric O |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Han J |e verfasserin |4 aut | |
| 700 | 1 | |a Shaffrey, Christopher I |e verfasserin |4 aut | |
| 700 | 1 | |a Burton, Douglas C |e verfasserin |4 aut | |
| 700 | 1 | |a Mundis, Gregory M |e verfasserin |4 aut | |
| 700 | 1 | |a Gupta, Manish C |e verfasserin |4 aut | |
| 700 | 1 | |a Schwab, Frank J |e verfasserin |4 aut | |
| 700 | 1 | |a Lafage, Virginie |e verfasserin |4 aut | |
| 700 | 0 | |a International Spine Study Group (ISSG) |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Global spine journal |d 2011 |g 14(2023), 1 vom: 20. Jan., Seite 41-48 |w (DE-627)NLM233811001 |x 2192-5682 |7 nnns |
| 773 | 1 | 8 | |g volume:14 |g year:2023 |g number:1 |g day:20 |g month:01 |g pages:41-48 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1177/21925682221092003 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 14 |j 2023 |e 1 |b 20 |c 01 |h 41-48 | ||