Long-term Impact of Sagittal Malalignment on Hardware After Posterior Fixation of the Thoracolumbar Spine: a Retrospective Study

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2020 Jun 18

PMID 32546153

Citations 2

Authors

Mahmoud Elshamly

Reinhard Windhager

Stefan Toegel

Josef Georg Grohs

Affiliations

Soon will be listed here.

Abstract

Background: The importance of sagittal alignment in healthy individuals and in reconstructive spinal surgery has been studied over the last 15 years. The aim of the present study was to assess the long-term effects of abnormal sagittal alignment on hardware after posterior thoracolumbar spinal fusion.

Methods: Patients who had undergone revision surgery (revision cohort, n = 34) due to breakage of their implants were compared retrospectively with patients who had intact implants at the final follow-up investigation after a long posterior thoracolumbar and/or lumbar spinal fusion (control cohort, n = 22). Clinical data and radiological parameters including the sagittal vertical axis (SVA), pelvic incidence (PI), lordosis gap (LG), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and the femoral obliquity angle (FOA) were assessed on full-spine lateral radiographs obtained in regular standing position. Data were analysed using descriptive statistics, parametric and non-parametric inferential statistics.

Results: Patients in the breakage group (female n = 21, male n = 9, mean age 60.9 ± 15.6 years) had a higher anterior shift of the C7 plumb line (SVA) (p = 0.02), retroversion of the pelvis (PT) (p < 0.001), PI-LL mismatch (LG) (p = 0.001), and PI (p = 0.002) than the intact group (female n = 10, male n = 12, mean age 65.7 ± 12.4 years). No significant difference was registered between groups in regard of SS, LL, TK, FOA, and the mean number of comorbidities.

Conclusion: Failure of restoration of the SVA and the LG to the acceptable ranges, especially in patients with a high PI, may be regarded as a risk factor for the long-term failure of implants after posterior thoracolumbar spinal fusion.

Citing Articles

Sagittal spinal alignment measurements and evaluation: Historical perspective.

Knebel A, Daher M, Singh M, Fisher L, Daniels A, Diebo B N Am Spine Soc J. 2024; 19:100519.

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Cost Benefit of Implementation of Risk Stratification Models for Adult Spinal Deformity Surgery.

Passias P, Williamson T, Kummer N, Pellise F, Lafage V, Lafage R Global Spine J. 2023; 15(2):818-830.

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Do adult spinal deformity patients who achieve and maintain PI-LL < 10 have better patient-reported and clinical outcomes compared to patients with PI-LL ≥ 10? A propensity score-matched analysis.

Mohanty S, Mikhail C, Lai C, Hassan F, Stephan S, Lewerenz E Spine Deform. 2023; 12(1):209-219.

PMID: 37819577 DOI: 10.1007/s43390-023-00766-y.

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