Abstract
BACKGROUND CONTEXT It has been proposed that achieving optimal spinopelvic alignment is needed to attain significant clinical improvement. PURPOSE The purpose of this study was to determine whether obtaining optimal spinopelvic alignment was necessary to achieve a minimal clinically important difference (MCID) or substantial clinical benefit (SCB). STUDY DESIGN/SETTING Multicenter retrospective review. PATIENT SAMPLE A total of 153 patients who underwent less invasive surgery for adult spinal deformity (ASD). OUTCOME MEASURES Oswestry Disability Index. METHODS Inclusion criteria were age ≥18 years, and one of the following: coronal Cobb>20°, SVA>5cm, PT>20°, PI-LL>10°. Patients were treated with circumferential MIS or hybrid surgery and had 2-year minimum follow-up. Based on optimal spinopelvic parameters (PI-LL±10°, PT RESULTS There were 74 AL and 149 MAL patients. Age and BMI were similar between groups. Although baseline SVA was similar, PI-LL (9.9° vs. 17.7°, p=0.002) and PT (19° vs. 24.7°, p=0.001) significantly differed between AL and MAL groups, respectively. As expected postoperatively, the AL and MAL groups differed significantly in PI-LL (−0.9° vs. 13.1°, p 0.05) or SCB (40.5% vs. 46.3%, p>0.05), respectively. On multivariate analysis controlling for surgical and preop demographic differences, achieving optimal spinopelvic parameters was not associated with achieving MCID (OR 0.645, 0.31–1.33, 95%CI) or SCB (OR 0.644, 0.31–1.35, 95%CI) ODI. CONCLUSIONS Achieving optimal spinopelvic parameters does not appear to be a predictor for achieving MCID or SCB. Since spinopelvic parameters are correlated with clinical outcomes, our findings suggest that the presently accepted optimal spinopelvic parameters may require modification.
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