Outcomes of Surgical Treatment for 138 Patients With Severe Sagittal Deformity at a Minimum 2-Year Follow-up: A Case Series.

Abstract

Operative treatment of adult spinal deformity (ASD) can be very challenging with high complication rates. It is well established that patients benefit from such treatment; however, the surgical outcomes for patients with severe sagittal deformity have not been reported. To report the outcomes of patients undergoing surgical correction for severe sagittal deformity. Retrospective review of a prospective, multicenter ASD database. Inclusion criteria: operative patients age≥18, sagittal vertical axis (SVA)≥15 cm, mismatch between pelvic incidence and lumbar lordosis (PI-LL)≥30°, and/or lumbar kyphosis≥5° with minimum 2 yr follow-up. Health-related quality of life (HRQOL) scores including minimal clinically important difference (MCID)/substantial clinical benefit (SCB), sagittal and coronal radiographic values, demographic, frailty, surgical, and complication data were collected. Comparisons between 2 yr postoperative and baseline HRQOL/radiographic data were made. P<.05 was significant. A total of 138 patients were included from 502 operative patients (54.3% Female, Average (Avg) age 63.3±11.5 yr). Avg operating room (OR) time 386.2±136.5 min, estimated blood loss (EBL) 1829.8±1474.6 cc. A total of 71(51.4%) had prior fusion. A total of 89.9% were posterior fusion only. Mean posterior levels fused 11.5±4.1. A total of 44.9% had a 3-column osteotomy. All 2 yr postoperative radiographic parameters were significantly improved compared to baseline (P<.001 for all). All 2yr HRQOL measures were significantly improved compared to baseline (P<.004 for all). A total of 46.6% to 73.8% of patients met either MCID/SCB for all HRQOL. A total of 74.6% of patients had at least 1 complication, 11.6% had 4 or more complications, 33.3% had minimum 1 major complication, and 42(30.4%) had a postop revision. Patients with severe sagittal malalignment benefit from surgical correction at 2 yr postoperative both radiographically and clinically despite having a high complication rate.