Outcomes of Surgical Treatment for One Hundred and Thirty-Eight Patients With Severe Sagittal Deformity at a Minimum 2-Year Follow-Up

Abstract

Abstract INTRODUCTION Operative treatment of ASD can be very challenging with high complication rates. It's well established that pts benefit from such treatment. However, the surgical outcomes for pts with severe sagittal deformity have not been reported. METHODS Retrospective review of a prospective, multicenter adult spinal deformity (ASD) database. Inclusion criteria: operative patients age = 18, SVA = 15 cm, PI-LL = 30 degrees, and/or lumbar kyphosis = 5 degrees with a minimum 2 yr follow-up. Health-related quality of life (HRQOL) scores: Oswestry Disability Index (ODI), Short form-36 (SF36), Scoliosis Research Society (SRS22), back/leg pain numerical rating scale (NRS) and min clinically important difference (MCID)/substantial clinical benefit (SCB) for patients eligible to meet it. Radiographic values: max coronal cobb angle, coronal C7 plumb line, pelvic tilt, mismatch between pelvic incidence and lumbar lordosis, thoracic kyphosis, C7 sagittal vertical axis. Demographic, frailty, surgical, and complication data were also collected. Comparisons between 2 yr postop and baseline HRQOL/radiographic data were made. P < .05 was significant. RESULTS About 138 patients were included from 502 operative patients (54.3% females, average age 63.3 ± 11.5 yr). Averege baseline frailty score was 4.1 ± 1.4, indicating that patients were frail. A total of 71 (51.4%) of the patients had a prior fusion. A total of 89.9% patients had posterior fusion only, with an average 11.5 ± 4.1 post levels fused. About 44.9% had 3-column osteotomy. Two standard deviations was considered for for SVA = 14.8 cm. All 2-yr postop radiographic parameters were significantly improved compared to baseline (P < .05) except coronal C7 plumb line (P > .05). All 2-yr HRQOL measures were significantly improved compared to baseline (P < .004). About 46.6% to 73.8% of patients met either MCID or 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 a minimum 1 major complication, and 42 (30.4%) had a postop revision. CONCLUSION Patients with a severe sagittal malalignment benefit from surgical correction at 2 yr postop both radiographically and clinically despite having a high complication rate.