Abstract
BACKGROUND CONTEXT Age-adjusted alignment targets for adult spinal deformity (ASD) patients have the potential to reduce the incidence of PJK while ensuring optimal HRQL. Previous studies demonstrated the interplay between lumbar lordosis (LL) and thoracic kyphosis (TK) and their relationship with pelvic morphology as measured by the plevic incidence (PI). In clinical practice, reaching this ideal alignment remains challenging as the relationship between lordosis and kyphosis is not clearly elucidated. PURPOSE This study aimed at developing a pragmatic formula on how much lumbar lordosis is needed based on the patient age, PI and exiting thoracic kyphosis. STUDY DESIGN/SETTING Multicenter retrospective review of a prospective database. PATIENT SAMPLE A total of 347 adult spinal deformity patients reaching age-adjusted alignment at 1-year post surgery. OUTCOME MEASURES Sagittal alignment and internal validation of predictive formula. METHODS Surgical ASD patients reaching an age-adjusted ideal alignment at one year were identified. Multilinear regressions analysis was used to identify the relationship between regional curvatures (LL &TK) permitting to reach a given global alignment (TPA) based on pelvic incidence. RESULTS The 347 patients included (60 years old, 72% female, BMI 29±6.2) had a significant improvement in all sagittal parameters from pre-op to 1Y (p CONCLUSIONS This study provides a simple guideline to identify the amount of lordosis needed to reach a given alignment (ie, age-adjusted target) based on pelvic incidence and associated thoracic kyphosis. Implementation of this predictive formula during pre-operative surgical planning can help to reduce unexpected sub-optimal post-operative alignment outcomes. These values could be integrated into pre-contoured rods for true patient specific alignment. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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