Rigorous Correction of Sagittal Vertical Axis Is Correlated With Better ODI Outcomes After Extensive Corrective Fusion in Elderly or Extremely Elderly Patients With Spinal Deformity

Abstract

Study DesignRetrospective analysis of a prospectively collected consecutive case series. ObjectivesTo determine the effect of spinopelvic correction on clinical outcomes and discuss the approach to target alignment in elderly or extremely elderly spinal deformity patients. Summary of Background DataAge-dependent target alignment during corrective fusion surgery in elderly patients remains controversial. Age-related target spinal alignment should be examined based on the outcomes data of patients with fused, nonphysiological spines. MethodsConsecutive adult spinal deformity (ASD) patients aged 45 years or older who underwent thoracolumbar corrective fusion of at least five levels were included. Spinopelvic radiographic parameters, health-related quality of life (Oswestry Disability Index [ODI]), and the scores on a numeric rating scale of low back pain were investigated before and after the operation. The patients were stratified into three groups according to age as follows: Middle-Age, 45–64 years; Elderly, 65–74 years; and Extremely Elderly, ≥75 years. We also stratified the patients into three groups according to lumber lordosis (LL) as follows: ideal (within ±5° of ideal LL), moderate (between −5° and −20° of ideal LL), and under (under ideal LL by −20°). ResultsA total of 149 patients (Middle-Age, 38; Elderly, 68; and Extremely Elderly, 43) were included in this study. No significant difference was observed in any of the radiographic parameters in each age group. The ODI and numeric rating scale scores of the ideal-correction group at two years after surgery were significantly better than those of the undercorrection group across all ages. A significant correlation with ODI was observed between sagittal spinopelvic parameters in the Elderly and Extremely Elderly groups. A stronger correlation was observed in the Extremely Elderly group compared with the Elderly group. ConclusionsRigorous realignment of sagittal vertical axis is correlated with ODI outcomes, especially in very elderly patients. Level of EvidenceLevel 4.