Which Is More Predictive Value for Mechanical Complications: Fixed Thoracolumbar Alignment (T1 Pelvic Angle) Versus Dynamic Global Balance Parameter (Odontoid-Hip Axis Angle)
Kwang-Ryeol Kim,
Jean-Charles Le Huec,
Hyun-Jun Jang,
Sung-Hyun Noh,
Jeong-Yoon Park,
Yoon Ha,
Sung-Uk Kuh,
Dong-Kyu Chin,
Keun-Su Kim,
Byung-Ho Jin,
Yong-Eun Cho,
Kyung-Hyun Kim
Affiliations
Kwang-Ryeol Kim
Department of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
Jean-Charles Le Huec
Department of Orthopedic Surgery, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
Hyun-Jun Jang
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
Sung-Hyun Noh
Department of Neurosurgery, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
Jeong-Yoon Park
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
Yoon Ha
Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Sung-Uk Kuh
Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
Dong-Kyu Chin
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
Keun-Su Kim
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
Byung-Ho Jin
Department of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
Yong-Eun Cho
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
Kyung-Hyun Kim
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
Objective In this study, we investigate about relationship between postoperative global sagittal imbalance and occurrence of mechanical complications after adult spinal deformity (ASD) surgery. In global sagittal balance parameters, odontoid-hip axis (OD-HA) angle and T1 pelvic angle (TPA) were analyzed. Methods Between January 2009 and December 2016, 199 consecutive patients (26 males and 173 females) with ASD underwent corrective fusion of more than 4 levels and were followed up for more than 2 years. Immediate postoperative and postoperative 2 years whole spine x-rays were checked for evaluating immediate postoperative OD-HA, TPA, and other parameters. In clinical outcomes, back and leg pain visual analogue scale, Scoliosis Research Society-22 spinal deformity questionnaire (SRS-22), Oswestry Disability Index (ODI), 36-item Short Form Health Survey (SF-36) were evaluated. Results Based on the occurrence of mechanical complications, a comparative analysis was performed for each parameter. In univariable analysis, mechanical complications were significantly much more occurred in OD-HA abnormal group (odds ratio [OR], 3.296; p<0.001; area under the curve [AUC]=0.645). In multivariable analysis, the result was much more related (OR, 2.924; p=0.001; AUC=0.727). In contrast, there was no significant difference between normal and the occurrence of mechanical complications in TPA. In clinical outcomes (normal vs. abnormal), the differences of SRS-22 (0.88±0.73 vs. 0.68±0.64, p=0.042), ODI (-24.72±20.16 vs. -19.01±19.95, p=0.046), SF-36 physical composite score (19.33±18.55 vs. 12.90±16.73, p=0.011) were significantly improved in OD-HA normal group. Conclusion The goal of ASD surgery is to improve patient life quality through correction. In our study, TPA was associated with spinopelvic parameter and OD-HA angle was associated with health-related quality of life and complications. OD-HA angle is predictable factor for mechanical complications after ASD surgery.
