Determinants of Postoperative Spinal Height Change among Adult Spinal Deformity Patients with Long Construct Circumferential Fusion

Abstract

Study Design Retrospective clinical study. Purpose To describe postoperative height changes and identify the predictive factors of spinal height (SH) changes among patients with adult spinal deformity (ASD) who underwent circumferential lumbar fusion with instrumentation. Overview of Literature Postoperative height changes remain an important issue after spinal fusion surgery that affects the overall satisfaction with surgery. Previous studies of postoperative height change have focused exclusively on young patients with adolescent idiopathic scoliosis (AIS). Methods We retrospectively reviewed the clinical and imaging data of ASD patients who underwent lumbar corrective circumferential fusion of ≥3 levels (n=106). SH was defined as the vertical distance between C2 and S1 on a standing lateral image. As potential predictors of postoperative height change, the number of lateral lumbar interbody fusion (LLIF) levels, change in spino-pelvic parameters, total number of levels fused, and pedicle subtraction osteotomies (PSO) were documented. Univariate and multivariate linear regression analyses were performed to identify the predictors of postoperative height change. Results The mean SH change was −2.39±50.8 mm (range, −160 to 172 mm). The univariate analyses showed that the number of LLIF levels (coefficient=10.9, p=0.03), the absolute coronal vertical axis change (coefficient=0.6, p=0.01), and the absolute Cobb angle change (coefficient=−0.9, p=0.03) were significant predictors for height change. Patients with PSOs (n=14) tended to have a shorter height postoperatively (coefficient=−26.1); however, this difference was not significant (p=0.07). Multivariate analyses conducted with variables of p<0.20 showed that pelvic tilt (PT) change is an independent contributor to SH change (coefficient=−0.99, p=0.04, R2=0.11). Conclusions Utilizing a modified definition of SH used in previous AIS studies, we demonstrated that patients with ASD lose SH postoperatively and that PT change was an independent contributor of SH change.

Keywords

• spinal height
• adult spinal deformity
• lateral lumbar interbody fusion
• circumferential fusion
• thoraco-lumbar spine