Skip to main content

Advertisement

SpringerLink
Log in

The validation study of preoperative surgical planning for corrective target in adult spinal deformity surgery with 5-year follow-up for mechanical complications

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

We used the Hamamatsu formula as an indicator of correction goals in surgery for adult spinal deformity (ASD). However, it is reported that correction according to Global Alignment and Proportion (GAP) score and the Roussouly algorithm reduces implant-related complications. The purpose of this study was to validate three preoperative plannings for the incidence of complications.

Methods

Patients who underwent ASD surgery and followed up for 5 years were included. The Hamamatsu formula was also divided into three groups: ideal (I), moderate (M), and under (U). The GAP score was divided into three groups: proportioned (P), moderately disproportioned (MD), and severely disproportioned (SD). Patients who met the postoperative Roussouly classification algorithm were defined as the restored (R) group and those who did not were defined as the non-restored (NR) group. Proximal junctional kyphosis (PJK) and rod fractures were investigated.

Results

In the Hamamatsu formula, there were 51, 108, and 44 patients in Groups I, M, and U, respectively, with no significant differences in their complications. In the GAP score, there were 45, 71, and 87 patients in the P, MD, and SD group, respectively, with no significant differences in their complications. In the Roussouly classification, there were 102 and 101 patients in the R and NR group, respectively, with a significant difference in their complication rate (R/NR = 51%:70%; P = 0.005). PJK was significantly lower in the R group (R/NR = 15%:30%; P = 0.010).

Conclusion

Correction according to the Roussouly algorithm is useful for the prevention of mechanical complications, especially PJK.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Smith JS, Kelly MP, Yanik EL et al (2021) Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis at 5-year follow-up: durability of outcomes and impact of treatment-related serious adverse events. J Neurosurg Spine 35:67–79. https://doi.org/10.3171/2020.9.SPINE201472

    Article  Google Scholar 

  2. Schwab F, Ungar B, Blondel B et al (2012) Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine 37:1077–1082. https://doi.org/10.1097/BRS.0b013e31823e15e2

    Article  Google Scholar 

  3. Yamato Y, Hasegawa T, Kobayashi S et al (2016) Calculation of the target lumbar lordosis angle for restoring an optimal pelvic tilt in elderly patients with adult spinal deformity. Spine 41:E211–E217. https://doi.org/10.1097/BRS.0000000000001209

    Article  Google Scholar 

  4. Yilgor C, Sogunmez N, Boissiere L et al (2017) Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am 99:1661–1672. https://doi.org/10.2106/JBJS.16.01594

    Article  Google Scholar 

  5. Lafage R, Schwab F, Glassman S et al (2017) Age-adjusted alignment goals have the potential to reduce PJK. Spine 42:1275–1282. https://doi.org/10.1097/BRS.0000000000002146

    Article  Google Scholar 

  6. Bari TJ, Hansen LV, Gehrchen M (2020) Surgical correction of Adult Spinal Deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications. Spine Deform 8:1027–1037. https://doi.org/10.1007/s43390-020-00112-6

    Article  Google Scholar 

  7. Yamato Y, Hasegawa T, Togawa D et al (2019) 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. Spine Deform 7:610–618. https://doi.org/10.1016/j.jspd.2018.11.001

    Article  Google Scholar 

  8. Roussouly P, Gollogly S, Berthonnaud E et al (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine 30:346–353. https://doi.org/10.1097/01.brs.0000152379.54463.65

    Article  Google Scholar 

  9. Laouissat F, Sebaaly A, Gehrchen M et al (2018) Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J 27:2002–2011. https://doi.org/10.1007/s00586-017-5111-x

    Article  Google Scholar 

  10. Sebaaly A, Grobost P, Mallam L et al (2018) Description of the sagittal alignment of the degenerative human spine. Eur Spine J 27:489–496. https://doi.org/10.1007/s00586-017-5404-0

    Article  Google Scholar 

  11. Schwab F, Blondel B, Chay E et al (2015) The comprehensive anatomical spinal osteotomy classification. Neurosurgery 76(1):S33-41. https://doi.org/10.1227/01.neu.0000462076.73701.09

    Article  Google Scholar 

  12. Soroceanu A, Diebo BG, Burton D et al (2015) Radiographical and implant-related complications in adult spinal deformity surgery: incidence, patient risk factors, and impact on health-related quality of life. Spine 40:1414–1421. https://doi.org/10.1097/BRS.0000000000001020

    Article  Google Scholar 

  13. Wang J, Zhao Y, Shen B et al (2010) Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis. Injury 41:415–420. https://doi.org/10.1016/j.injury.2010.01.001

    Article  Google Scholar 

  14. Yagi M, King AB, Boachie-Adjei O (2012) Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up. Spine 37:1479–1489. https://doi.org/10.1097/BRS.0b013e31824e4888

    Article  Google Scholar 

  15. Akazawa T, Kotani T, Sakuma T et al (2013) Rod fracture after long construct fusion for spinal deformity: clinical and radiographic risk factors. J Orthop Sci 18:926–931. https://doi.org/10.1007/s00776-013-0464-4

    Article  Google Scholar 

  16. Yamato Y, Hasegawa T, Yoshida G et al (2022) Revision surgery for a rod fracture with multirod constructs using a posterior-only approach following surgery for adult spinal deformity. Asian Spine J. https://doi.org/10.31616/asj.2021.0244

    Article  Google Scholar 

  17. Yamato Y, Hasegawa T, Kobayashi S et al (2018) Treatment strategy for rod fractures following corrective fusion surgery in adult spinal deformity depends on symptoms and local alignment change. J Neurosurg Spine 29:59–67. https://doi.org/10.3171/2017.9.SPINE17525

    Article  Google Scholar 

  18. Smith JS, Shaffrey CI, Ames CP et al (2012) Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. Neurosurgery 71:862–867. https://doi.org/10.1227/NEU.0b013e3182672aab

    Article  Google Scholar 

  19. Smith JS, Shaffrey E, Klineberg E et al (2014) Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine 21:994–1003. https://doi.org/10.3171/2014.9.SPINE131176

    Article  Google Scholar 

  20. Wang H, Guo J, Wang S et al (2017) Instrumentation failure after posterior vertebral column resection in adult spinal deformity. Spine 42:471–478. https://doi.org/10.1097/BRS.0000000000001844

    Article  CAS  Google Scholar 

  21. Yamanaka K, Mori M, Yamazaki K et al (2015) Analysis of the fracture mechanism of Ti-6Al-4V alloy rods that failed clinically after spinal instrumentation surgery. Spine 40:E767–E773. https://doi.org/10.1097/BRS.0000000000000881

    Article  Google Scholar 

  22. Yasuda T, Hasegawa T, Yamato Y et al (2016) Lumbosacral junctional failures after long spinal fusion for adult spinal deformity-which vertebra is the preferred distal instrumented vertebra? Spine Deform 4:378–384. https://doi.org/10.1016/j.jspd.2016.03.001

    Article  Google Scholar 

  23. Kwan KYH, Lenke LG, Shaffrey CI et al (2021) Are higher global alignment and proportion scores associated with increased risks of mechanical complications after adult spinal deformity surgery? An external validation. Clin Orthop Relat Res 479:312–320. https://doi.org/10.1097/CORR.0000000000001521

    Article  Google Scholar 

  24. Ohba T, Ebata S, Oba H et al (2019) Predictors of poor global alignment and proportion score after surgery for adult spinal deformity. Spine 44:E1136–E1143. https://doi.org/10.1097/BRS.0000000000003086

    Article  Google Scholar 

  25. Jakinapally S, Yamato Y, Hasegawa T et al (2020) Effect of sagittal shape on proximal junctional kyphosis following thoracopelvic corrective fusion for adult spinal deformity: postoperative inflection vertebra cranial to T12 is a significant risk factor. Spine Deform 8:1313–1323. https://doi.org/10.1007/s43390-020-00162-w

    Article  Google Scholar 

Download references

Funding

Medtronic Sofamor Danek Inc. Japan Medical Dynamic Marketing Inc. Meitoku Medical Institution Jyuzen Memorial Hospital. We have not received funding from the NIH or HHMI.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan

    Shin Oe & Yu Yamato

  2. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Koichiro Ide, Tomohiro Yamada, Kenta Kurosu, Keiichi Nakai, Takeuchi Yuki & Yukihiro Matsuyama

Authors
  1. Shin Oe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu Yamato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomohiko Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Go Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomohiro Banno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hideyuki Arima
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Koichiro Ide
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomohiro Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kenta Kurosu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Keiichi Nakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takeuchi Yuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yukihiro Matsuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shin Oe.

Ethics declarations

Conflict of interest

Shin Oe and Yu Yamato are members of the division of geriatric musculoskeletal health funded by a donor.

Ethical approval

The study protocol was approved by the Institutional Review Board of the Hamamatsu University School of Medicine, Shizuoka, Japan (IRB No.21–295).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oe, S., Yamato, Y., Hasegawa, T. et al. The validation study of preoperative surgical planning for corrective target in adult spinal deformity surgery with 5-year follow-up for mechanical complications. Eur Spine J 31, 3662–3672 (2022). https://doi.org/10.1007/s00586-022-07420-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07420-7

Keywords

Search

Navigation