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Surgical correction of Adult Spinal Deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications

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Abstract

Study design

Single-center, retrospective.

Objectives

To assess the restoration of ideal sagittal spine shape in accordance to the Roussouly classification and the effect on postoperative mechanical complications.

Summary of background data

Surgical correction of Adult Spinal Deformity is both challenging and complex. The risk of postoperative complications is considerable, especially mechanical complications requiring revision surgery. Attention has been directed toward defining alignment targets in attempts to minimize these risks, and the Roussouly classification has been proposed as a potential surgical aim.

Methods

All patients undergoing ASD surgery from 2013–2016 were included at a single, quaternary institute. Successful restoration of Roussouly spine shape was retrospectively assessed, and patients were classified as either “restored” or “non-restored”. Cumulative incidence of revision surgery due to mechanical failure was estimated using the Aalen–Johansen estimator, with death as the competing risk. A multivariable proportional odds model was used to estimate the effect of the Roussouly algorithm on revision surgery due to mechanical failure.

Results

We identified a complete and consecutive cohort of 233 patients who were followed for a mean period of 36 (± 14) months. The 2-year cumulative incidence of revision surgery was 28%. Comparing the “restored” to the “non-restored” group, the overall revision rates were high in both groups. However, when adjusting for known cofounders in a multivariable proportional odds analysis, there was an almost fivefold increased odds of revision due to mechanical failure in the “non-restored” group (p = 0.036).

Conclusion

Surgical correction of ASD in accordance to the ideal Roussouly spine shape was correlated to a marked and significant decrease in risk of revision surgery due to mechanical failure. Nonetheless, the overall revision risk was elevated in both groups.

Level of evidence

Therapeutic III.

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Authors and Affiliations

  1. Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Tanvir Johanning Bari, Lars Valentin Hansen & Martin Gehrchen

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  1. Tanvir Johanning Bari
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  2. Lars Valentin Hansen
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Contributions

TJB: substantial contributions to the conception or design of the work, substantial contributions to the acquisition, analysis and interpretation of data, revising the work critically for important intellectual content, final approval of the version to be published; LVH and MG: substantial contributions to the conception or design of the work, revising the work critically for important intellectual content, final approval of the version to be published.

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Correspondence to Tanvir Johanning Bari.

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MG (institutional grants from K2M and Medtronic outside of the submitted work), the remaining authors report no conflicts of interest.

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This study was approved by the National Health and Medical authority and The National Data Protection Agency.

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

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