Pelvic Non-Response Following Treatment of Adult Spinal Deformity: Influence of Realignment Strategies on Occurrence.
Spine (Phila Pa 1976)
PURPOSE: Despite adequate correction, the pelvis may fail to readjust, deemed pelvic non-response. To assess alignment outcomes(pelvic non-response[PNR], PJK, postoperative cervical deformity[CD]) following ASD surgery utilizing different realignment strategies.
METHODS: ASD patients with 2-year(2Y) data were included. PNR defined as undercorrected in age-adjusted pelvic tilt(PT) at 6W and maintained at 2Y. Patients classified by alignment utilities: [a] Improvement in SRS-Schwab SVA,[b] Matching in age-adjusted PI-LL,[c] Matching in Roussouly,[d] aligning Global Alignment and Proportionality(GAP) score. Multivariable regression analyses, controlling for age, baseline deformity, and surgical factors, assessed rates of PNR, PJK, and CD development following realignment.
RESULTS: 686 patients met inclusion criteria. Rates of postop PJK and CD were not significant in the PNR group(both P>0.15). PNR patients less often met substantial clinical benefit in ODI by 2Y(OR: 0.6,[0.4-0.98]). Patients overcorrected in age-adjusted PI-LL, matching Roussouly, or proportioned in GAP at 6W had lower rates of PNR(all P
CONCLUSIONS: Following ASD corrective surgery, 24.9% of patients showed residual pelvic malalignment. This occurrence was often accompanied by undercorrection of lumbopelvic mismatch and less improvement of pain. However, overcorrection in any strategy incurred higher rates of PJK. We recommend surgeons identify a middle ground using one, or more, of the available classifications to inform correction goals in this regard.
LEVEL OF EVIDENCE: III.
Orthopedics & Sports Medicine
Neurosciences (Brain & Spine)
Passias, Peter G; Pierce, Katherine E; Williamson, Tyler K; Krol, Oscar; Lafage, Renaud; Lafage, Virginie; Schoenfeld, Andrew J; Protopsaltis, Themistocles S; Vira, Shaleen; Line, Breton; Diebo, Bassel G; Ames, Christopher P; Kim, Han Jo; Smith, Justin S; Chou, Dean; Daniels, Alan H; Gum, Jeffrey L; Shaffrey, Christopher I; Burton, Douglas C; Kelly, Michael P; Klineberg, Eric O; Hart, Robert A; Bess, Shay; Schwab, Frank J; and Gupta, Munish C, "Pelvic Non-Response Following Treatment of Adult Spinal Deformity: Influence of Realignment Strategies on Occurrence." (2022). Articles, Abstracts, and Reports. 6529.