Are the Choice of Frame and Intraoperative Patient Positioning Associated With Radiologic and Clinical Outcomes in Long-instrumented Lumbar Fusion for Adult Spinal Deformity?

Abstract

Background Previous studies of patient positioning during spinal surgery evaluated intraoperative or immediate postoperative outcomes after short-instrumented lumbar fusion. However, patient positioning during longinstrumented fusion for an adult spinal deformity (ASD) might be associated with differences in intraoperative parameters such as blood loss and longer-term outcomes such as spine alignment, and comparing types of surgical tables in the context of these larger procedures and evaluating longer-term outcome scores seem important. Questions/purposes (1) Do blood loss and the number of transfusions differ between patients who underwent multi-level spinal fusion with a Wilson frame and those with a four-poster frame? (2) Does restoration of lumbar lordosis and the sagittal vertical axis differ between patients who underwent surgery with the use of one frame or the other? (3) Do clinical outcomes as determined by Numeric Rating Scale and Oswestry Disability Index scores differ between the two groups of patients? (4) Are there differences in postoperative complications between the two groups? Methods Among 651 patients undergoing thoracolumbar instrumented fusion between 2015 and 2018, 129 patients treated with more than four levels of initial fusion for an ASD were identified. A total of 48% (62 of 129) were This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2021R1I1A1A01059501). Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Ethical approval for this study was obtained from the Catholic University of Korea (approval number KC21RISI0002).

CORR Insights®: Are the Choice of Frame and Intraoperative Patient Positioning Associated With Radiologic and Clinical Outcomes in Long-instrumented Lumbar Fusion for Adult Spinal Deformity?

“…The current study by Park et al [14] reinforces the positive impact of fourposter frames over Wilson frames. The impact is notable in larger deformities, but surgeons should strongly consider their use even in short segment fusions for degenerative disease, where inadequate restoration of lordosis may contribute to long-term problems.…”

“…In the current study [14], the authors compared outcomes in patients with adult spinal deformity before and after transition from Wilson frame and a four-poster frame. Despite the unavoidable heterogeneity among patients with adult spinal deformity, the groups appeared reasonably well matched.…”

Application of Escherichia coli-Derived Recombinant Human Bone Morphogenic Protein-2 to Unstable Spinal Fractures

“…After general anesthesia, patients were placed on the four-poster frame with the abdomen suspended to avoid excessive epidural bleeding and restore the collapsed vertebral height by extension of the thoracolumbar junction [15]. After a midline longitudinal skin incision, periosteal dissection along the paravertebral muscles was carried out to expose the lamina and facets.…”