Radiographic Predictors for Mechanical Failure After Adult Spinal Deformity Surgery

Hallager, Dennis Winge; Karstensen, Sven; Bukhari, Naeem; Gehrchen, Martin; Dahl, Benny

doi:10.1097/brs.0000000000001996

Cited by 38 publications

(22 citation statements)

References 51 publications

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“…To avoid the rod breakage or loss of correction, before the delayed AF, a BLDR configuration was performed. The BLDR was proven to reduce the primary rod stress increasing the stability of posterior fixation and creating a favorable biomechanical behavior for future anterior fusion [12].…”

Section: Discussionmentioning

confidence: 99%

Surgical pathway proposal for severe paralytic scoliosis in adolescents with myelomeningocele

Giorgi¹,

Schirò²,

Capitani³

et al. 2021

Childs Nerv Syst

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Purpose The increased life expectancy of patients with myelomeningocele led to the necessity of new management for addressing complex spine deformities with severe pelvic obliquity. Tethered cord release (TCR) and spinal fusion were described as treatment options. However, nowadays, the surgical strategy is not well defined and high rates of mechanical failures and complications are reported. Our aim was to propose a new two-stage surgical pathway to treat a selected group of severe myelomeningocele scoliosis. Methods This is a retrospective series of myelomeningocele scoliosis in paralytic adolescent patients treated with concurrent TCR and posterior spinal fusion (PSF), followed by delayed anterior fusion (ASF) through minimally invasive lateral approach. Inclusion criteria were as follows: evolutive scoliosis in tethered cord syndrome and paraplegia, main curve >70°, pelvic obliquity >20°, and age between 10 and 18 years. Clinical, surgical, and radiographic parameters were evaluated preoperatively and at a mean follow-up (FU) of 2.8 years. Results Six patients out of 58 met the inclusion criteria and were included in the study (mean age 12.3 years old). The mean curve and pelvic obliquity correction were 68.8% and 82%, respectively. No loss of correction was recorded at FU. One case of cerebrospinal fluid leakage requiring revision surgery was recorded. Conclusion To the best of our knowledge, this is the first study proposing a two-stage surgical pathway for severe MMC spinopelvic deformity treatment. Concurrent TCR and PSF with delayed minimally invasive ASF permitted to minimize complications providing good fusion rates without loss of correction and implant failure.

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Section: Discussionmentioning

confidence: 99%

Surgical pathway proposal for severe paralytic scoliosis in adolescents with myelomeningocele

Giorgi¹,

Schirò²,

Capitani³

et al. 2021

Childs Nerv Syst

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“…The greatest risk factors for PJK/PJF, in addition to age and osteoporosis, are the presence of sagittal imbalance and magnitude of deformity correction. 3 , 49 - 51 Therefore, it behooves the deformity surgeon to achieve less than full correction of global sagittal alignment parameters and aim for patient-specific alignment thresholds. 14 , 52 , 53 However, there are no clear guidelines how to incorporate objective values of BMD into recommended correction parameters, contrary to age and pelvic incidence.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Treatment Strategies for the Prevention of Junctional Complications After Long-Segment Fusions in the Osteoporotic Spine

Echt

Ranson

Steinberger

et al. 2020

Global Spine Journal

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Study Design: Systematic review Objectives: Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are well-known complications after long-segment fusions in the thoracolumbar spine of osteoporotic patients. Recent advances in anti-resorptive and anabolic medications, instrumentation, surgical technique, and cement augmentation have all aided in the avoidance of junctional kyphosis. In this article, current literature on the prevention of PJK and PJF in the osteoporotic spine is reviewed. Methods: A systematic literature review was conducted using the PubMed/MEDLINE and Embase databases in order to search for the current preventive treatment methods for PJK and PJF published in the literature (1985 to present). Inclusion criteria included (1) published in English, (2) at least 1-year mean and median follow-up, (3) preoperative diagnosis of osteoporosis, (4) at least 3 levels instrumented, and (5) studies of medical treatment or surgical techniques for prevention of junctional kyphosis. Results: The review of the literature yielded 7 studies with low levels of evidence ranging from level II to IV. Treatment strategies reviewed addressed prophylaxis against ligamentous failure, adjacent vertebral compression fracture, and/or bone-implant interface failure. This includes studies on the effect of osteoporosis medication, cement augmentation, multi-rod constructs, and posterior-tension band supplementation. The role of perioperative teriparatide therapy maintains the highest level of evidence. Conclusions: Perioperative teriparatide therapy represents the strongest evidence for preventive treatment, and further clinical trials are warranted. Use of cement augmentation, sublaminar tethers, and multi-rod constructs have low or insufficient evidence for recommendations. Future guidelines for adult spinal deformity correction may consider bone mineral density–adjusted alignment goals.

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“…Mechanical failures, including but not limited to PJK, PJF, DJK, and implant breakage, after spine deformity surgery occur in 12% to 47% of postoperative patients. [11][12][13] Given the high rates of mechanical failures, there has been a conscientious effort to limit such postoperative complications by screening and optimizing patients preoperatively, utilizing newly designed instrumentation, and developing new radiographic parameters to predict postoperative failures. 2,4,12 The recently developed GAP score is an example of a proposed way to predict postoperative mechanical complications using new radiographic parameters.…”

Section: Discussionmentioning

confidence: 99%

Partial Intraoperative Global Alignment and Proportion Scores Do Not Reliably Predict Postoperative Mechanical Failure in Adult Spinal Deformity Surgery

Hong

Coury

et al. 2020

Global Spine Journal

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Study Design: Retrospective radiographic review. Objectives: The Global Alignment and Proportion (GAP) score allows sagittal plane analysis for deformity patients and may be predictive of mechanical complications. This study aims to assess the effectiveness of predicting mechanical failure based on partial intraoperative GAP (iGAP) scores. Methods: A retrospective radiographic review was performed on 48 deformity patients between July 2015 to January 2017 with a 2-year follow-up. Using the same methodology as the original GAP study, the partial iGAP score was calculated with the sum of the scores for age, relative lumbar lordosis (RLL), and lordosis distribution index (LDI). Therefore, the iGAP score (0-7) was grouped into proportional (0-2), mildly disproportionate (3-5), and severely disproportionate (6-7). Logistic regression was performed to assess the ability of the partial iGAP score to predict postoperative mechanical failure. Results: The mean iGAP for patients with a mechanical failure was 3.54, whereas the iGAP for those without a mechanical failure was 3.46 ( P = .90). The overall mechanical failure rate was 27.1%. The mechanical failures included 8 proximal junctional kyphosis, 7 rod fractures, and 1 rod slippage from the distal end of the construct. Logistic regression analysis revealed that the partial iGAP score was not able to predict postoperative mechanical failure (χ2 = 1.4; P = .49). Conclusion: The iGAP scores for RLL or LDI did not show any significant correlation to postoperative mechanical failure. Ultimately, the proposed partial iGAP score did not predict postoperative mechanical failure and thus, cannot be used as an intraoperative alignment assessment to avoid postoperative mechanical complications.

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Radiographic Predictors for Mechanical Failure After Adult Spinal Deformity Surgery

Abstract: 4.

Cited by 38 publications

References 51 publications

Surgical pathway proposal for severe paralytic scoliosis in adolescents with myelomeningocele

Surgical pathway proposal for severe paralytic scoliosis in adolescents with myelomeningocele

A Systematic Review of Treatment Strategies for the Prevention of Junctional Complications After Long-Segment Fusions in the Osteoporotic Spine

Partial Intraoperative Global Alignment and Proportion Scores Do Not Reliably Predict Postoperative Mechanical Failure in Adult Spinal Deformity Surgery

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