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• W4386041636 abstract "BACKGROUND CONTEXT Age-adjusted sagittal spino-pelvic radiographic thresholds have been established and utilized by spine surgeons to assess postoperative success in ASD patients. But, recent studies have suggested that overcorrection can benefit some ASD patients without increasing the prevalence of PJK or PJF. Our research wanted to investigate how overcorrection of age-adjusted radiographic thresholds affects future rates of PJF or mechanical failure. PURPOSE To investigate what degree of overcorrection leads to PJF and mechanical failure with reoperation based on patient specific factors and degree of baseline deformity. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Prospectively collected operative ASD single center database. OUTCOME MEASURES Radiographic alignment, complications, reoperation. METHODS SD patients, fused from thoracic vertebrae to pelvis, with 2 year (2Y) data were included. Frailty was calculated using Passias ASD-mFI.Good Outcome (GO) at two years was defined as: no major mechanical complications, reoperations, PJF, and thoracic decompensation (>15 degree change from baseline in unfused thoracic kyphosis) and [meeting either: (1) Substantial Clinical Benefit for Oswestry Disability Index (ODI) (change >18.8), or (2) ODI 4.5]. (36007130) Poor outcomes (PO) was those that did not develop GO. Those that were over corrected (O) 1 standard deviation (SD1) (O1) in each parameter were evaluated. RESULTS A total of 302 ASD patients were included (age of 63±9.5yrs, 78% female, BMI 27.5±5.0kg/m2, CCI 1.9±1.7, ASD-mFI 7.2±4.7. Baseline radiographic deformity were: PT 26.3º±10.2º, PI 55.5º±12.6, PI-LL 21.1º±19.6º, TPA 25.9º±12.6º, mean LL Apex between L3-L4. Surgical characteristics for cohort were: mean levels fused 12.6±3.5, 70% had decompression, 80% had osteotomies, operative time 454±175 minutes, LOS of 8.1±4.3 days. Surgical correction in radiographic parameters were: TPA 10.7º±10.6 º, PI-LL 20.8º±16.8º, PT 6.8º±8.3º. By 2Y, 62.2% of the cohort developed PJK, 10.6% PJF, 18.5% thoracic decompensation, and 31.72% PO. Those that developed PJK, PJF, and thoracic decompensation had greater correction in SVA, PI-LL, and PT, especially when adjusting for baseline deformity and patient characteristics. Overcorrected cohort was significantly younger, had higher percentage of female, lower BMI, CCI, and frailty, while O that had GO had lower CCI (0.91 vs 1.70, p=0.040) and frailty (2.2 vs 3.2, p=0.078). When looking at O1, there was no difference in rates of PJK, however PJF rates were twofold higher (16.7% vs 7.7%, p=0.019). Implant malposition and operative complications were higher in PT O1 (p<.05). Reoperation due to implant failure had twofold higher rates in PILL O1 (15% vs 7%, p=0.058). Of patient factors, CCI was the most significant patient factor that led to PJF and PO (PJF OR: 1.351 [1.077-1.696], p=0.009 PO OR: 1.250 [1.031-1.514], p=0.023). Comparatively, the overcorrected cohort had double the likelihood of development of PO with higher CCI (CCI OR: 1.493 [1.005-2.219], p=0.047). Furthermore, age and BMI became significant predictors for the development of PO in O1 (Age OR: 1.077 [1.002-1.158], p=0.044, BMI OR: 1.219 [1.034-1.438], p=0.018). Threshold for CCI in O1 of less than 1 was determined for GO (41% vs 17%, p=0.024), less than 2 was determined for thoracic decompensation (14% vs 29%, p=0.048), and 3 for PJF (7% vs 29%, p=0.025). Baseline frailty threshold was found to be lower than 2.368 for GO (48% vs 21%, p=0.023). Age threshold for PJK was <65.3 (42% vs 63%, p=0.026). CONCLUSIONS Overcorrecting is often necessary in adult spinal deformity to achieve good outcomes. Determination of patient specific factors and radiographic parameters can lead to better outcomes. Our study suggests that overcorrecting in PT has the greatest impact in achievement of this and should be carefully considered, especially in those that have greater comorbidities. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Age-adjusted sagittal spino-pelvic radiographic thresholds have been established and utilized by spine surgeons to assess postoperative success in ASD patients. But, recent studies have suggested that overcorrection can benefit some ASD patients without increasing the prevalence of PJK or PJF. Our research wanted to investigate how overcorrection of age-adjusted radiographic thresholds affects future rates of PJF or mechanical failure. To investigate what degree of overcorrection leads to PJF and mechanical failure with reoperation based on patient specific factors and degree of baseline deformity. Retrospective cohort study. Prospectively collected operative ASD single center database. Radiographic alignment, complications, reoperation. SD patients, fused from thoracic vertebrae to pelvis, with 2 year (2Y) data were included. Frailty was calculated using Passias ASD-mFI.Good Outcome (GO) at two years was defined as: no major mechanical complications, reoperations, PJF, and thoracic decompensation (>15 degree change from baseline in unfused thoracic kyphosis) and [meeting either: (1) Substantial Clinical Benefit for Oswestry Disability Index (ODI) (change >18.8), or (2) ODI 4.5]. (36007130) Poor outcomes (PO) was those that did not develop GO. Those that were over corrected (O) 1 standard deviation (SD1) (O1) in each parameter were evaluated. A total of 302 ASD patients were included (age of 63±9.5yrs, 78% female, BMI 27.5±5.0kg/m2, CCI 1.9±1.7, ASD-mFI 7.2±4.7. Baseline radiographic deformity were: PT 26.3º±10.2º, PI 55.5º±12.6, PI-LL 21.1º±19.6º, TPA 25.9º±12.6º, mean LL Apex between L3-L4. Surgical characteristics for cohort were: mean levels fused 12.6±3.5, 70% had decompression, 80% had osteotomies, operative time 454±175 minutes, LOS of 8.1±4.3 days. Surgical correction in radiographic parameters were: TPA 10.7º±10.6 º, PI-LL 20.8º±16.8º, PT 6.8º±8.3º. By 2Y, 62.2% of the cohort developed PJK, 10.6% PJF, 18.5% thoracic decompensation, and 31.72% PO. Those that developed PJK, PJF, and thoracic decompensation had greater correction in SVA, PI-LL, and PT, especially when adjusting for baseline deformity and patient characteristics. Overcorrected cohort was significantly younger, had higher percentage of female, lower BMI, CCI, and frailty, while O that had GO had lower CCI (0.91 vs 1.70, p=0.040) and frailty (2.2 vs 3.2, p=0.078). When looking at O1, there was no difference in rates of PJK, however PJF rates were twofold higher (16.7% vs 7.7%, p=0.019). Implant malposition and operative complications were higher in PT O1 (p<.05). Reoperation due to implant failure had twofold higher rates in PILL O1 (15% vs 7%, p=0.058). Of patient factors, CCI was the most significant patient factor that led to PJF and PO (PJF OR: 1.351 [1.077-1.696], p=0.009 PO OR: 1.250 [1.031-1.514], p=0.023). Comparatively, the overcorrected cohort had double the likelihood of development of PO with higher CCI (CCI OR: 1.493 [1.005-2.219], p=0.047). Furthermore, age and BMI became significant predictors for the development of PO in O1 (Age OR: 1.077 [1.002-1.158], p=0.044, BMI OR: 1.219 [1.034-1.438], p=0.018). Threshold for CCI in O1 of less than 1 was determined for GO (41% vs 17%, p=0.024), less than 2 was determined for thoracic decompensation (14% vs 29%, p=0.048), and 3 for PJF (7% vs 29%, p=0.025). Baseline frailty threshold was found to be lower than 2.368 for GO (48% vs 21%, p=0.023). Age threshold for PJK was <65.3 (42% vs 63%, p=0.026). Overcorrecting is often necessary in adult spinal deformity to achieve good outcomes. Determination of patient specific factors and radiographic parameters can lead to better outcomes. Our study suggests that overcorrecting in PT has the greatest impact in achievement of this and should be carefully considered, especially in those that have greater comorbidities." @default.
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• W4386041636 title "P95. Overcorrection in sagittal alignment effect on optimal outcomes in adult spinal deformity patients" @default.
• W4386041636 doi "https://doi.org/10.1016/j.spinee.2023.06.320" @default.
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