Be prepared: Preoperative coronal malalignment often leads to more extensive surgery than sagittal malalignment during adult spinal deformity surgery

Scott L. Zuckerman, Christopher S. Lai, Yong Shen, Mena G. Kerolus, Alex S. Ha, Ian A. Buchanan, Nathan J. Lee, Eric Leung, Meghan Cerpa, Ronald A. Lehman, Lawrence G. Lenke

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objective: To evaluate the effect of coronal alignment on: (1) surgical invasiveness and operative complexity and (2) postoperative complications. Methods: A retrospective, cohort study of adult spinal deformity patients was conducted. Alignment groups were: (1) neutral alignment (NA): coronal vertical axis (CVA) ≤ 3 cm and sagittal vertical axis (SVA) ≤ 5 cm; (2) coronal malalignment (CM) only: CVA > 3 cm; (3) Sagittal malalignment (SM) only: SVA > 5 cm; and (4) coronal and sagittal malalignment (CCSM): CVA > 3 cm and SVA > 5 cm. Results: Of 243 patients, alignment groups were: NA 115 (47.3%), CM 48 (19.8%), SM 38 (15.6%), and CCSM 42 (17.3%). Total instrumented levels (TILs) were highest in CM (14.5 ± 3.7) and CCSM groups (14 ± 4.0) (p < 0.001). More 3-column osteotomies (3COs) were performed in SM (21.1%) and CCSM (28.9%) groups than CM (10.4%) (p = 0.003). CM patients had more levels instrumented (p = 0.029), posterior column osteotomies (PCOs) (p < 0.001), and TLIFs (p = 0.002) than SM patients. CCSM patients had more TLIFs (p = 0.012) and higher estimated blood loss (EBL) (p = 0.003) than SM patients. CVA displayed a stronger relationship with TIL (p = 0.002), EBL (p < 0.001), and operative time (p < 0.001) than SVA, which had only one significant association with EBL (p = 0.010). Both SM/CCSM patients had higher readmissions (p = 0.003) and reoperations (p < 0.001) than CM patients. Conclusion: Amount of preoperative CM was a better predictor of surgical invasiveness than the amount of SM, despite 3COs more commonly performed in SM patients. CM patients had more instrumented levels, PCOs, and TLIFs than SM patients.

Original languageEnglish (US)
Pages (from-to)570-579
Number of pages10
JournalNeurospine
Volume18
Issue number3
DOIs
StatePublished - 2021
Externally publishedYes

Keywords

  • Adult spine deformity
  • Adult spine surgery
  • Coronal malalignment
  • Sagittal malalignment

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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