Safety and efficacy of osteotomies in adult spinal deformity: what happens in the first year?

PURPOSE: Spinal surgery for adult spinal deformity (ASD) may require the use of osteotomies, which may have high complication rates (up to 80 %). These may be expected to affect health-related quality of life (HRQOL) in the early postoperative phase but little is known about the clinical course of these patients in the first year following surgery. The aim of the study is to evaluate the radiological results and HRQOL in patients undergoing a spinal osteotomy for ASD within the first year following surgery with special reference to the effect of complications. METHODS: From a prospective multicenter ASD database, patients who had undergone a Smith-Petersen osteotomy (SPO), pedicle substraction osteotomy (PSO), vertebral column resection (VCR) or any combination of these were reviewed for radiological sagittal alignment parameters [sagittal vertical axis (SVA), global tilt, lumbar lordosis, T2-sagittal tilt (ST)] as well as HRQOL [Oswestry Disability Index (ODI), short form-36 items (SF-36) Physical Component Score (PCS), SF-36 mental CS (MCS), Scoliosis Research Society (SRS)-22 questionnaire (SRS-22) subtotal] preoperatively and at the 6th- and 12th-month follow-ups with special reference to complications classified as major (life threatening or requiring additional surgery) and minor and their effects on HRQOL. RESULTS: 121 patients (85 F, 36 M) with a total of 71 SPOs, 45 PSOs and 13 VCRs were evaluated. Osteotomy resulted in correction of the major coronal Cobb angle from 43.0 ± 3.7° to 24.8 ± 2.8° (p < 0.001) and the SVA from 69.0 ± 10.3 to 52.4 ± 6.6 mm (p = 0.001). Other radiological parameters showed no significant changes. Remarkable improvements in HRQOL scores with a strong age effect (p ≤ 0.01), for all instruments except SF-36 MCS, were found. Most of these HRQOL improvements have been achieved within the first 6 months. A total of 114 complications (59 major, 55 minor) that had a lesser effect on the age-adjusted HRQOL scores (p < 0.05) (except for the SF-36 PCS) and 1 death were observed. CONCLUSIONS: Osteotomies were moderately effective in radiological improvement but resulted in a significant increase in HRQOL. They were associated with a high rate of complications but these had no/minimal effect on the clinical outcome. Contrary to the general perception, the greatest improvements in HRQOL were seen to take place during the first 6 months after surgery, even in the presence of complications.

Sagittal alignment of cervical spine in adult idiopathic scoliosis.

PURPOSE: Alignment of the cervical spine (CS) in adolescent idiopathic scoliosis (IS) as well as in asymptomatic adult populations has recently been studied and described as being less lordotic in the adolescent IS population. However, few studies have examined the sagittal alignment of the CS in adult IS or its association with other radiological variables and clinical relevance. The aim of this study is to analyse the sagittal alignment of CS in adult IS and its association with age, alignment of the thoracic, lumbar and global spinal column as well as health-related quality of life (HRQOL) parameters. METHODS: A retrospective review of prospectively collected data from a multicenter database was performed. Of 468 consecutive adult IS patients, 213 were included in the study; the remainder were excluded due to poor quality X-rays where the CS was not properly visible, or previous surgery. X-rays were measured for the following CS parameters: [Cranial base-C2 (C0-C2) lordosis, C2-C7 lordosis, thoracic (T1) slope, thoracic inlet angle (TIA) and odontoid (Od)-T1 offset using a measurement software]. These measurements were then evaluated for possible associations with patient age and with pre-existing alignment parameters and HRQOL scores using Pearson correlation tests. RESULTS: The average and standard deviations for CS alignment parameters were 32.3° ± 10.2° for C0-C2; 5.7° ± 14.1° for C2-C7; 23.9° ± 11.3° for T1 slope, 70.5° ± 14.7° for TIA and 20.8° ± 16.5° for Od-T1 offset. CS alignment showed a significant (p < 0.05) correlation with age, T kyphosis and several other sagittal alignment parameters such as sagittal vertical axis (SVA), global tilt and T1 sagittal tilt, but not with the HRQOL parameters. CONCLUSION: The sagittal alignment of the CS in adult IS is less lordotic than the normal average while less kyphotic than that of IS of a younger age. It correlates with age, thoracic kyphosis and some global sagittal alignment parameters. These findings suggest that CS alignment is likely a component of the global sagittal alignment strongly affected by thoracic kyphosis, and most probably does not affect HRQOL by itself.

Magnetic resonance imaging predictors of surgical outcome in degenerative lumbar spinal stenosis.

PURPOSE: To identify any MRI predictors for surgical outcomes of patients with degenerative lumbar spinal stenosis (DLSS) having instrumented posterior decompression (IPD) surgery. MATERIALS AND METHODS: Seventy patients with DLSS who underwent IPD were reviewed retrospectively. The clinical score of each patient was assessed using the JOAS (Japanese Orthopedics Association Scoring) system, which is mainly based on the subjective symptoms and physical signs of the patients before (JOAS-I) and after (JOAS-II) surgery. Healing rate (HR) was calculated as: [(JOAS-II) - (JOAS-I)] × 100/[15 - (JOAS-I)]. HR >50 % was considered clinical improvement. Radiological stenosis was assessed on MRI and was graded from 0 to 3 at the laminectomy level in terms of thecal sac-nerve root compression, foraminal stenosis, and facet degeneration. RESULTS: Mean HR of the improved patients (n = 39) was 81.94; HR of the unimproved patients (n = 31) was 34.75 (p < 0.05). There was no statistical difference in radiological stenosis parameters between the two groups (p > 0.05). HR was worse in patients with severe facet degeneration. CONCLUSIONS: Surgical outcomes of DLSS depend on multiple variables. It is not possible to predict the outcomes by assessing only one parameter. The possible outcomes should be analyzed by considering all the factors individually.

Reliability of ultrasonographic measurements in suspected patients of developmental dysplasia of the hip and correlation with the acetabular index.

BACKGROUND: Ultrasonography is accepted as a useful imaging modality in the early detection of developmental dysplasia of the hip (DDH). Early detection and early treatment of DDH prevents hip dislocation and related physical, social, economic, and psychological problems. The purpose of this study was to evaluate the reliability of ultrasonographic and roentgenographic measurements measured by seven different observers. MATERIALS AND METHODS: The alpha angles of 66 hips in 33 patients were measured using the Graf method by seven different observers. Acetabular index degrees on plane roentgenograms were measured in order to assess the correlation between the ultrasonographic alpha angle and the radiographic acetabular index, which both show the bony acetabular depth, retrospectively. RESULTS: The interclass correlation coefficient, measuring the interobserver reliability, was high and statistically significant for the ultrasonographic measurements. There was a negative correlation between the alpha angle and the acetabular index. CONCLUSIONS: Ultrasonography, when applied properly, is a reliable technique between different observers, in the diagnosis and follow up of DDH. When assessed concomitantly with the roentgenographic measurements, the results are reliable and statistically meaningful.

Postoperative evaluation of quality of life in lumbar spinal stenosis patients following instrumented posterior decompression.

OBJECTIVES: Spinal stenosis is a clinical condition in which bone and soft tissues compress the spinal canal, neuronal foramina and nerve roots. In this study, we aimed to evaluate the effectiveness of surgical treatment on patient satisfaction. Our sample included 64 patients with degenerative lumbar spinal stenosis on whom posterior decompression and instrumentation was applied. METHODS: In this retrospective study, files of 64 patients who underwent posterior decompression surgery with instrumentation for degenerative lumbar spinal stenosis between March 2004 and April 2008 were examined. Patients were evaluated with Japanese Orthopaedic Association (JOA) form, form of degenerative lumbar spinal stenosis and the most recent postoperative orthopedic inspection findings for a minimum of one year after surgery. RESULTS: Mean age of patients was 59.9 years and mean follow-up was 27.9 months. When evaluated using the Japanese Orthopaedic Association form, postoperative scores in 63.5% of the patients improved. Based on this postoperative improvement; Japanese Orthopaedic Association scores were found statistically significant (p<0.001). Gender (p=0.651), age (p=0.192), with the length of complaint (p=0.095), time passed after surgery (p=0.933), number of laminectomy level (p=0.997), deformity before operation (p=0.773) and systemic disease were not statistically correlated with improvement based upon Japanese Orthopaedic Association scores (p=0.052). But Japanese Orthopaedic Association scores were found to have improved (83%) in cases with no systemic diseases. CONCLUSION: Our findings show that posterior decompression surgery with instrumentation is a useful treatment modality for patients with severe degenerative lumbar spinal stenosis. There is no secondary factor affecting improvement and instability after surgery is not observed in patient groups.