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Fixed Coronal Malalignment (CM) In the Lumbar Spine Independently Impacts Disability in Adult Spinal Deformity (ASD) Patients when Considering the Obeid-CM (O-CM) Classification – Lumbar Fusion

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This article discusses the classification and impact of fixed coronal malalignment (CM) on patient outcomes in adults with spinal deformities. The study analyzed data from 747 patients with long lumbar fusion and at least two years of follow-up. The patients were classified according to the O-CM classification modifiers, and the impact of the Central Sacral Vertical Line (CSVL) on patient-reported outcome measures (PROMs) was analyzed. The results showed that CM independently affects disability in patients, with disability increasing linearly with CSVL. Patients classified with specific CM modifiers had the worst scores in terms of social life and self-image. The study suggests that fixed postoperative CM, as classified by O-CM, correlates with worse PROMs independently of sagittal malalignment

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSION: In a fused spine, CM independently affects disability in ASD patients. Disability increases linearly with CSVL. Despite previous reports that failed to find correlations of CM with PROMs, our study showed that fixed postoperative CM, according to O-CM classification, correlates independently from sagittal malalignment with worse PROMs.

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Spine J. 2023 Aug 24:S1529-9430(23)03349-1. doi: 10.1016/j.spinee.2023.08.004. Online ahead of print.ABSTRACTBACKGROUND: Postoperative Flatback has been described in detail for sagittal plane considerations over the past 2 decades, and its correlations with disability is now accepted. Fixed Coronal Malalignment (CM) has been less described, and some authors report no significant association with the clinical outcome. The,

Spine J. 2023 Aug 24:S1529-9430(23)03349-1. doi: 10.1016/j.spinee.2023.08.004. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative Flatback has been described in detail for sagittal plane considerations over the past 2 decades, and its correlations with disability is now accepted. Fixed Coronal Malalignment (CM) has been less described, and some authors report no significant association with the clinical outcome. The O-CM classification analyses CM and incorporates specific modifiers for each curve type.

PURPOSE: This study evaluates the O-CM classification modifiers according to age, sagittal alignment, and Patient Reported Outcome Measures (PROMs). Our hypothesis is that fixed CM correlates with PROMs independently from sagittal alignment and age.

STUDY DESIGN: Retrospective analysis of a large Adult Spinal Deformity (ASD) database prospectively collected.

PATIENT SAMPLE: We included 747 patients from the database with long lumbar fusion (more than 3 levels), with at least two years of follow-up. 3 categories of patients met the inclusion criteria (prior surgery at baseline and no revision surgery afterwards, prior surgery at baseline and revision afterwards, no prior surgery at baseline but fusion>3 levels and 2 years follow-up).

OUTCOME MEASURES: All patients completed the Oswestry Disability Index (ODI), Short Form 36 (SF36) and Scoliosis Research Society 22(SRS22) scores.

METHODS: The patients were classified according to the six modifiers of the O-CM classification. Central Sacral Vertical Line (CSVL) above 2, 3 and 4cms’ impact on PROMs was analyzed. Multivariate analysis was performed on the relationship between PROMS and age, global tilt (GT) and CM modifiers.

RESULTS: After multivariate analysis using age and GT as confounding factors, we found that CM independently affects PROMs starting at 2cm offset. Disability increases linearly with CSVL. Patients classified with 2B modifiers have the worst SRS-22 total score, social life, and self-image.

CONCLUSION: In a fused spine, CM independently affects disability in ASD patients. Disability increases linearly with CSVL. Despite previous reports that failed to find correlations of CM with PROMs, our study showed that fixed postoperative CM, according to O-CM classification, correlates independently from sagittal malalignment with worse PROMs.

PMID:37633521 | DOI:10.1016/j.spinee.2023.08.004

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Fixed Coronal Malalignment (CM) In the Lumbar Spine Independently Impacts Disability in Adult Spinal Deformity (ASD) Patients when Considering the Obeid-CM (O-CM) Classification

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Spine J. 2023 Aug 24:S1529-9430(23)03349-1. doi: 10.1016/j.spinee.2023.08.004. Online ahead of print.ABSTRACTBACKGROUND: Postoperative Flatback has been described in detail for sagittal plane considerations over the past 2 decades, and its correlations with disability is now accepted. Fixed Coronal Malalignment (CM) has been less described, and some authors report no significant association with the clinical outcome. The
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