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Lumbar Lordosis Redistribution and Segmental Correction in Adult Spinal Deformity (ASD): Does it Matter? – Lumbar Fusion

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The article presents a retrospective analysis of prospectively collected data to evaluate the impact of correcting to normative segmental lordosis values on post-operative outcomes in adult spinal deformity surgery. The study found that restoring lumbar lordosis magnitude is crucial, but the optimal location and segmental distribution remain unclear. Patients were grouped based on their offset to normative segmental lordosis values, and surgical technique, patient-reported outcome measures (PROMs), and surgical complications were compared across groups. The results showed that overcorrected patients experienced higher rates of proximal junctional failure (PJF), while undercorrected patients had increased rates of revision for implant failure. The study concludes that patients undergoing fusion for adult spinal deformity suffer higher rates of PJF with overcorrection and increased rates of implant failure with undercorrection based on normative segmental lordosis

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most specialised spine clinic on Harley Street UK

Published article

S: Patients undergoing fusion for adult spinal deformity suffer higher rates of PJF with overcorrection and increased rates of implant failure with undercorrection based on normative segmental lordosis.

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Spine (Phila Pa 1976). 2024 Jan 25. doi: 10.1097/BRS.0000000000004930. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective analysis of prospectively collected data.OBJECTIVE: Evaluate the impact of correcting to normative segmental lordosis values on post-operative outcomes.BACKGROUND: Restoring lumbar lordosis magnitude is crucial in adult spinal deformity surgery, but the optimal location and segmental distribution remains unclear.METHODS: Patients were,

Spine (Phila Pa 1976). 2024 Jan 25. doi: 10.1097/BRS.0000000000004930. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective analysis of prospectively collected data.

OBJECTIVE: Evaluate the impact of correcting to normative segmental lordosis values on post-operative outcomes.

BACKGROUND: Restoring lumbar lordosis magnitude is crucial in adult spinal deformity surgery, but the optimal location and segmental distribution remains unclear.

METHODS: Patients were grouped based on offset to normative segmental lordosis values, extracted from recent publications. Matched patients were within 10% of the cohort’s mean offset, less than or over 10% were under- and over-corrected. Surgical technique, PROMs, and surgical complications were compared across groups at baseline and 2-year.

RESULTS: 510 patients with an average age of 64.6, mean CCI 2.08, and average follow-up of 25 months. L4-5 was least likely to be matched (19.1%), while L4-S1 was the most likely (24.3%). More patients were overcorrected at proximal levels (T10-L2; Undercorrected, U: 32.2% vs. Matched, M: 21.7% vs. Overcorrected, O: 46.1%) and undercorrected at distal levels (L4-S1: U: 39.0% vs. M: 24.3% vs. O: 36.8%). Postoperative ODI was comparable across correction groups at all spinal levels except at L4-S1 and T10-L2/L4-S1, where overcorrected patients and matched were better than undercorrected (U: 32.1 vs. M: 25.4 vs. O: 26.5, P=0.005; U: 36.2 vs. M: 24.2 vs. O: 26.8, P=0.001; respectively). Patients overcorrected at T10-L2 experienced higher rates of proximal junctional failure (PJF) (U: 16.0% vs. M: 15.6% vs. O: 32.8%, P<0.001) and had greater posterior inclination of the upper instrumented vertebra (UIV) (U: -9.2±9.4° vs. M: -9.6±9.1° vs. O: -12.2±10.0°, P<0.001), whereas undercorrection at these levels led to higher rates of revision for implant failure (U: 14.2% vs. M: 7.3% vs. O: 6.4%, P=0.025).

S: Patients undergoing fusion for adult spinal deformity suffer higher rates of PJF with overcorrection and increased rates of implant failure with undercorrection based on normative segmental lordosis.

LEVEL OF EVIDENCE: IV.

PMID:38270393 | DOI:10.1097/BRS.0000000000004930

The London Spine Unit : most specialised spine clinic on Harley Street UK

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Lumbar Lordosis Redistribution and Segmental Correction in Adult Spinal Deformity (ASD): Does it Matter?

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Spine (Phila Pa 1976). 2024 Jan 25. doi: 10.1097/BRS.0000000000004930. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective analysis of prospectively collected data.OBJECTIVE: Evaluate the impact of correcting to normative segmental lordosis values on post-operative outcomes.BACKGROUND: Restoring lumbar lordosis magnitude is crucial in adult spinal deformity surgery, but the optimal location and segmental distribution remains unclear.METHODS: Patients were

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