Day Case Lumbar Fusion Surgery
A recent article published in Spine examines the risk factors for loss of correction within the instrumented lumbar spine following adult deformity surgery (ASD). The study conducted a retrospective cohort analysis of 321 patients who underwent fusion of the lumbar spine with a revision-free follow-up of at least three years. The results showed that approximately 25.5% of patients experienced a loss of more than 5° of correction, with an average loss of 10°. Lack of a supplemental rod and fusion length were identified as significant factors associated with loss of correction. The study suggests that the use of supplemental rods and avoiding sagittal overcorrection may help mitigate the loss
Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : innovative day surgery hospital in London
Published article
S: Approximately a quarter of revision-free patients lose an average of 10° of their 6-week correction by 3 years. Lordosis is lost proximally through the instrumentation (i.e. tulip/shank angle shifts and/or rod bending). The use of supplemental rods and avoiding sagittal overcorrection may help mitigate this loss.
Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Spine (Phila Pa 1976). 2023 Oct 17. doi: 10.1097/BRS.0000000000004852. Online ahead of print.ABSTRACTSTUDY DESIGN: Multicenter retrospective cohort study.OBJECTIVE: To investigate risk factors for loss of correction within the instrumented lumbar spine following ASD surgery.SUMMARY OF BACKGROUND DATA: The sustainability of adult deformity (ASD) surgery remains a health care challenge. Malalignment is a major reason for,
Spine (Phila Pa 1976). 2023 Oct 17. doi: 10.1097/BRS.0000000000004852. Online ahead of print.
ABSTRACT
STUDY DESIGN: Multicenter retrospective cohort study.
OBJECTIVE: To investigate risk factors for loss of correction within the instrumented lumbar spine following ASD surgery.
SUMMARY OF BACKGROUND DATA: The sustainability of adult deformity (ASD) surgery remains a health care challenge. Malalignment is a major reason for revision surgery.
METHODS: 321 patients who underwent fusion of the lumbar spine (≥5 levels, LIV pelvis) with a revision-free follow-up ≥3 years were identified. Patients were stratified by change in PI-LL from 6 weeks to 3 years postop as Maintained vs. Loss >5°. Those with instrumentation failure (broken rod, screw pullout, etc.) were excluded before comparisons. Demographics, surgical data, and radiographic alignment were compared. Repeated measure ANOVA was performed to evaluate the maintenance of the correction for L1-L4 and L4-S1. Multivariate logistic regression was conducted to identify independent surgical predictors of correction loss.
RESULTS: The cohort had a mean age of 64 yrs, mean BMI 28 kg/m2, 80% female. 82 patients (25.5%) lost >5° of PI-LL correction (mean loss 10±5°). After exclusion of patients with instrumentation failure, 52 Loss were compared to 222 Maintained. Demographics, osteotomies, 3CO, IBF, use of BMP, rod material, rod diameter, and fusion length were not significantly different. L1-S1 screw orientation angle was 1.3±4.1 from early postop to 3 years (P=0.031), but not appreciably different at L4-S1 (-0.1±2.9 P=0.97). Lack of a supplemental rod (OR 4.0, P=0.005) and fusion length (OR 2.2, P=0.004) were associated with loss of correction.
S: Approximately a quarter of revision-free patients lose an average of 10° of their 6-week correction by 3 years. Lordosis is lost proximally through the instrumentation (i.e. tulip/shank angle shifts and/or rod bending). The use of supplemental rods and avoiding sagittal overcorrection may help mitigate this loss.
PMID:37847773 | DOI:10.1097/BRS.0000000000004852
The London Spine Unit : innovative day surgery hospital in London
Read the original publication:
3 Years After Adult Spinal Deformity Surgery: Who and Why?”>Revision Free Loss of Sagittal Correction > 3 Years After Adult Spinal Deformity Surgery: Who and Why?
