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

Bassel G Diebo; Mariah Balmaceno-Criss; Renaud Lafage; Mohammad Daher; Manjot Singh; D Kojo Hamilton; Justin S Smith; Robert K Eastlack; Richard Fessler; Jeffrey L Gum; Munish C Gupta; Richard Hostin; Khaled M Kebaish; Stephen Lewis; Breton G Line; Pierce D Nunley; Gregory M Mundis; Peter G Passias; Themistocles S Protopsaltis; Jay Turner; Thomas Buell; Justin K Scheer; Jeffery Mullin; Alex Soroceanu; Christopher P Ames; Shay Bess; Christopher I Shaffrey; Lawrence G Lenke; Frank J Schwab; Virginie Lafage; Douglas C Burton; Alan H Daniels; International Spine Study Group (ISSG)

doi:10.1097/BRS.0000000000004930

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

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

Authors

Bassel G Diebo¹, Mariah Balmaceno-Criss¹, Renaud Lafage², Mohammad Daher¹, Manjot Singh¹, D Kojo Hamilton³, Justin S Smith⁴, Robert K Eastlack⁵, Richard Fessler⁶, Jeffrey L Gum⁷, Munish C Gupta⁸, Richard Hostin⁹, Khaled M Kebaish¹⁰, Stephen Lewis¹¹, Breton G Line¹², Pierce D Nunley¹³, Gregory M Mundis⁵, Peter G Passias¹⁴, Themistocles S Protopsaltis¹⁴, Jay Turner¹⁵, Thomas Buell³, Justin K Scheer¹⁶, Jeffery Mullin¹⁷, Alex Soroceanu¹⁸, Christopher P Ames¹⁹, Shay Bess¹², Christopher I Shaffrey²⁰, Lawrence G Lenke¹⁶, Frank J Schwab², Virginie Lafage², Douglas C Burton²¹, Alan H Daniels¹; International Spine Study Group (ISSG)

Affiliations

¹ Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
² Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York.
³ Department of Neurological Surgery, University of Pittsburgh.
⁴ Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia.
⁵ Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California.
⁶ Department of Neurosurgery, Rush Medical College, Illinois.
⁷ Norton Leatherman Spine Center, Louisville, Kentucky.
⁸ Department of Orthopedic Surgery, Washington University, St. Louis, Missouri.
⁹ Department of Orthopaedic Surgery, Southwest Scoliosis Center, Dallas, Texas.
¹⁰ Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹¹ Department of Orthopedics, University of Toronto, Toronto, Canada.
¹² Department of Spine Surgery, Denver International Spine Center, Denver, Colorado.
¹³ Spine Institute of Louisiana, Shreveport, Louisiana.
¹⁴ Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York.
¹⁵ Barrow Brain and Spine, Phoenix, Arizona.
¹⁶ Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York.
¹⁷ Department of Neurosurgery, University of Buffalo, Amherst, New York, New York.
¹⁸ Department of Orthopedic Surgery, University of Calgary, Canada.
¹⁹ Department of Neurological Surgery, University of California, San Francisco, California.
²⁰ Department of Neurosurgery, Duke Spine Division, Durham, North Carolina.
²¹ Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas.

PMID: 38270393
DOI: 10.1097/BRS.0000000000004930

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).

Conclusions: 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.