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RISS 인기검색어
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- 저자 : Renaud Lafage (검색결과 3 건)
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Sebastian Decker,Renaud Lafage,Christian Krettek,Robert Hart,Christopher Ames,Justin S. Smith,Douglas Burton,Eric Klineberg,Shay Bess,Frank J. Schwab,Virginie Lafage,International Spine Study Group 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.2
Study Design: Retrospective cohort study. Purpose: To investigate the role of sacral extension (SE) for the development of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery. Overview of Literature: The development of PJK is multifactorial and different risk factors have been identified. Of these, there is some evidence that SE also affects the development of PJK, but data are insufficient. Methods: Using a combined database comprising two propensity-matched groups of fusions following ASD surgery, one with fixation to S1 or S1 and the ilium (SE) and one without SE but with a lower instrumented vertebra of L5 or higher (lumbar fixation, LF), PJK and the role of further parameters were analyzed. The propensity-matched variables included age, the upper-most instrumented vertebra (UIV), preoperative sagittal alignment, and the baseline to 1 year change of the sagittal alignment. Results: Propensity matching led to two groups of 89 patients each. The UIV, pelvic incidence minus lumbar lordosis, sagittal vertical axis, pelvic tilt, age, and body mass index were similar in both groups (p>0.05). The incidence of PJK at postoperative 1 year was similar for SE (30.3%) and LF (22.5%) groups (p=0.207). The PJK angle was comparable (p=0.963) with a change of −8.2° (SE) and −8.3° (LF) from the preoperative measures (p=0.954). A higher rate of PJK after SE (p=0.026) was found only in the subgroup of patients with UIV levels between T9 and T12. Conclusions: Instrumentation to the sacrum with or without iliac extension did not increase the overall risk of PJK. However, an increased risk for PJK was found after SE with UIV levels between T9 and T12.
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Neuromuscular Scoliosis: Comorbidities and Complications
Weissmann Karen Andrea,Lafage Virginie,Pitaque Carlos Barrios,Lafage Renaud,Huaiquilaf Carlos M.,Ang Bryan,Schulz Ronald G. 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.6
Study Design: Single-center, retrospective cohort study conducted from 2013 to 2017.Purpose: To determine the risk factors for surgical complications in neuromuscular scoliosis based on known patient comorbidities. Overview of Literature: The concept of neuromuscular scoliosis includes a wide variety of pathologies affecting the neuromuscular system. Complications are numerous and are often difficult to predict.Methods: A retrospective analysis of a single-center database was conducted from 2013 to 2017. Inclusion criteria were patients aged <25 years, diagnosis of neuromuscular scoliosis, and history of posterior fusion deformity surgery. A total of 64 patients (mean age, 15 years; 63% females) were included in this study. Clinical, radiological, and laboratory parameters in the preoperative, intraoperative, and postoperative settings were analyzed. Univariate analysis was performed using Student t -test for continuous variables, and a chi-square test was used for noncontinuous variables. Multivariate analysis was performed to identify predictors of major, mechanical, and total complications.Results: Complications were found in 44% of patients, with 46.9% consisting of major complications, and 84.4% being early complications. Univariate analysis revealed that the presence of perinatal comorbidities, independent of other comorbidities, increased the risk for complications (p =0.029). Preoperative hypoglycemia, high number of instrumented levels, longer surgical time, use of an all-screw construct, lower preoperative pelvic obliquity, postoperative lower kyphosis, high thoracic spinopelvic angle (as measured by T9 spino-pelvic inclination), absence of deep drain, and use of superficial drain were associated with postoperative complications (all p <0.05). Logistic regression demonstrated that comorbidities, longer surgical time, hypoglycemia, and absence of deep drains are predictors of complications. Independent variables that predicted major complications were the number of levels fused, postoperative kyphosis (p =0.025; odds ratio [OR], 1.074), and high screw density (p =0.014; OR, 4.380).Conclusions: Complications in neuromuscular scoliosis are increased by comorbidities, long surgical time, and inadequate correction. Preventative measures to decrease these complications include appropriate preoperative patient preparation and surgical planning.
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Katherine E. Pierce,Peter G. Passias,Avery E. Brown,Cole A. Bortz,Haddy Alas,Lara Passfall,Oscar Krol,Nicholas Kummer,Renaud Lafage,Dean Chou,Douglas C. Burton,Breton Line,Eric Klineberg,Robert Hart,J 대한척추신경외과학회 2021 Neurospine Vol.18 No.3
Objective: To prioritize the cervical parameter targets for alignment. Methods: Included: cervical deformity (CD) patients (C2–7 Cobb angle>10°, cervical lordosis>10°, cervical sagittal vertical axis [cSVA]>4 cm, or chin-brow vertical angle>25°) with full baseline (BL) and 1-year (1Y) radiographic parameters and Neck Disability Index (NDI) scores; patients with cervical [C] or cervicothoracic [CT] Primary Driver Ames type. Patients with BL Ames classified as low CD for both parameters of cSVA (<4 cm) and T1 slope minus cervical lordosis (TS–CL) (<15°) were excluded. Patients assessed: meeting minimum clinically important differences (MCID) for NDI (<-15 ΔNDI). Ratios of correction were found for regional parameters categorized by primary Ames driver (C or CT). Decision tree analysis assessed cutoffs for differences associated with meeting NDI MCID at 1Y. Results: Seventy-seven CD patients (mean age, 62.1 years; 64% female; body mass index, 28.8 kg/m2). Forty-one point six percent of patients met MCID for NDI. A backwards linear regression model including radiographic differences as predictors from BL to 1Y for meeting MCID for NDI demonstrated an R2 of 0.820 (p=0.032) included TS–CL, cSVA, McGregor’s slope (MGS), C2 sacral slope, C2–T3 angle, C2–T3 SVA, cervical lordosis. By primary Ames driver, 67.5% of patients were C, and 32.5% CT. Ratios of change in predictors for MCID NDI patients for C and CT were not significant between the 2 groups (p> 0.050). Decision tree analysis determined cutoffs for radiographic change, prioritizing in the following order: ≥42.5° C2–T3 angle, >35.4° cervical lordosis, <-31.76° C2 slope, <-11.57-mm cSVA, <-2.16° MGS, >-30.8-mm C2–T3 SVA, and ≤-33.6° TS–CL. Conclusion: Certain ratios of correction of cervical parameters contribute to improving neck disability. Prioritizing these radiographic alignment parameters may help optimize patient-reported outcomes for patients undergoing CD surgery.
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