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.

Is Sacral Extension a Risk Factor for Early Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery?

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.

Reciprocal changes in cervical spine alignment after corrective thoracolumbar deformity surgery.

Ha, Yoon,Schwab, Frank,Lafage, Virginie,Mundis, Gregory,Shaffrey, Christopher,Smith, Justin,Bess, Shay,Ames, Christopher Springer-Verlag 2014 European spine journal Vol.23 No.3

<P>To identify changes in cervical alignment parameters following surgical correction of thoracolumbar deformity and then assess the preoperative parameters which induce changes in cervical alignment following corrective thoracolumbar deformity surgery.</P>

Sagittal Spinopelvic Malalignment in Parkinson Disease: Prevalence and Associations With Disease Severity

Oh, Jae Keun,Smith, Justin S.,Shaffrey, Christopher I.,Lafage, Virginie,Schwab, Frank,Ames, Christopher P.,Matsumoto, Morio,Baik, Jong Sam,Ha, Yoon by Lippincott Williams Wilkins 2014 1528-1159) Vol.39 No.14

STUDY DESIGN.: Prospective study. OBJECTIVE.: Our objectives were to evaluate the prevalence of sagittal spinopelvic malalignment in a consecutive series of patients with Parkinson disease (PD) and to identify factors associated with sagittal spinopelvic deformity in this population. SUMMARY OF BACKGROUND DATA.: PD is a degenerative neurological condition characterized by tremor, rigidity, bradykinesia, and loss of postural reflexes. The prevalence of spinal deformity in PD is higher than that of age-matched adults without PD. METHODS.: This study was a prospective assessment of consecutive patients with PD presenting to a neurology clinic during 12 months. Inclusion criteria included age more than 21 years and diagnosis of PD. Age- and sex-matched control group was selected from patients with cervical spondylosis. Clinical and demographic factors were collected including Unified Parkinson Disease Rating Scale score and Hoehn and Yahr stage. Full-length standing spine radiographs were assessed. Patients were grouped into either low C7 sagittal vertical axis (SVA) (<5 cm) or high C7 SVA (≥5 cm) and into matched (≤10°) or mismatched (>10°) pelvic incidence (PI)-lumbar lordosis. RESULTS.: Eighty-nine patients met criteria (41 males/48 females), including 52 with low C7 SVA and 37 with high C7 SVA. Significantly higher prevalence of high C7 SVA was found in PD (41.6 vs. 16.8%; P < 0.001). The high C7 SVA group was significantly older (72.4 vs. 65.1 yr; P < 0.001) and had a higher proportion of females (68% vs. 44%; P = 0.034), greater severity of PD based on Hoehn and Yahr stage (1.89 vs. 1.37; P < 0.001) and Unified Parkinson Disease Rating Scale (30.5 vs. 17.2; P = 0.002. Unified Parkinson Disease Rating Scale significantly correlated with C7 SVA (r = 0.474). Compared with the matched (≤10°) PI-lumbar lordosis group, the mismatch PI-lumbar lordosis group had higher C7 SVA, higher PI, higher pelvic tilt, lower lumbar lordosis, and lower thoracic kyphosis (P ≤ 0.003). CONCLUSION.: Patients with PD have a high prevalence of sagittal spinopelvic malalignment than control group patients. Greater severity of PD is associated with sagittal spinopelvic malalignment.Level of Evidence: 3

Prevalence and type of cervical deformities among adults with Parkinson's disease: a cross-sectional study

Moon, Bong Ju,Smith, Justin S.,Ames, Christopher P.,Shaffrey, Christopher I.,Lafage, Virginie,Schwab, Frank,Matsumoto, Morio,Baik, Jong Sam,Ha, Yoon Journal of Neurosurgery Publishing Group 2016 Journal of Neurosurgery: Spine Vol.24 No.4

<B>OBJECT</B><P>To identify the characteristics of cervical deformities in Parkinson's disease (PD) and the role of severity of PD in the development of cervical spine deformities, the authors investigated the prevalence of the cervical deformities, cervical kyphosis (CK), and cervical positive sagittal malalignment (CPSM) in patients with PD. They also analyzed the association of severity of cervical deformities with the stage of PD in the context of global sagittal spinopelvic alignment.</P><B>METHODS</B><P>This study was a prospective assessment of consecutively treated patients (n = 89) with PD. A control group of the age- and sex-matched patients was selected from patients with degenerative cervical spine disease but without PD. Clinical and demographic parameters including age, sex, duration of PD, and Hoehn and Yahr (H&Y) stage were collected. Full-length standing radiographs were used to assess spinopelvic parameters. CK was defined as a C2-7 Cobb angle < 0°. CPSM was defined as C2-7 sagittal vertical axis (SVA) > 4 cm.</P><B>RESULTS</B><P>A significantly higher prevalence of CPSM (28% vs 1.1%, p < 0.001), but not CK (12% vs 10.1%, p = 0.635), was found in PD patients compared with control patients. Among patients with PD, those with CK were younger (62.1 vs 69.0 years, p = 0.013) and had longer duration of PD (56.4 vs 36.2 months, p = 0.034), but the severity of PD was not significantly different. Logistic regression analysis revealed that the presence of CK was associated with younger age, higher mismatch between pelvic incidence and lumbar lordosis, and lower C7-S1 SVA. The patients with CPSM had significantly greater thoracic kyphosis (TK) (p < 0.001) and a trend toward more advanced H&Y stage (p = 0.05). Logistic regression analysis revealed that CPSM was associated with male sex, greater TK, and more advanced H&Y stage.</P><B>CONCLUSIONS</B><P>Patients with PD have a significantly higher prevalence of CPSM compared with age- and sex-matched control patients with cervical degenerative disease but without PD. Among patients with PD, CK is not associated with the severity of PD but is associated with overall global sagittal malalignment. In contrast, the presence of CPSM is associated more with the severity of PD than it is with the presence of global sagittal malalignment. Collectively, these data suggest that the neuromuscular pathogenesis of PD may affect the development of CPSM more than of CK.</P>

Outcomes of Surgical Treatment for Patients With Mild Scoliosis and AgeAppropriate Sagittal Alignment With Minimum 2-Year Follow-up

Justin K. Scheer,Justin S. Smith,Peter G. Passias,Han Jo Kim,Shay Bess,Douglas C. Burton,Eric O. Klineberg,Virginie Lafage,Munish Gupta,Christopher P. Ames 대한척추신경외과학회 2023 Neurospine Vol.20 No.3

Objective: The goal of this study was to determine if patients with mild scoliosis and ageappropriate sagittal alignment have favorable outcomes following surgical correction. Methods: Retrospective review of a prospective, multicenter adult spinal deformity database. Inclusion criteria: operative patients age ≥18 years, and preoperative pelvic tilt, mismatch between pelvic incidence and lumbar lordosis (PI–LL), and C7 sagittal vertical axis all within established age-adjusted thresholds with minimum 2-year follow-up. Health-related quality of life (HRQoL) scores: Oswestry Disability Index (ODI), 36-item Short Form health survey (SF-36), Scoliosis Research Society-22R (SRS22R), back/leg pain Numerical Rating Scale and minimum clinically important difference (MCID)/substantial clinical benefit (SCB). Two-year and preoperative HRQoL radiographic data were compared. Patients with mild scoliosis (Mild Scoli, Max coronal Cobb 10°–30°) were compared to those with larger curves (Scoli). Results: One hundred fifty-one patients included from 667 operative patients (82.8% women; average age, 56.4 ± 16.2 years). Forty-two patients (27.8%) included in Mild Scoli group. Mild Scoli group had significantly worse baseline leg pain, ODI, and physical composite scores (p < 0.02). Mean 2-year maximum coronal Cobb angle was significantly improved compared to baseline (p < 0.001). All 2-year HRQoL measures were significantly improved compared to (p < 0.001) except mental composite score, SRS activity and SRS mental for the Mild Scoli group (p > 0.05). From the mild Scoli group, 36%–74% met either MCID or SCB for the HRQoL measures. Sixty-four point three percent had minimum 1 complication, 28.6% had a major complication, 35.7% had reoperation. Conclusion: Mild scoliosis patients with age-appropriate sagittal alignment benefit from surgical correction, decompression, and stabilization at 2 years postoperative despite having a high complication rate.