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Comparison of Postoperative Outcomes According to Compensatory Changes of the Thoracic Spine Among Patients with a T1 Slope More Than 40°.
Spine 2018 September 18
STUDY DESIGN: Retrospective study of postoperative outcomes of adult spinal deformity (ASD) surgery.
OBJECTIVE: To clarify the differences in postoperative outcomes depending on the presence or absence of thoracic compensatory changes among patients with a T1 slope (TS)more than 40°.
SUMMARY OF BACKGROUND DATA: Loss correction after ASD surgery is more likely to occur when preoperative TS ismore than 40°. When preoperative TS is more than 40°, some cases involve compensatory changes in the thoracic spine and decreased thoracic kyphosis (TK); others involve increased TK without compensatory changes.
METHODS: Seventy-nine patients with TSmore than 40° who underwent ASD surgery were enrolled and separated into compensated and non-compensatedgroups (group C:TK <40°;group NC: TK ≥40°). Radiographic parameters obtained by whole-spine standing X-ray, the Oswestry Disability Index (ODI), and Scoliosis Research Society-22 (SRS-22) questionnaire were assessed.
RESULTS: There were 41 patients in group C and 38 patients in group NC.Preoperative significant differences in TS did not disappear after surgery (preoperative TS: group C and group NC = 46° and 55°, P < 0.001; just after surgery: group C and group NC = 27° and 40°, P < 0.001; 2 years later: group C and group NC = 34° and 47°, P < 0.001).There were no significant differences in ODI and all domains of the SRS-22 before surgery. However, 2 years after the surgery, ODI (38%), pain (3.5), self-image (3.0), and total (3.2) values of the SRS-22 for group NC were significantly worse than those(28%, 4.0, 3.4, and 3.5, respectively) for group C (P < 0.05).
CONCLUSION: Changes in the thoracic spine (TS and TK more than 40°) result in poor postoperative outcomes. Extending the upper instrumented vertebra (UIV) to the upper thoracic spine must be considered.Even when TS ismore than 40°, TK less than 40° and UIV set to the lower thoracic level result ingood postoperative outcomes.
LEVEL OF EVIDENCE: 3.
OBJECTIVE: To clarify the differences in postoperative outcomes depending on the presence or absence of thoracic compensatory changes among patients with a T1 slope (TS)more than 40°.
SUMMARY OF BACKGROUND DATA: Loss correction after ASD surgery is more likely to occur when preoperative TS ismore than 40°. When preoperative TS is more than 40°, some cases involve compensatory changes in the thoracic spine and decreased thoracic kyphosis (TK); others involve increased TK without compensatory changes.
METHODS: Seventy-nine patients with TSmore than 40° who underwent ASD surgery were enrolled and separated into compensated and non-compensatedgroups (group C:TK <40°;group NC: TK ≥40°). Radiographic parameters obtained by whole-spine standing X-ray, the Oswestry Disability Index (ODI), and Scoliosis Research Society-22 (SRS-22) questionnaire were assessed.
RESULTS: There were 41 patients in group C and 38 patients in group NC.Preoperative significant differences in TS did not disappear after surgery (preoperative TS: group C and group NC = 46° and 55°, P < 0.001; just after surgery: group C and group NC = 27° and 40°, P < 0.001; 2 years later: group C and group NC = 34° and 47°, P < 0.001).There were no significant differences in ODI and all domains of the SRS-22 before surgery. However, 2 years after the surgery, ODI (38%), pain (3.5), self-image (3.0), and total (3.2) values of the SRS-22 for group NC were significantly worse than those(28%, 4.0, 3.4, and 3.5, respectively) for group C (P < 0.05).
CONCLUSION: Changes in the thoracic spine (TS and TK more than 40°) result in poor postoperative outcomes. Extending the upper instrumented vertebra (UIV) to the upper thoracic spine must be considered.Even when TS ismore than 40°, TK less than 40° and UIV set to the lower thoracic level result ingood postoperative outcomes.
LEVEL OF EVIDENCE: 3.
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