Study Design.

Retrospective review of prospectively-collected database.

Objective.

This study aims to compare 2-year clinical outcomes of patients who underwent surgical reconstructions based on their achievement to age-adjusted alignment ideals.

Summary of Background Data.

Recent research in sagittal plane has proposed age-adjusted alignment thresholds. However, the impact of these thresholds on postoperative health-related quality of life (HRQOL) is yet to be investigated.

Methods.

Patients were included if they were more than 18-years old and underwent surgical correction of adult spinal deformity with a complete 2-year follow-up. Patients were stratified into three groups based on achievement of age-adjusted thresholds in pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis (SVA). First group included patients who reached the exact age-adjusted threshold±10 years (MATCHED), other two groups included patients who were over corrected (OVER), and under corrected (UNDER). Clinical outcomes including actual value and offset from age-adjusted Oswestry Disability Index, Short-Form-36 (SF-36)-physical component summary, and Scoliosis Research Society-22r (SRS-22r) were compared between groups at 2 years follow-up.

Results.

A total of 343 patients (mean, 57 yrs and 83% females) were included. Sagittal profile of the population was: PT= 23.6, SVA= 65.8 mm, and PI-LL= 15.6. At 2-year follow-up, there was significant improvement in all sagittal modifiers with 25.7%, 24.3%, and 33.1% of the patients matching their age alignment targets in terms of PT, PI-LL, and SVA, respectively. For PT and PI-LL, the three groups (MATCHED, OVER, and UNDER) had comparable values and offsets from age-adjusted patient reported outcome. However, for SVA groups, patients in UNDER had significantly worse HRQOL than the two other groups. Patients in PT, PI-LL, and SVA UNDER groups were significantly younger than the other groups, P< 0.05.

Conclusion.

At 2 years after adult spinal deformity surgical treatment, only 24.3% to 33.1% of the patients reached age-adjusted alignment thresholds. Those under corrected in SVA demonstrated worse clinical outcomes. No significant improvements were found between matched and overcorrected patients, with overcorrection being an established risk for proximal junctional kyphosis. These results further emphasize the need for patient specific operative planning.

Level of Evidence: 3

Adult spinal deformity (ASD) is associated with sagittal spinopelvic malalignment, which has been correlated with significant pain and disability. 1–7 It has been well established that increased sagittal vertical axis (SVA) is associated with poor health-related quality of life (HRQOL). 1–4, 7–9 This concept has been expanded to spinopelvic parameters including, pelvic tilt (PT) and the mismatch between pelvic incidence and lumbar lordosis (PI-LL), which also have a fundamental role in spinal alignment and HRQOL. 5, 10, 11 The goal of ASD surgery is to restore sagittal and coronal alignment based on established thresholds for the primary sagittal parameters of PT, PI-LL, and SVA.