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Functional Alignment Within the Fusion in Adult Spinal Deformity (ASD) Improves Outcomes and Minimizes Mechanical
Fares Ani1, Ethan W Ayres, Alex Soroceanu
1Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.
Spine
|September 12, 2023
Summary
Achieving functional spinal alignment based on pelvic incidence and age improves patient outcomes and reduces proximal junctional kyphosis (PJK). This patient-specific approach provides intraoperative targets for adult spinal deformity correction.
Area of Science:
- Spine surgery
- Orthopedics
- Spinal deformity correction
Background:
- Pelvic incidence (PI) is crucial for preoperative planning in adult spinal deformity.
- Patient-specific, age-adjusted alignment targets can minimize mechanical failures.
- The relationship between PI, age, and functional alignment needs further analysis.
Purpose of the Study:
- To define age-appropriate functional alignment targets using T1-pelvic angle (T10PA).
- To correlate functional alignment with proximal junctional kyphosis (PJK) and clinical outcomes.
- To establish patient-specific correction goals for adult spinal deformity.
Main Methods:
- Retrospective analysis of 1052 adult spinal deformity patients fused to the pelvis.
- Utilized T10PA to categorize patients into overcorrected, under-corrected, and functionally corrected groups.
- Correlated alignment with Short Form 36-Physical Component Score (SF36-PCS) and PJK incidence.
Main Results:
- T10PA correlated with SF36-PCS and PI (R=0.601).
- Functional correction was achieved in 40.7% of patients; overcorrection in 39.4%; undercorrection in 20.9%.
- Overcorrected patients showed significantly higher PJK rates (18.1%) compared to functionally (11.3%) and under-corrected (9.5%) groups.
Conclusions:
- Functional alignment, based on PI and age-appropriate physical function, improves clinical outcomes.
- Correcting to functional alignment minimizes PJK rates.
- This patient-specific strategy offers valuable intraoperative targets for adult spinal deformity surgery.
