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Mechanical complications and patient-reported outcome measures associated with high pelvic incidence and persistent pelvic retroversion: the Roussouly “false type 2” profile

Thamrong Lertudomphonwanit Department of Orthopaedic Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;

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Munish C. Gupta Department of Orthopedic Surgery, University of California, San Francisco, California;

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Alekos A. Theologis Department of Orthopedic Surgery, Washington University, St. Louis, Missouri;

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Julio J. Jauregui Department of Orthopedic Surgery, University of California, San Francisco, California;

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Lawrence G. Lenke Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York; and

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Keith H. Bridwell Department of Orthopedic Surgery, University of California, San Francisco, California;

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James P. Wondra II Department of Orthopedic Surgery, University of California, San Francisco, California;

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Michael P. Kelly Department of Orthopedic Surgery, Rady Children’s Hospital, University of California, San Diego, California

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Publication Date:
12 May 2023
Page Range:
151–156
体积/Issue:
体积39: Issue 2
DOI link:
https://doi.org/10.3171/2023.4.SPINE22368
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OBJECTIVE

The objective of this paper was to report mechanical complications and patient-reported outcome measures (PROMs) for adult spinal deformity (ASD) patients with a Roussouly "false type 2" (FT2) profile.

开云体育世界杯赔率

ASD patients treated from 2004 to 2014 at a single center were identified. Inclusion criteria were pelvic incidence ≥ 60° and a minimum 2-year follow-up. FT2 was defined as a high postoperative pelvic tilt (PT), as defined by the Global Alignment and Proportion target, and thoracic kyphosis < 30°. Mechanical complications, defined as proximal junctional kyphosis (PJK) and/or instrumentation failure, were determined and compared. Scoliosis Research Society–22r (SRS-22r) scores were compared between groups.

RESULTS

Ninety-five patients (normal PT [NPT] group 49, FT2 group 46) who met the inclusion criteria were identified and studied. Most surgeries were revisions (NPT group 30 [61%], FT2 group 30 [65%]), and most were performed via a posterior-only approach (86%) (mean ± SD 9.6 ± 5 levels). Proximal junctional angles increased after surgery in both groups, without differences between groups. Neither rates of radiographic PJK (p = 0.10), revision for PJK (p = 0.45), nor revision for pseudarthrosis (p = 0.66) were different between groups. There were no differences between groups for SRS-22r domain scores or subscores.

CONCLUSIONS

In this single-center experience, patients with high pelvic incidence fixed with persistent lumbopelvic parameter mismatch and engaged compensatory mechanisms (Roussouly FT2) had mechanical complications and PROMs not different from those with normalized alignment parameters. Compensatory PT may be acceptable in some cases of ASD surgery.

ABBREVIATIONS

ASD = adult spinal deformity ; FT2 = false type 2 ; GAP = Global Alignment and Proportion ; HRQOL = health-related quality of life ; LL = lumbar lordosis ; NPT = normal PT ; PI = pelvic incidence ; PJA = proximal junctional angle ; PJK = proximal junctional kyphosis ; PROM = patient-reported outcome measure ; PT = pelvic tilt ; rhBMP-2 = recombinant human bone morphogenetic protein–2 ; SRS-22r = Scoliosis Research Society–22r ; SVA = sagittal vertical axis ; TK = thoracic kyphosis ; UIV = upper instrumented vertebra .
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Cover Journal of Neurosurgery: Spine

体积39: Issue 2 (Aug 2023)

inJournal of Neurosurgery: Spine
Figure from Yu et al. (pp 238–246).
体积39: Issue 2

Contributor Notes

CorrespondenceMichael P. Kelly: Rady Children’s Hospital, University of California, San Diego, CA.mpkspine@gmail.com.

INCLUDE WHEN CITINGPublished online May 12, 2023; DOI: 10.3171/2023.4.SPINE22368.

DisclosuresDr. Gupta reported royalties from Innomed; royalties from and being a consultant for DePuy and Globus; being a consultant for and fees for travel from Medtronic; nonfinancial support for travel from Globus, Medtronic, DePuy, and Zimmer; being on the Board of Directors of and nonfinancial support for travel from the Scoliosis Research Society; and stock ownership in Johnson & Johnson, outside the submitted work. Dr. Theologis reported personal fees from DePuy Spine, Alphatec, Icotec, Carbofix, Restor3D, Surgalign, and Stryker/K2M, outside the submitted work. Dr. Lenke reported a grant (money to institution) from AO Spine; and being a consultant for Medtronic, Abryx, Acuity Surgical, and EOS Technology, outside the submitted work. Dr. Kelly reported being a Deputy Editor for Wolters Kluwer; being on the Board of Directors of the Scoliosis Research Society; and being on the Steering Committee of AO Spine, outside the submitted work. Dr. Bridwell reported a grant from the Scoliosis Research Society, administered by the International Spine Study Group Foundation, outside the submitted work.
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