Postoperative Sagittal Spinal Alignment Changes Following Corrective Surgery in Adult Spinal Deformity

Ahmed Albayar; Ashwin Ramayya; Patricia Zadnik Sullivan; Jang Yoon; Comron Saifi; Abigail Roche; Zarina S. Ali; William C. Welch; Vincent Arlet; Ali K. Ozturk

doi:10.14444/8194

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Figure 1
Bar plots representing radiographic changes at 3 months postsurgery compared to immediate postoperative radiographs. (A) Significant changes in thoracic kyphosis (TK) Cobb angles (t [36] = 2.91, P = 0.006). (B) Lumbar lordosis and (C) sagittal vertical axis changes did not reach statistical significance (P = 0.21 and P = 0.18, respectively).
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Figure 2
Lateral whole-spine radiographic scans representing changes in thoracic kyphosis (TK) at 3-month postoperative time point compared to immediate postoperative TK. (A) Immediate postoperative radiographs showing TK Cobb angle measurement, 36°. (B) The 3-month postoperative radiographs showing TK Cobb angle measurement; 43°. The difference between TK measurements is 7°.
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Figure 3
Graphic representation of changes in the sagittal vertical axis. Changes in the 3-month postoperative period have shown wide variability.
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Figure 4
Lateral whole-spine radiographic scans representing changes in sagittal vertical axis (SVA) at 3-month postoperative time point compared to immediate postoperative SVA. (A) Immediate postoperative radiograph showing SVA measurement, +60 mm. (B) Three-month postoperative radiographs showing SVA measurement, -32 mm. The difference between measurements is -92 mm.
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Figure 5
Bar plot representing a comparison between changes of thoracic kyphosis in upper thoracic (UT) to pelvis fusions and lower thoracic (LT) to pelvis fusions. The difference is not statically significant (P = 0.74).

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Patients’ characteristics and surgical details.

Characteristics and Surgical Details	N = 36
Gender, female patients, n (%)	29 (81%)
Age at surgery, y, mean (SD)	61.5 y(8.7)
BMI, kg/m², mean (SD)	27.7 (5.6)
LOS, d, mean (SD)	7.8 (4.2)
Smoking status, active smokers, n (%)	6 (17%)
History of previous spine surgery, n (%)	28 (78%)
Staged spine procedure, n (%)	9 (25%)
Collective EBL^a, mL, mean (SD)	1406.4 (720.4)
Return to OR, n (%)	9 (25%)
LT-P fusions, n (%)	25 (69%)
UT-P fusions, n (%)	11 (31%)
Combined anterior and posterior spine procedures, n (%)	32 (89%)
Use of hooks, n (%)	24 (67%)
Smith–Peterson osteotomies, n (%)	32 (89%)
Use of HLCs, n (%)	30 (83%)
Vertebroplasty, n (%)	4 (11%)

aCollective EBL refers to the sum of EBL after spine procedures either staged (anterior and posterior surgeries) or EBL of 1-stage spine surgery.
BMI, body mass index; EBL, estimated blood loss; LOS, length of stay; LT-P, lower thoracic to pelvis fusion cases; OR, operating room; SD, standard deviation; UT-P, upper thoracic to pelvis fusion cases.