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Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications

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Abstract

Purpose

There are still no data proving whether restoring the ideal sagittal profile (according to Roussouly classification) in adult scoliosis (AS) patients leads to any additional benefit, especially regarding mechanical complications.

Methods

Retrospective analysis of operated AS patients recorded in a prospective multicenter database. Demographic and radiographic (preoperative and 6-week postoperative) data were analyzed. Patients with and without mechanical complications were compared looking especially at the surgical restoration of the ideal (based on Pelvic Incidence) sagittal profile. Univariate and multivariate analysis was performed to identify causes of mechanical complications at 2-year minimum follow-up.

Results

Ninty-six AS patients were analyzed. Thirty-nine patients suffered a mechanical complication (18 PJK, 11 pseudoarthrosis, 10 screw pull-out), and 57 patients had no mechanical complications. Postoperatively, 72% of patients not matching the ideal Roussouly-type suffered mechanical complications compared to 15% of matched patients (P < 0.001). Univariate analysis showed that older patients 64.9 ± 13 versus 40.7 ± 15.6 years (P < 0.001), higher postoperative Global Tilt (27° vs. 14.7°) and Pelvic Tilt (25° vs. 16°) (P < 0.001), upper instrumented vertebra at the thoracolumbar junction (62% vs. 21%) (P < 0.001), fixation to the Iliac (76% vs. 6%) (P < 0.001), and postoperative Roussouly-type mismatch (72% vs. 15%) (P < 0.001) significantly increased the rate of mechanical complications. Multivariate logistic regression analysis selected: postoperative Roussouly-type mismatch (OR = 41.9; 95%CI = 5.5–315.7; P < 0.001), iliac instrumentation (OR = 19.4; 95%CI = 2.6–142.5; P = 0.004), and age (OR = 1.1; 95%CI = 1.02–1.16; P = 0.004), as the most important variables.

Conclusions

Adult scoliosis surgery should restore the ideal Roussouly sagittal profile to decrease the rate of mechanical complications, especially in patients older than 65, instrumented to the pelvis.

Graphical Abstract

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Acknowledgements

Johnson and Johnson DePuy-Synthes Spine and Medtronic research grant were received in partial support of this work.

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Authors and Affiliations

  1. Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain

    Javier Pizones, Lucía Moreno-Manzanaro & Francisco Javier Sánchez Pérez-Grueso

  2. Spine Research Unit, Vall d’Hebron Institute of Research, Barcelona, Spain

    Alba Vila-Casademunt

  3. Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey

    Caglar Yilgor & Ahmet Alanay

  4. Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France

    Ibrahim Obeid

  5. Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland

    Frank Kleinstück

  6. Orthopedic Spine Unit, Ankara Spine Center, Ankara, Turkey

    Emre R. Acaroglu

  7. Spine Surgery Unit, Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Ferran Pellisé

Authors
  1. Javier Pizones
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  2. Lucía Moreno-Manzanaro
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  3. Francisco Javier Sánchez Pérez-Grueso
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  8. Frank Kleinstück
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  9. Emre R. Acaroglu
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ESSG European Spine Study Group

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Correspondence to Javier Pizones.

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Pizones, J., Moreno-Manzanaro, L., Sánchez Pérez-Grueso, F.J. et al. Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications. Eur Spine J 29, 54–62 (2020). https://doi.org/10.1007/s00586-019-06176-x

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  • DOI: https://doi.org/10.1007/s00586-019-06176-x

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