Purpose: To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification.
Methods: This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded.
Results: A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5-4.3; p < 0.001) CONCLUSION: In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD.
Level of evidence: IV cross-sectional observational study. These slides can be retrieved under Electronic Supplementary Material.
Keywords: Adult spinal deformity; Complications; Degenerative spine; Roussouly classification; Scoliosis.
Restoring the Ideal Roussouly Sagittal Profile in Adult Scoliosis Surgery Decreases the Risk of Mechanical ComplicationsJ Pizones et al. Eur Spine J 29 (1), 54-62. PMID 31641904.Adult scoliosis surgery should restore the ideal Roussouly sagittal profile to decrease the rate of mechanical complications, especially in patients older than 65, instru …
Complication Rates Associated With 3-column Osteotomy in 82 Adult Spinal Deformity Patients: Retrospective Review of a Prospectively Collected Multicenter Consecutive Series With 2-year Follow-UpJS Smith et al. J Neurosurg Spine 27 (4), 444-457. PMID 28291402.OBJECTIVE Although 3-column osteotomy (3CO) can provide powerful alignment correction in adult spinal deformity (ASD), these procedures are complex and associated with hi …
Prospective Multicenter Assessment of Perioperative and Minimum 2-year Postoperative Complication Rates Associated With Adult Spinal Deformity SurgeryJS Smith et al. J Neurosurg Spine 25 (1), 1-14. PMID 26918574.OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complicati …
Proximal Junctional Kyphosis in Adult Scoliosis: Comparison of Four Radiological Predictor ModelsA Sebaaly et al. Eur Spine J 27 (3), 613-621. PMID 28597300.250 patients were included; mean age was 56.67 years and mean FU was 2.5 years. PJK occurred in 25.6% of cases. PJK occurred in 19.9% in patients with a GSA <45° and i …
Impact of Adult Scoliosis on Roussouly Sagittal Shape ClassificationJ Pizones et al. Spine (Phila Pa 1976) 44 (4), 270-279. PMID 30020277.Roussouly four-type sagittal shape classification could be applied to AS patients. AS modified the theoretical type in one of every three patients. No particular associat …