Abstract：
OBJECTIVE: The objective was to determine the degree of regional decompensation to pelvic tilt (PT) normalization after complex adult spinal deformity (ASD) surgery.
METHODS: Operative ASD patients with 1 year of PT measurements were included. Patients with normalized PT at baseline were excluded. Predicted PT was compared to actual PT, tested for change from baseline, and then compared against age-adjusted, Scoliosis Research Society-Schwab, and global alignment and proportion (GAP) scores. Lower-extremity (LE) parameters included the cranial-hip-sacrum angle, cranial-knee-sacrum angle, and cranial-ankle-sacrum angle. LE compensation was set as the 1-year upper tertile compared with intraoperative baseline. Univariate analyses were used to compare normalized and nonnormalized data against alignment outcomes. Multivariable logistic regression analyses were used to develop a model consisting of significant predictors for normalization related to regional compensation.
RESULTS: In total, 156 patients met the inclusion criteria (mean ± SD age 64.6 ± 9.1 years, BMI 27.9 ± 5.6 kg/m2, Charlson Comorbidity Index 1.9 ± 1.6). Patients with normalized PT were more likely to have overcorrected pelvic incidence minus lumbar lordosis and sagittal vertical axis at 6 weeks (p < 0.05). GAP score at 6 weeks was greater for patients with nonnormalized PT (0.6 vs 1.3, p = 0.08). At baseline, 58.5% of patients had compensation in the thoracic and cervical regions. Postoperatively, compensation was maintained by 42% with no change after matching in age-adjusted or GAP score. The patients with nonnormalized PT had increased rates of thoracic and cervical compensation (p < 0.05). Compensation in thoracic kyphosis differed between patients with normalized PT at 6 weeks and those with normalized PT at 1 year (69% vs 35%, p < 0.05). Those who compensated had increased rates of implant complications by 1 year (OR [95% CI] 2.08 [1.32-6.56], p < 0.05). Cervical compensation was maintained at 6 weeks and 1 year (56% vs 43%, p = 0.12), with no difference in implant complications (OR 1.31 [95% CI -2.34 to 1.03], p = 0.09). For the lower extremities at baseline, 61% were compensating. Matching age-adjusted alignment did not eliminate compensation at any joint (all p > 0.05). Patients with nonnormalized PT had higher rates of LE compensation across joints (all p < 0.01). Overall, patients with normalized PT at 1 year had the greatest odds of resolving LE compensation (OR 9.6, p < 0.001). Patients with normalized PT at 1 year had lower rates of implant failure (8.9% vs 19.5%, p < 0.05), rod breakage (1.3% vs 13.8%, p < 0.05), and pseudarthrosis (0% vs 4.6%, p < 0.05) compared with patients with nonnormalized PT. The complication rate was significantly lower for patients with normalized PT at 1 year (56.7% vs 66.1%, p = 0.02), despite comparable health-related quality of life scores.
CONCLUSIONS: Patients with PT normalization had greater rates of resolution in thoracic and LE compensation, leading to lower rates of complications by 1 year. Thus, consideration of both the lower extremities and thoracic regions in surgical planning is vital to preventing adverse outcomes and maintaining pelvic alignment.
METHODS: Operative ASD patients with 1 year of PT measurements were included. Patients with normalized PT at baseline were excluded. Predicted PT was compared to actual PT, tested for change from baseline, and then compared against age-adjusted, Scoliosis Research Society-Schwab, and global alignment and proportion (GAP) scores. Lower-extremity (LE) parameters included the cranial-hip-sacrum angle, cranial-knee-sacrum angle, and cranial-ankle-sacrum angle. LE compensation was set as the 1-year upper tertile compared with intraoperative baseline. Univariate analyses were used to compare normalized and nonnormalized data against alignment outcomes. Multivariable logistic regression analyses were used to develop a model consisting of significant predictors for normalization related to regional compensation.
RESULTS: In total, 156 patients met the inclusion criteria (mean ± SD age 64.6 ± 9.1 years, BMI 27.9 ± 5.6 kg/m2, Charlson Comorbidity Index 1.9 ± 1.6). Patients with normalized PT were more likely to have overcorrected pelvic incidence minus lumbar lordosis and sagittal vertical axis at 6 weeks (p < 0.05). GAP score at 6 weeks was greater for patients with nonnormalized PT (0.6 vs 1.3, p = 0.08). At baseline, 58.5% of patients had compensation in the thoracic and cervical regions. Postoperatively, compensation was maintained by 42% with no change after matching in age-adjusted or GAP score. The patients with nonnormalized PT had increased rates of thoracic and cervical compensation (p < 0.05). Compensation in thoracic kyphosis differed between patients with normalized PT at 6 weeks and those with normalized PT at 1 year (69% vs 35%, p < 0.05). Those who compensated had increased rates of implant complications by 1 year (OR [95% CI] 2.08 [1.32-6.56], p < 0.05). Cervical compensation was maintained at 6 weeks and 1 year (56% vs 43%, p = 0.12), with no difference in implant complications (OR 1.31 [95% CI -2.34 to 1.03], p = 0.09). For the lower extremities at baseline, 61% were compensating. Matching age-adjusted alignment did not eliminate compensation at any joint (all p > 0.05). Patients with nonnormalized PT had higher rates of LE compensation across joints (all p < 0.01). Overall, patients with normalized PT at 1 year had the greatest odds of resolving LE compensation (OR 9.6, p < 0.001). Patients with normalized PT at 1 year had lower rates of implant failure (8.9% vs 19.5%, p < 0.05), rod breakage (1.3% vs 13.8%, p < 0.05), and pseudarthrosis (0% vs 4.6%, p < 0.05) compared with patients with nonnormalized PT. The complication rate was significantly lower for patients with normalized PT at 1 year (56.7% vs 66.1%, p = 0.02), despite comparable health-related quality of life scores.
CONCLUSIONS: Patients with PT normalization had greater rates of resolution in thoracic and LE compensation, leading to lower rates of complications by 1 year. Thus, consideration of both the lower extremities and thoracic regions in surgical planning is vital to preventing adverse outcomes and maintaining pelvic alignment.
摘要：
目的：目的是确定复杂的成人脊柱畸形（ASD）手术后局部代偿至骨盆倾斜（PT）正常化的程度。
方法：纳入1年PT测量的ASD手术患者。排除基线时PT正常的患者。预测PT与实际PT进行比较，测试从基线的变化，然后与年龄调整后进行比较，脊柱侧弯研究协会-施瓦布，以及全球一致性和比例(GAP)分数。下肢（LE）参数包括颅骨-髋骨角，颅-膝-骶骨角度,和颅踝骶骨角。与术中基线相比，LE补偿设定为1年上三分位数。使用单变量分析比较标准化和非标准化数据与比对结果。使用多变量逻辑回归分析来开发一个模型，该模型由与区域补偿相关的归一化的重要预测因子组成。
结果：总计，156例患者符合纳入标准（平均±SD年龄64.6±9.1岁，BMI27.9±5.6kg/m2，Charlson合并症指数1.9±1.6）。正常PT的患者在第6周时更有可能出现过度矫正的骨盆发生率减去腰椎前凸和矢状面垂直轴（p<0.05）。非正常PT患者在6周时的GAP评分更高（0.6vs1.3，p=0.08）。在基线,58.5％的患者在胸和颈部区域有补偿。术后,在年龄校正或GAP评分匹配后,补偿维持42%,无变化.非正常PT患者的胸颈部代偿率增加（p<0.05）。胸椎后凸的代偿在6周时PT正常的患者和1年时PT正常的患者之间存在差异(69%vs35%,p<0.05)。代偿者1年植入并发症发生率增加(OR[95%CI]2.08[1.32-6.56],p<0.05)。宫颈补偿维持在6周和1年(56%vs43%,p=0.12),植入物并发症无差异(OR1.31[95%CI-2.34至1.03]，p=0.09)。对于基线处的下肢,61%的人正在补偿。匹配的年龄调整对齐没有消除任何关节的补偿（所有p>0.05）。非正常PT患者关节间LE补偿率较高（均p<0.01）。总的来说,1年时PT恢复正常的患者获得LE补偿的几率最大(OR9.6,p<0.001).术后1年PT恢复正常的患者植入失败率较低（8.9%vs19.5%，p<0.05)，棒材破损(1.3%对13.8%，p<0.05)，和假关节(0%vs4.6%，p<0.05）与PT未正常化的患者相比。术后1年PT恢复正常患者的并发症发生率明显较低(56.7%vs66.1%,p=0.02),尽管与健康相关的生活质量评分相当。
结论：PT正常化的患者在胸廓和LE代偿方面有更高的消退率，导致1年并发症发生率较低。因此，在手术计划中同时考虑下肢和胸部对于预防不良结局和维持骨盆对齐至关重要.
方法：纳入1年PT测量的ASD手术患者。排除基线时PT正常的患者。预测PT与实际PT进行比较，测试从基线的变化，然后与年龄调整后进行比较，脊柱侧弯研究协会-施瓦布，以及全球一致性和比例(GAP)分数。下肢（LE）参数包括颅骨-髋骨角，颅-膝-骶骨角度,和颅踝骶骨角。与术中基线相比，LE补偿设定为1年上三分位数。使用单变量分析比较标准化和非标准化数据与比对结果。使用多变量逻辑回归分析来开发一个模型，该模型由与区域补偿相关的归一化的重要预测因子组成。
结果：总计，156例患者符合纳入标准（平均±SD年龄64.6±9.1岁，BMI27.9±5.6kg/m2，Charlson合并症指数1.9±1.6）。正常PT的患者在第6周时更有可能出现过度矫正的骨盆发生率减去腰椎前凸和矢状面垂直轴（p<0.05）。非正常PT患者在6周时的GAP评分更高（0.6vs1.3，p=0.08）。在基线,58.5％的患者在胸和颈部区域有补偿。术后,在年龄校正或GAP评分匹配后,补偿维持42%,无变化.非正常PT患者的胸颈部代偿率增加（p<0.05）。胸椎后凸的代偿在6周时PT正常的患者和1年时PT正常的患者之间存在差异(69%vs35%,p<0.05)。代偿者1年植入并发症发生率增加(OR[95%CI]2.08[1.32-6.56],p<0.05)。宫颈补偿维持在6周和1年(56%vs43%,p=0.12),植入物并发症无差异(OR1.31[95%CI-2.34至1.03]，p=0.09)。对于基线处的下肢,61%的人正在补偿。匹配的年龄调整对齐没有消除任何关节的补偿（所有p>0.05）。非正常PT患者关节间LE补偿率较高（均p<0.01）。总的来说,1年时PT恢复正常的患者获得LE补偿的几率最大(OR9.6,p<0.001).术后1年PT恢复正常的患者植入失败率较低（8.9%vs19.5%，p<0.05)，棒材破损(1.3%对13.8%，p<0.05)，和假关节(0%vs4.6%，p<0.05）与PT未正常化的患者相比。术后1年PT恢复正常患者的并发症发生率明显较低(56.7%vs66.1%,p=0.02),尽管与健康相关的生活质量评分相当。
结论：PT正常化的患者在胸廓和LE代偿方面有更高的消退率，导致1年并发症发生率较低。因此，在手术计划中同时考虑下肢和胸部对于预防不良结局和维持骨盆对齐至关重要.
