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Achieving an adequate level of patient’s satisfaction with results is one of the goals of adult spinal deformity (ASD) surgery. However, it is unclear whether the same factors affect satisfaction in all patient populations. Patients’ age influences the postoperative course and prevalence of complications after ASD surgery. The purpose of this study was to determine the factors predicting satisfaction 2 years after ASD surgery in younger and older patients. A total of 119 patients under 40 years old, 155 patients 40 to 65 years old, and 148 patients over 65 years old at surgery who were followed for a minimum of 2 years after surgery were included. Multivariate analysis was used to determine independent related factors with maximum AUC for satisfaction 2 years after surgery in each group. A propensity-matched cohort under equivalent demographic and clinical characteristics was used to confirm the results. Logistic regression analyses revealed satisfaction among the under-40 group corresponded to prior spine surgery, complications, and self-image. That among the 40-to-65 group corresponded to neurologic complication, revision surgery, pain, and sagittal vertical axis restoration. Among the over-65 group satisfaction correlated with revision surgery, standing ability, and lumbar lordosis index restoration. Propensity score matching confirmed that sagittal alignment correction led to substantial satisfaction. In younger patients, avoiding complications and improving patients’ self-image were essential for substantial satisfaction levels. In older patients, revision, standing ability, as well as sagittal spinopelvic alignment restoration, were the key factors. Surgeons should consider the differences in goals of each patient.

OBJECTIVEAchieving high patient satisfaction with management is often one of the goals after adult spinal deformity (ASD) surgery. However, literature on associated factors and their correlations with patient satisfaction is limited. The aim of this study was to determine the clinical and radiographic factors independently correlated with patient satisfaction in terms of management at 2 years after surgery.METHODSA multicenter prospective database of ASD surgery was retrospectively reviewed. The demographics, complications, health-related quality of life (HRQOL) subdomains, and radiographic parameters were examined to determine their correlation coefficients with the Scoliosis Research Society-22 questionnaire (SRS-22R) satisfaction scores at 2 years (Sat-2y score). Subsequently, factors determined to be independently associated with low satisfaction (Sat-2y score ≤ 4.0) were used to construct 2 types of multivariate models: one with 2-year data and the other with improvement (score at 2 years − score at baseline) data.RESULTSA total of 422 patients who underwent ASD surgery (mean age 53.1 years) were enrolled. All HRQOL subdomains and several coronal and sagittal radiographic parameters had significantly improved 2 years after surgery. The Sat-2y score was strongly correlated with the SRS-22R self-image (SI)/appearance subdomain (r = 0.64), followed by moderate correlation with subdomains related to standing (r = 0.53), body pain (r = 0.49–0.55), and function (r = 0.41–0.55) at 2 years. Conversely, the correlation between radiographic or demographic parameters with Sat-2y score was weak (r < 0.4). Multivariate analysis to eliminate confounding factors revealed that a worse Oswestry Disability Index (ODI) score for standing (≥ 2 points; OR 4.48) and pain intensity (≥ 2 points; OR 2.07), SRS-22R SI/appearance subdomain (< 3 points; OR 2.70) at 2 years, and a greater sagittal vertical axis (SVA) (> 5 cm; OR 2.68) at 2 years were independent related factors for low satisfaction. According to the other model, a lower improvement in ODI for standing (< 30%; OR 2.68), SRS-22R pain (< 50%; OR 3.25) and SI/appearance (< 50%; OR 2.18) subdomains, and an inadequate restoration of the SVA from baseline (< 2 cm; OR 3.16) were associated with low satisfaction.CONCLUSIONSSelf-image, pain, standing difficulty, and sagittal alignment restoration may be useful goals in improving patient satisfaction with management at 2 years after ASD surgery. Surgeons and other medical providers have to take care of these factors to prevent low satisfaction.

Preoperative patient self-image (SI) in adult spinal deformity (ASD) is the most relevant factor for surgical decision-making. Postoperative SI has an important role in a patient’s satisfaction with surgery. However, few studies are available to describe these variables. The aim was to investigate the factors that correlate with SI before and 2 years after ASD surgery. This study was a retrospective review of prospectively collected multicentric data. Patients who underwent ASD surgery with a minimum follow-up of 2 years were enrolled (n = 391). They were divided into high-SI and low-SI groups, both preoperatively and postoperatively, according to SRS-22R SI/appearance subdomain scores at baseline and at 2 years, respectively. Independently related factors for SI were determined using logistic regression analysis. Crucial factors for SI at baseline were the scores on the SRS-22R function/activity (OR: 2.61), SRS-22R mental health (OR: 2.63) subdomains, and relative spinopelvic alignment (RSA, OR: 0.95). SF-36 MCS (OR: 1.07) at baseline as well as sagittal vertical axis (SVA, OR: 0.99) at 2 years, and complications (OR: 0.44) were independent predictive factors for SI at 2 years. The patients who transitioned from the preoperative low-SI group to the postoperative high-SI group achieved larger global sagittal alignment restoration and had lesser complications than those who did not. Mental status and sagittal spinopelvic alignment are key determinants of SI. The results indicate that considering mental status, preventing complications, and global sagittal alignment, restoration is crucial for achieving substantial SI scores after ASD surgery. These slides can be retrieved under Electronic Supplementary Material.

Multiple-rod constructs (Multi-Rod: extra rods for additional pillar support) are occasionally used in adult spinal deformity (ASD) surgery. We aimed to compare and analyze the general outcome of multi-rod constructs with a matched two-rod cohort, to better understand the differences and the similitudes. This is a retrospective matched cohort study including patients with ASD that underwent surgical correction with long posterior instrumentation (more than five levels), pelvic fixation and a minimum 1-year follow-up. Matching was considered with demographical data, preoperative radiographical parameters, preoperative clinical status [health-related quality-of-life (HRQoL) scores] and surgical characteristics (anterior fusion, decompression, rod material, osteotomies). Postoperative radiographical and clinical parameters, as well as complications, were obtained. Univariate and multivariate analysis was performed regarding postoperative improvement, group variables comparison and parameters correlation. Thirty-three patients with multi-rod construct and 33 matched with a two-rod construct were selected from a database with 346 ASD-operated patients. Both groups had a significant improvement with surgical management in the radiographical and HRQoL parameters (p

Objective: When a lumbar fractures developes a significant deformity, the sagittal balance is altered which can lead to clinical consequences. The aim of this study was to measure and analyze the sagittal balance in patients with lumbar fractures operated with posterior instrumentation after three months and analyze their correlation with the different variables of the patient and the fracture. Methods: Sixty-three medical records of patients with lumbar fracture operated with posterior instrumentation were analyzed, excluding those with previous spinal pathology, or inability to stand upright. The parameters of pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, lumbar lordosis/pelvic incidence (LL/ PI) ratio, as well as the pre and postoperative status of segmental kyphosis and residual pain were measured. Results: Eighteen women, 44 men, with mean age of 42 years, with lumbar fractures: 29 in L1, 19 in L2, 10 in L3, 3 in L4 and 1 in L5. AOSpine Clasification: 2 type A1, 2 type A2, 37 type A3, 19 type A4, 2 type B. All patients were operated with a transpedicular polyaxial system. More than 80% of patients with spinopelvic balance within parameters considered normal. More than 70% with lumbar lordosis and LL/PI ratio within parameters. All with improvement of segmental kyphosis (average correction of 8.5°, p 80% dos pacientes com balanço espinopélvico, dentro de parâmetros considerados normais. > 70% com lordose lombar e relação LL / IP dentro dos parâmetros. Todos com melhora da cifose segmentar (correção média de 8,5°, p

Objective: To determine the correlation between morbidity/mortality and the pre-surgical protocol in patients undergoing anterior cervical surgical approach. Methods: Retrospective, cross-sectional and descriptive study, in which 114 patients who underwent anterior cervical surgical approach were reviewed, divided into two groups: “Group A” Conventional Presurgical Protocol (CPP) and “Group B” Extended Presurgical Protocol (EPP). Statistical analysis used the IBM SPSS Statistics Base v.24 software. Results: We evaluated 114 patients, 35 from “Group A”, 79 from “Group B”, 83 (72.8%) with cervical myelopathy, 30 (26.3%) with cervicobrachialgia. “Group A” had 10 cases of respiratory failure, with 5 secondary to bronchial secretion, 2 secondary to cervical hematoma. “Group B” had 12 cases of respiratory failure, 3 secondary to bronchial secretion and 1 secondary to cervical hematoma. Conclusions: The extended presurgical protocol can be the answer to reduce complications by improving selection parameters of the candidate patient for a surgical procedure of the cervical spine. Level of Evidence III; Case-control studyg. RESUMO Objetivo: Determinar a correlação entre morbidade e mortalidade e o protocolo pré-cirúrgico, em pacientes submetidos à cirurgia de coluna cervical anterior. Método: Estudo retrospectivo, transversal e descritivo, em 114 pacientes com cirurgia cervical anterior, dois grupos foram montados: “Grupo A” pré-cirúrgico convencional (PPP) e “grupo B” protocolo pré-cirúrgico estendido (PPE), a análise v.24 SPSS Statistics Base. Resultados: 114 casos de pacientes, 35 “Grupo A”, 79 “grupo B”, 83 (72,8%) com a mielopatia cervical, 30 (26,3%) com cervicobraquialgia avaliada. No “Grupo A” forma relatados: 10 casos de insuficiência respiratória, 5 são secundárias a secreção brônquica, 2 são secundárias a hematoma cervical. No “Grupo B” foram relatados: 12 casos de aflição respiratória, 3 são secreção brônquica secundária e um secundário ao hematoma cervical. Conclusão: protocolo pré-cirúrgico estendido pode ser a resposta para reduzir as complicações, a partir do momento que se melhoram os parâmetros de seleção do paciente, que é candidato a um procedimento cirúrgico anterior da coluna cervical. Nível de evidência III, Estudo de caso controleg. RESUMEN Objetivo: Determinar la correlación entre la morbimortalidad y el protocolo prequirúrgico en pacientes sometidos a cirugía de la columna cervical por vía anterior. Métodos: Estudio retrospectivo, transversal y descriptivo, en el cual se revisaron 114 pacientes con cirugía cervical anterior, divididos en dos grupos: “Grupo A”, Protocolo Prequirúrgico Convencional (PPC) y “Grupo B” Protocolo Prequirúrgico Extendido (PPE). El análisis estadístico se hizo con el software IBM SPSS Statistics Base v.24. Resultados: Se evaluaron 114 casos de pacientes, 35 del “Grupo A”, 79 del “Grupo B”, 83 (72,8%) con mielopatía cervical, 30 (26,3%) con cervicobraquialgia. El “Grupo A” tuvo 10 casos de insuficiencia respiratoria, con 5 secundarios a secreción bronquial, 2 secundarios a hematoma cervical. El “Grupo B” tuvo 12 casos de insuficiencia respiratoria, 3 secundarios a secreción bronquial y 1 secundario a hematoma cervical. Conclusiones: El protocolo prequirúrgico extendido puede ser la respuesta para reducir las complicaciones mediante la mejoría de los parámetros de selección del paciente candidato a un procedimiento quirúrgico anterior de la columna cervical. Nivel de evidencia III; Estudio de caso controlg.

OBJECTIVE: To describe the results of surgical treatment of Scheuermann's disease by the posterior approach. METHOD: A descriptive, retrospective, longitudinal study in which patients with Scheuermann's disease, treated surgically by the posterior approach at the Hospital de Traumatologia y Ortopedia [Hospital for Traumatology and Orthopedics] "Lomas Verdes" IMSS. The Cobb method was used to measure the kyphosis in all the patients, of T5-T12. The surgical technique used was vertebral shortening by the Ponte osteotomy technique, at the apex of the deformity, accompanied by transpedicular instrumentation and posterior arthrodesis. RESULTS: Five patients were included; three men and two women, with an average age of 16.6 years. The initial average kyphosis was 76º, which was corrected to 42º after surgery. Blood loss was 590 ml, with a surgery time of 3 hours. Three patients were submitted to neurophysiological monitoring. No neurological lesion was found. There was no loss of correction at 6 months of evolution. CONCLUSIONS: The vertebral shortening technique with posterior instrumentation eliminates the use of the anterior approach to release the anterior longitudinal ligament. Osteotomies by the Ponte technique make the spine more flexible, and together with pedicular instrumentation, correct the deformity and preserve the correction over time. OBJETIVO: Descrever os resultados do tratamento cirúrgico da doença de Scheuermann por acesso posterior. MÉTODO: Estudo descritivo, retrospectivo e longitudinal, no qual foram incluídos pacientes com doença de Scheuermann tratados cirurgicamente por acesso posterior no Hospital de Traumatologia y Ortopedia "Lomas Verdes" IMSS. O método de Cobb foi utilizado para medir a cifose em todos os pacientes de T5-T12. A técnica cirúrgica utilizada foi encurtamento vertebral pela técnica de osteotomia de Ponte no ápice da deformidade, acompanhada por instrumentação transpedicular e artrodese posterior. RESULTADOS: Foram incluídos cinco pacientes, três homens e duas mulheres, com média de idade de 16,6 anos. A cifose média inicial era de 76º e foi corrigida para 42º depois da cirurgia. O sangramento foi 590 ml, com tempo cirúrgico de 3 horas. Três pacientes foram submetidos à monitoração neurofisiológica. Não foi encontrada nenhuma lesão neurológica. Não houve perda da correção aos 6 meses de evolução. CONCLUSÕES: A técnica de encurtamento vertebral com instrumentação posterior elimina o emprego do acesso anterior para liberar o ligamento longitudinal anterior. A osteotomias pela técnica de Ponte flexibilizam a coluna e, em conjunto com a instrumentação pedicular, corrigem a deformidade e mantêm a correção no decorrer do tempo. OBJETIVO: Describir los resultados del tratamiento quirúrgico de la enfermedad de Scheuermann por vía posterior. MÉTODO: Es un estudio descriptivo, retrospectivo longitudinal en el cual se incluyeron pacientes con enfermedad de Scheuermann manejados quirúrgicamente por vía posterior en el Hospital de Traumatología y Ortopedia "Lomas Verdes" IMSS. Se utilizó el método de Cobb para la medición de la cifosis en todos los pacientes de T5-T12. La técnica quirúrgica utilizada fue el acortamiento vertebral mediante osteotomías de Ponte en el ápice de la deformidad, acompañada de instrumentación transpedicular y artrodesis posterior. RESULTADOS: Se incluyeron cinco pacientes, tres hombres y dos mujeres, con un promedio de edad 16,6 años. La cifosis inicial promedio fue de 76º y corrigió a 42º después de la cirugía. El sangrado promedio fue de 590 ml con un tiempo quirúrgico de 3 horas. Se utilizó monitoreo neurofisiológico en tres de los pacientes. No se presentó ninguna lesión neurológica. No hubo pérdida de la corrección a los 6 meses de evolución. CONCLUSIONES: La técnica de acortamiento vertebral con instrumentación posterior omite el abordaje anterior para la liberación del ligamento longitudinal anterior. Las osteotomías tipo Ponte flexibilizan la columna y junto con la instrumentación pedicular logran corregir la deformidad y mantenerla a través del tiempo.