106 results on '"Yilgor C"'
Search Results
2. Validation of a Simplified SRS-Schwab Classification Using a Sagittal Modifier
- Author
-
Kieser, D.C., Boissiere, L., Cawley, D.T., Larrieu, D., Yilgor, C., Takemoto, M., Yoshida, G., Alanay, A., Acaroglu, E., Kleinstück, F., Pellisé, F., Perez-Grueso, F.J.S., Vital, J.M., and Obeid, I.
- Published
- 2019
- Full Text
- View/download PDF
3. Influence of implant density on mechanical complications in adult spinal deformity surgery
- Author
-
Charles, Y.P., Séverac, F., Núñez-Pereira, S., Haddad, S., Pellise, F., Obeid, I., Boissiere, L., Yilgor, C., Yucekul, A., Alanay, A., Kleinstück, F., Loibl, M., Raganato, R., Perez-Grueso, F. Sanchez, Pizones, J., and Essg, E.S.S.G.
- Published
- 2024
- Full Text
- View/download PDF
4. Elevated postoperative compressive forces might explain junctional complications: a combined clinical and personalized musculoskeletal modeling study
- Author
-
Conticello, S., Rieger, F., Galbusera, F., Kleinstück, F., Fekete, T., Haschtmann, D., Jeszenszky, D., Richner-Wunderlin, S., Pellise, F., Obeid, I., Pizones, J., Pérez-Grueso, F.J., Karaman, I., Alanay, A., Yilgor, C., Ferguson, S.J., Loibl, M., Ignasiak, D., and Essg, E.S.S.G.
- Published
- 2024
- Full Text
- View/download PDF
5. Adaptation of abdominal wall to spinal deformity might compromise postoperative biomechanics and contribute to PJK - simulation study
- Author
-
Jolas, E., Galbusera, F., Kleinstück, F., Fekete, T., Haschtmann, D., Jeszenszky, D., Richner-Wunderlin, S., Pellise, F., Obeid, I., Pizones, J., Perez-Grueso, F. Sanchez, Alanay, A., Yilgor, C., Ferguson, S.J., Loibl, M., and Ignasiak, D.
- Published
- 2024
- Full Text
- View/download PDF
6. Radiomics-Powered Radiographic Image Analysis for Enhanced Mechanical Complications Prediction and Surgical Planning in Adult Spine Deformity
- Author
-
Pellise, F., Haddad, S., Núñez-Pereira, S., Yilgor, C., Barcheni, M., Pupak, A., Ramirez, M., Pizones, J., Alanay, A., Obeid, I., Kleinstück, F., Galbusera, F., Sagarra, O., and Essg, E.S.S.G.
- Published
- 2024
- Full Text
- View/download PDF
7. Does VBT cause disc and facet joint degeneration? An MRI study with minimum 5-years follow-up
- Author
-
Yucekul, A., Kilic, F., Durbas, A., Carus, E.G., Kaval, A., Ergene, G., Senay, S., Dikmen, P. Yalinay, Balci, S. Turgut, Karaarslan, E., Zulemyan, T., Yavuz, Y., Yilgor, C., and Alanay, A.
- Published
- 2024
- Full Text
- View/download PDF
8. How to best restore the pelvic version with adult deformity surgery?
- Author
-
Raganato, R., primary, Pérez-Grueso, F.J., additional, Yilgor, C., additional, Gomez-Rice, A., additional, Moreno-Manzanaro, L., additional, Escamez, F., additional, Talavera, G., additional, Sanchez-Marquez, J.M., additional, Fernández-Baíllo, N., additional, Kleinstück, F., additional, Obeid, I., additional, Alanay, A., additional, Pellise, F., additional, Pizones, J., additional, and Essg, E.S.S.G., additional
- Published
- 2023
- Full Text
- View/download PDF
9. Prediction of longitudinal growth and growth modulation after VBT surgery: A comparative analysis of different skeletal maturity staging systems
- Author
-
Yucekul, A., primary, Yilgor, C., additional, Demirci, N., additional, Gurel, I.E., additional, Orhun, O., additional, Karaman, I., additional, Durbas, A., additional, Sim, L.H., additional, Zulemyan, T., additional, Yavuz, Y., additional, and Alanay, A., additional
- Published
- 2023
- Full Text
- View/download PDF
10. Comparison of radiographic and clinical outcomes of adult vs adolescent Scheuermann kyphosis patients: A matched cohort analysis after surgery
- Author
-
Yilgor, C., primary, Yucekul, A., additional, Zulemyan, T., additional, Yavuz, Y., additional, Lonner, B., additional, Obeid, I., additional, Yaszay, B., additional, Kleinstück, F., additional, Shah, S., additional, Pizones, J., additional, Shufflebarger, H.L., additional, Pérez-Grueso, F.J., additional, Newton, P.O., additional, Pellise, F., additional, Alanay, A., additional, and Essg, E.S.S.G., additional
- Published
- 2023
- Full Text
- View/download PDF
11. A comprehensive analysis of outcomes and treatment success of thoracic, thoracolumbar and bilateral vertebral body tethering surgery
- Author
-
Yilgor, C., primary, Yucekul, A., additional, Demirci, N., additional, Kilic, F., additional, Aktas, S., additional, Pallotta, L., additional, Ergene, G., additional, Senay, S., additional, Balci, S. Turgut, additional, Dikmen, P. Yalinay, additional, Zulemyan, T., additional, Yavuz, Y., additional, and Alanay, A., additional
- Published
- 2023
- Full Text
- View/download PDF
12. Long term mechanical failure in well aligned adult spinal deformity patients
- Author
-
Haddad, S., primary, Núñez-Pereira, S., additional, Ramirez, V.M., additional, Barcheni, M., additional, Pizones, J., additional, Yilgor, C., additional, Alanay, A., additional, Obeid, I., additional, Pérez-Grueso, F.J., additional, Kleinstück, F., additional, Pellise, F., additional, and Essg, E.S.S.G., additional
- Published
- 2023
- Full Text
- View/download PDF
13. Digitized radiographs outperform radiographic measurements in predicting mechanical complications in adult spinal deformity
- Author
-
Barcheni, M., primary, Kakeh, N., additional, Capdevila, B.M., additional, Núñez-Pereira, S., additional, Haddad, S., additional, Ramirez, V.M., additional, Pizones, J., additional, Pérez-Grueso, F.J., additional, Obeid, I., additional, Kleinstück, F., additional, Alanay, A., additional, Galbusera, F., additional, Yilgor, C., additional, Mannion, A.F., additional, Pellise, F., additional, and Essg, E.S.S.G., additional
- Published
- 2023
- Full Text
- View/download PDF
14. Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning
- Author
-
Obeid, I., Boissière, L., Yilgor, C., Larrieu, D., Pellisé, F., Alanay, A., Acaroglu, E., Perez-Grueso, F. J., Kleinstück, F., Vital, J. M., Bourghli, A., and on behalf of European Spine Study Group, ESSG
- Published
- 2016
- Full Text
- View/download PDF
15. Toward the Development of a Comprehensive Clinically Oriented Patient Profile: A Systematic Review of the Purpose, Characteristic, and Methodological Quality of Classification Systems of Adult Spinal Deformity.
- Author
-
Kwan, K.Y.H., Naresh-Babu, J., Jacobs, W, Kleuver, M. de, Polly, D.W., Yilgor, C., Wu, Y., Park, J.B., Ito, M., Hooff, M.L. van, Kwan, K.Y.H., Naresh-Babu, J., Jacobs, W, Kleuver, M. de, Polly, D.W., Yilgor, C., Wu, Y., Park, J.B., Ito, M., and Hooff, M.L. van
- Abstract
Item does not contain fulltext, BACKGROUND: Existing adult spinal deformity (ASD) classification systems are based on radiological parameters but management of ASD patients requires a holistic approach. A comprehensive clinically oriented patient profile and classification of ASD that can guide decision-making and correlate with patient outcomes is lacking. OBJECTIVE: To perform a systematic review to determine the purpose, characteristic, and methodological quality of classification systems currently used in ASD. METHODS: A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science for literature published between January 2000 and October 2018. From the included studies, list of classification systems, their methodological measurement properties, and correlation with treatment outcomes were analyzed. RESULTS: Out of 4470 screened references, 163 were included, and 54 different classification systems for ASD were identified. The most commonly used was the Scoliosis Research Society-Schwab classification system. A total of 35 classifications were based on radiological parameters, and no correlation was found between any classification system levels with patient-related outcomes. Limited evidence of limited quality was available on methodological quality of the classification systems. For studies that reported the data, intraobserver and interobserver reliability were good (kappa = 0.8). CONCLUSION: This systematic literature search revealed that current classification systems in clinical use neither include a comprehensive set of dimensions relevant to decision-making nor did they correlate with outcomes. A classification system comprising a core set of patient-related, radiological, and etiological characteristics relevant to the management of ASD is needed.
- Published
- 2021
16. Intraoperative neuromonitoring practice patterns in spinal deformity surgery: a global survey of the Scoliosis Research Society.
- Author
-
Dikmen, P.Y., Halsey, M.F., Yucekul, A., Kleuver, M. de, Hey, L., Newton, P.O., Havlucu, I., Zulemyan, T., Yilgor, C., Alanay, A., Dikmen, P.Y., Halsey, M.F., Yucekul, A., Kleuver, M. de, Hey, L., Newton, P.O., Havlucu, I., Zulemyan, T., Yilgor, C., and Alanay, A.
- Abstract
Item does not contain fulltext, PURPOSE: Although multimodal IONM has reached a widespread use, several unresolved issues have remained in clinical practice. The aim was to determine differences in approaches to form a basis for taking actions to improve patient safety globally. METHODS: A survey comprising 19 questions in four sections (demographics, setup, routine practices and reaction to alerts) was distributed to the membership of the SRS. RESULTS: Of the estimated 1300 members, 205 (~ 15%) completed the survey. Respondent demographics reflected SRS member distribution. Most of the respondents had > 10 years of experience. TcMEP and SSEP were available to > 95%. Less than 5% reported that a MD/PhD with neurophysiology background routinely examines patients preoperatively, while 19% would consult if requested. After an uneventful case, 36% reported that they would decrease sedation and check motor function if the patient was to be transferred to ICU intubated. Reactions to dropped signals that recovered or did not fully recover varied between attempting the same correction to aborting the surgery with no rods and returning another day, with or without implant removal. After a decrease of signals, 85.7% use steroids of varied doses. Of the respondents, 53.7% reported using the consensus-created checklist by Vitale et al. Approximately, 14% reported never using the wake-up test while others use it for various conditions. CONCLUSION: The responses of 205 experienced SRS members from different regions of the world showed that surgeons had different approaches in their routine IONM practices and in the handling of alerts. This survey indicates the need for additional studies to identify best practices.
- Published
- 2021
17. CUSTOM MADE PELVIC PROSTHESIS RECONSTRUCTION AFTER TUMOUR RESECTION FOR MALIGNANT BONE TUMOURS: EHS2012_089
- Author
-
Tokgozoglu, M., Yilgor, C., and Ayvaz, M.
- Published
- 2012
- Full Text
- View/download PDF
18. TOTAL FEMUR PROSTHESIS FOR TUMOUR RECONSTRUCTION: OUR RECENT EXPERIENCE: EHS2012_092
- Author
-
Tokgozoglu, M., Yilgor, C., and Ayvaz, M.
- Published
- 2012
- Full Text
- View/download PDF
19. The Impact of Corrective Surgery on Health-Related Quality of Life Subclasses in Adult Scoliosis: Will Degree of Correction Prognosticate Degree of Improvement?
- Author
-
Cawley, D. T., Takemoto, M., Boissiere, L., Larrieu, D., Kieser, D. C., Fujishiro, T., Hayashi, K., Bourghli, A., Yilgor, C., Alanay, A., Perez Grueso, F. J., Pelisse, F., Kleinstück, F., Vital, J. M., and Obeid, I.
- Subjects
QUALITY of life ,SCOLIOSIS ,SPINE abnormalities ,ADULTS ,PATIENT satisfaction ,SPINAL surgery ,ORTHOPEDIC braces - Abstract
Purpose: Objectives in scoliosis corrective surgery include restoration of normal sagittal and coronal parameters to achieve patient satisfaction. HRQLs improvements remain limited after corrective surgery. The aim of this study was to evaluate the HRQL subclass variability specific to the sagittal and coronal correction in adult scoliosis surgery. Methods: This multi-centre prospective analysis of consecutive adult spinal deformity (ASD) patients, from five European centres, only included multilevel instrumentation for scoliosis. d-(delta) values for each parameter represented pre to post-operative changes. Parameters included demographics, baseline, 1- and 2-year. HRQL outcomes (Oswestry disability index (ODI), Scoliosis Research Society (SRS)-22 and Short Form (SF36)), sagittal correction including relative spinopelvic alignment (dRSA) and coronal correction including major Cobb (dCobb) angles. Results: A total of 353 patients reached 1-year and 2-year follow up. All HRQL total scores significantly improved postoperatively, including ODI, SRS-22 and SF36. HRQL subclasses which displayed persistent improvements correlated to dRSA included sex-life, self-image, fatigue, vitality, social functioning. The only HRQL subclass improvement that correlated with dCobb was self-image. Conclusion: Adult scoliosis surgery improves overall HRQL, having a minimal effect on each variable. Importantly, greater coronal deformity correction affects only greater self-image scores, whereas with greater sagittal correction there are many greater HRQL sub-class impacts. Correction and restoration of coronal balance is one of the surgical goals in adult scoliosis but the degree to which Cobb angle is corrected, apart from self-image, does not correlate with gains in sub-classes of HRQL. These results need to be taken into account when planning surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
20. Semitendinosus snapping: analysis of movement, electromyographic activities, muscle strength and endurance, motor control and joint position sense
- Author
-
Guney, H., primary, Kaya, D., additional, Yilgor, C., additional, Cilli, M., additional, Aritan, S., additional, Yuksel, I., additional, and Doral, M.N., additional
- Published
- 2019
- Full Text
- View/download PDF
21. ADULT SPINAL DEFORMITY SURGERY UNDERSTANDING THE TRUE IMPACT ON SPECIFIC ACTIVITIES OF DAILY LIVING.
- Author
-
KIESER, D., BOISSIÈRE, L., GHAILANE, S., LARRIEU, D., BOURGHLI, A., YILGOR, C., ALANAY, A., PELISSÉ, F., GRUESO, F.-J. SANCHEZ PEREZ, KLEINSTÜCK, F., ACAROGLU, E., YOSHIDA, G., GILLE, O., VITAL, J.-M., and OBEID, I.
- Published
- 2018
- Full Text
- View/download PDF
22. Epoxy Resin Chemistry II
- Author
-
RONALD S. BAUER, R. S. DRAKE, D. R. EGAN, W. T. MURPHY, J. S. RIFFLE, I. YILGOR, C. TRAN, G. L. WILKES, J. E. McGRATH, A. K. BANTHIA, S. GAZIT, JAMES P. BELL, S. GAZIT, JAMES P. BELL, WILLIAM A. ROMANCHICK, JOHN E. SOHN, JON F. GEIBEL, ANTHONY J. DENICOLA, JAMES P. BELL, K. L. HAWTHORNE, F. C. HENSO and RONALD S. BAUER, R. S. DRAKE, D. R. EGAN, W. T. MURPHY, J. S. RIFFLE, I. YILGOR, C. TRAN, G. L. WILKES, J. E. McGRATH, A. K. BANTHIA, S. GAZIT, JAMES P. BELL, S. GAZIT, JAMES P. BELL, WILLIAM A. ROMANCHICK, JOHN E. SOHN, JON F. GEIBEL, ANTHONY J. DENICOLA, JAMES P. BELL, K. L. HAWTHORNE, F. C. HENSO
- Published
- 1983
23. Tissue engineering strategies in ligament regeneration
- Author
-
Yilgor C., Yilgor Huri P., Huri G., and Çukurova Üniversitesi
- Abstract
Ligaments are dense fibrous connective tissues that connect bones to other bones and their injuries are frequently encountered in the clinic. The current clinical approaches in ligament repair and regeneration are limited to autografts, as the gold standard, and allografts. Both of these techniques have their own drawbacks that limit the success in clinical setting; therefore, new strategies are being developed in order to be able to solve the current problems of ligament grafting. Tissue engineering is a novel promising technique that aims to solve these problems, by producing viable artificial ligament substitutes in the laboratory conditions with the potential of transplantation to the patients with a high success rate. Direct cell and/or growth factor injection to the defect site is another current approach aiming to enhance the repair process of the native tissue. This review summarizes the current approaches in ligament tissue engineering strategies including the use of scaffolds, their modification techniques, as well as the use of bioreactors to achieve enhanced regeneration rates, while also discussing the advances in growth factor and cell therapy applications towards obtaining enhanced ligament regeneration. © 2012 Caglar Yilgor et al.
- Published
- 2012
24. Evaluation of acetabular development after Dega acetabuloplasty in developmental dysplasia of the hip.
- Author
-
Aksoy C, Yilgor C, Demirkiran G, Caglar O, Aksoy, Cemalettin, Yilgor, Caglar, Demirkiran, Gokhan, and Caglar, Omur
- Published
- 2013
- Full Text
- View/download PDF
25. Is expansion thoracoplasty a safe procedure for mobility and growth potential of the spine? Spontaneous fusion after multiple chest distractions in young children.
- Author
-
Yilgor C, Demirkiran G, Ayvaz M, and Yazici M
- Published
- 2012
- Full Text
- View/download PDF
26. Semitendinosus snapping: analysis of movement, electromyographic activities, muscle strength and endurance, motor control and joint position sense
- Author
-
Guney H, Kaya D, Yilgor C, Cilli M, Aritan S, Inci Yuksel, and Mn, Doral
27. Obeid-Coronal Malalignment Classification Is Age Related and Independently Associated to Personal Reported Outcome Measurement Scores in the Nonfused Spine
- Author
-
Kieser, David Christopher, Boissiere, Louis, Bourghli, Anouar, Hayashi, Kazunori, Cawley, Derek, Yilgor, Caglar, Alanay, Ahmet, Acaroglu, Emre, Kleinstueck, Frank, Pizones, Javier, Pellise, Ferran, Perez-Grueso, Francisco Javier Sanchez, Obeid, Ibrahim, Grp, European Spine Study, Institut Català de la Salut, [Kieser DC] Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand. [Boissiere L, Hayashi K, Cawley D] L’Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France. [Bourghli A] Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia. [Yilgor C] Acibadem University School of Medicine, Istanbul, Turkey. [Pellise F] Unitat de Cirurgia de Columna, Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, and Acibadem University Dspace
- Subjects
Pelvic tilt ,medicine.medical_specialty ,Multivariate analysis ,deformity ,Scoliosis ,spine ,Edat òssia ,medicine ,Deformity ,Columna vertebral - Malformacions - Cirurgia ,RC346-429 ,Epidemiology and Biostatistics::Epidemiology::Epidemiologic Studies::Epidemiology, Descriptive::Population Characteristics::Age Effect [PUBLIC HEALTH] ,Musculoskeletal Diseases::Bone Diseases::Bone Malalignment [DISEASES] ,scoliosis ,enfermedades musculoesqueléticas::enfermedades óseas::desviación ósea [ENFERMEDADES] ,Cobb angle ,business.industry ,epidemiología y bioestadística::epidemiología::estudios epidemiológicos::epidemiología descriptiva::Características de la Población::efecto edad [SALUD PÚBLICA] ,Confounding ,Otros calificadores::Otros calificadores::/cirugía [Otros calificadores] ,medicine.disease ,Sagittal plane ,Other subheadings::Other subheadings::/surgery [Other subheadings] ,Surgery ,medicine.anatomical_structure ,Coronal plane ,Neurology (clinical) ,Neurology. Diseases of the nervous system ,medicine.symptom ,business ,coronal malalignment - Abstract
Deformitat; Escoliosi; Columna vertebral Deformidad; Escoliosis; Espina dorsal Deformity; Scoliosis; Spine Objective To evaluate Obeid-coronal malalignment (O-CM) modifiers according to age, sagittal alignment, and patient-reported outcome measures (PROMs), in the mobile spine. Methods Retrospective review of a prospective multicenter adult spinal deformity (ASD) database with 1,243 (402 nonoperative, 841 operative) patients with no prior fusion surgery. Patients were included if they were aged over 18 years and were affected by spinal deformity defined by one of: Cobb angle ≥ 20°, pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°. Patients were classified according to the O-CM classification and compared to coronally aligned patients. Multivariate analysis was performed on the relationship between PROMs and age, global tilt (GT) and coronal malalignment (CM). Results Four hundred forty-three patients had CM of more than 2 cm compared to 800 who did not. The distribution of these modifiers was correlated to age. After multivariate analysis, using age and GT as confounding factors, we found that before the age of 50 years, 2A1 patients had worse sex life and greater satisfaction than patients without CM. After 50 years of age, patients with CM (1A1, 1A2) had worse self-image and those with 2A2, 2B had worse self-image, satisfaction, and 36-item Short Form Health Survey physical function. Self-image was the consistent determinant of patients opting for surgery for all ages. Conclusion CM distribution according to O-CM modifiers is age dependent. A clear correlation between the coronal malalignment and PROMs exists when using the O-CM classification and in the mobile spine, this typically affects self-image and satisfaction. Thus, CM classified according to O-CM modifiers is correlated to PROMs and should be considered in ASD
- Published
- 2021
28. Global tilt and lumbar lordosis index: two parameters correlating with health-related quality of life scores-but how do they truly impact disability?
- Author
-
Boissière, L, Takemoto, M, Bourghli, A, Vital, J M, Pellisé, F, Alanay, A, Yilgor, C, Acaroglu, E, Perez-Grueso, F J, Kleinstück, F, Obeid, I, European Spine Study Group, ESSG, Boissière, Louis, Takemoto, Mitsuru, Bourghli, Anouar, Vital, Jean-Marc, Pellisé, Ferran, Alanay, Ahmet, Yilgor, Caglar, and Acaroglu, Emre
- Subjects
- *
COMPARATIVE studies , *FUNCTIONAL assessment , *RESEARCH methodology , *MEDICAL cooperation , *POSTURE , *QUALITY of life , *QUESTIONNAIRES , *RADIOGRAPHY , *RESEARCH , *SCOLIOSIS , *EVALUATION research , *LORDOSIS - Abstract
Background Context: Many radiological parameters have been reported to correlate with patient's disability including sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI-LL). European literature reports other parameters such as lumbar lordosis index (LLI) and the global tilt (GT). If most parameters correlate with health-related quality of life scores (HRQLs), their impact on disability remains unclear.Purpose: This study aimed to validate these parameters by investigating their correlation with HRQLs. It also aimed to evaluate the relationship between each of these sagittal parameters and HRQLs to fully understand the impact in adult spinal deformity management.Study Design: A retrospective review of a multicenter, prospective database was carried out.Patient Sample: The database inclusion criteria were adults (>18 years old) presenting any of the following radiographic parameters: scoliosis (Cobb ≥20°), SVA ≥5 cm, thoracic kyphosis ≥60° or PT ≥25°. All patients with complete data at baseline were included.Outcome Measures: Health-related quality of life scores, demographic variables (DVs), and radiographic parameters were collected at baseline.Methods: Differences in HRQLs among groups of each DV were assessed with analyses of variance. Correlations between radiographic variables and HRQLs were assessed using the Spearman rank correlation. Multivariate linear regression models were fitted for each of the HRQLs (Oswestry Disability Index [ODI], Scoliosis Research Society-22 subtotal score, or physical component summaries) with sagittal parameters and covariants as independent variables. A p<.05 value was considered statistically significant.Results: Among a total of 755 included patients (mean age, 52.1 years), 431 were non-surgical candidates and 324 were surgical candidates. Global tilt and LLI significantly correlated with HRQLs (r=0.4 and -0.3, respectively) for univariate analysis. Demographic variables such as age, gender, body mass index, past surgery, and surgical or non-surgical candidate were significant predictors of ODI score. The likelihood ratio tests for the addition of the sagittal parameters showed that SVA, GT, T1 sagittal tilt, PI-LL, and LLI were statistically significant predictors for ODI score even adjusted for covariates. The differences of R2 values from Model 1 were 1.5% at maximum, indicating that the addition of sagittal parameters to the reference model increased only 1.5% of the variance of ODI explained by the models.Conclusion: GT and LLI appear to be independent radiographic parameters impacting ODI variance. If most of the parameters described in the literature are correlated with ODI, the impact of these radiographic parameters is less than 2% of ODI variance, whereas 40% are explained by DVs. The importance of radiographic parameters lies more on their purpose to describe and understand the malalignment mechanisms than their univariate correlation with HRQLs. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
29. Long term mechanical failure in well aligned adult spinal deformity patients.
- Author
-
Haddad S, Yilgor C, Jacobs E, Vila L, Nuñez-Pereira S, Ramirez Valencia M, Pupak A, Barcheni M, Pizones J, Alanay A, Kleinstuck F, Obeid I, and Pellisé F
- Abstract
Background Context: Mechanical complications (MC) are frequently linked to suboptimal postoperative alignment and represent a primary driver of revision surgery in the context of Adult Spinal Deformity (ASD). However, it's worth noting that even among those deemed "well aligned," the risk of experiencing MCs persists, hinting at the potential influence of factors beyond alignment., Purpose: The aim was to assess the incidence of MCs among well-aligned patients and delving into the relevant risk factors and surgical outcomes that come into play within this specific subgroup., Study Design/setting: A retrospective analysis was conducted using data from a prospective multicenter database dedicated to ASD., Patient Sample: The study focused on patients aged 55 years or older, who had a minimum follow-up period of 2 years, and exhibited a Global Alignment and Proportion (GAP) score of 2 points or less (excluding age) within 6 weeks of their index surgery., Outcome Measures: Mechanical complications such as rod fractures, pseudarthrosis, or junctional kyphosis or failure, METHODS: Patients who developed mechanical complications were identified. Comparative analyses were performed, encompassing both continuous and categorical variables. Furthermore, binary logistic regression tests were employed to pinpoint risk factors, and ROC curves were used to determine the optimal threshold values for these variables., Results: A total of 83 patients met the inclusion criteria for this study, with a mean age of 66 years. On average, they had 10 instrumented levels, and 77% of them had fusion extending to the pelvis. Additionally, 27% of the patients had undergone 3-column osteotomies (3-CO). Among them, 33 patients (40%) experienced at least 1 MC during an average follow-up period of 4 years, which included 14 cases of proximal junctional kyphosis (PJK) and 20 cases of nonunion or rod breakage. 15 patients (18%) required revision surgery specifically for MC. In univariable analyses, patients who developed MC were characterized by higher body weight, poorer baseline general health (as indicated by worse SF-36 scores), and less favorable preoperative coronal and sagittal alignment. They also had longer hospital stays, a greater number of instrumented levels, and achieved less favorable postoperative coronal and sagittal alignment. Interestingly, factors such as 3-column osteotomies, postoperative bracing, and the addition of an anterior approach did not significantly alter the risk of MC in well-aligned adult spinal deformity (ASD) patients. Binary regression models revealed that independent risk factors for MC included the residual coronal lumbosacral curve, the number of instrumented levels, and Relative Spinopelvic Alignment (RSA). ROC curves identified an optimal threshold of a residual lumbosacral curve of ≤4° and RSA of ≤3°. Moreover, the rate of MCs showed a stepwise increase within the GAP-Proportioned group, with rates of 31% for GAP=0, 54% for GAP=1, and 75% for GAP=2, with RSA emerging as the most influential parameter. Lastly, patients with MC exhibited poorer functional and radiological outcomes at their last follow-up assessment., Conclusions: The rate of MCs remains elevated in sagittally "well-aligned" ASD patients that can be attributed to suboptimal residual sagittal and coronal malalignment, which in turn leads to poorer functional outcomes. This study reaffirms the multifaceted nature of MCs and underscores the significance of achieving impeccable postoperative alignment, particularly in the presence of additional risk factors such as extensive surgical correction, a high lever arm (involving instrumented vertebrae), excessive body weight, and frailty (as indicated by SF-36 scores)., Competing Interests: Declarations of Competing Interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
30. Correction: Anterior vertebral body tethering shows clinically comparable shoulder balance outcomes to posterior spinal fusion.
- Author
-
Meyers J, Eaker L, Samdani A, Miyanji F, Herrera M, Wilczek A, Alanay A, Yilgor C, Hoernschemeyer D, Shah S, Newton P, and Lonner B
- Published
- 2024
- Full Text
- View/download PDF
31. Primary Pelvic Anteversion: Definition, Relevance, and History After Surgery for Adult Spine Deformity.
- Author
-
Baroncini A, Boissiere L, Yilgor C, Larrieu D, Alanay A, Pellisé F, Kleinstueck F, Pizones J, Charles YP, Roscop C, Bourghli A, and Obeid I
- Subjects
- Humans, Female, Male, Adult, Middle Aged, Retrospective Studies, Aged, Pelvis surgery, Pelvis diagnostic imaging, Spinal Curvatures surgery, Spinal Curvatures diagnostic imaging, Spine surgery, Spine diagnostic imaging, Pelvic Bones diagnostic imaging, Pelvic Bones surgery, Young Adult, Postoperative Complications etiology, Postoperative Complications epidemiology, Scoliosis surgery, Scoliosis diagnostic imaging
- Abstract
Study Design: Retrospective analysis of prospectively collected data., Objective: To identify the best definition of primary anteverted pelvis in the setting of adult spine deformity (ASD), and to investigate whether this is a pathologic setting that requires surgical correction., Summary of Background Data: While pelvic retroversion has been thoroughly investigated, pelvic anteversion (AP) is a far lesser discussed topic. Four different AP definitions have been proposed, and AP has been described as a normal or pathologic entity by different authors., Materials and Methods: All patients consulting for ASD at the five participating sites were included. First, the four definitions of AP were compared with descriptive statistics (anatomic method-Pelvic Tilt <0°; Relative Pelvic Version method-RPV >5°; Roussouly method-Pelvic Incidence (PI)<50° and Sacral Slope (SS)>35°); low PT method-PT/PI <25th percentile). Second a subgroup analysis among operated AP patients with a two-year follow-up was performed. Complication rate, radiographic parameters, and clinical scores (ODI, SF-36) were compared in a multivariate analysis between patients who did and did not maintain an AP at the 2-year follow-up., Results: A total of 1163 patients were available for the first analysis. The RPV method seemed to be the most appropriate to define AP in ASD patient. For the second analysis, data on 410 subjects were available, and most of them were young adults with idiopathic scoliosis that did not require pelvic fixation. AP patients who maintained an AP after ASD surgery presented comparable radiographic and clinical outcomes to the patients who presented a normoverted/retroverted pelvis after surgery., Conclusions: According to the results of the presented study, the RPV method is the most appropriate to define primary AP, which is not a pathologic condition and is most often observed in young adults with idiopathic scoliosis. Anteverted pelvis does not require direct surgical correction in this patient group., Competing Interests: LB Consultant: Spineart, Spinevision; I.O.: Royalties : Spineart, alphatec, Clariance, Consultant : Medtronic, Depuy, spinevision Research support : Medtronic, Depuy; JP Consultant: Medtronic, Grants: Medtronic Depuy; F.P.: Research support: DePuySpine Synthes/Medtronic/Nuvasive/Orthofix/SpineArt Consultant: Medtronic/Nuvasive; A.A.: Consultancy: Globus, Zimvie, Research Grant: Depuy, Medtronic Royalty: Zimvie; F.K.: Depuy Spine Speakers Bureau and Research Grant; YPC: Consultant: Clariance, Stryker, Ceraver, Spinevision, Research Grants: Clariance, Stryker, Medtronic; C.Y.: Consultant, Medtronic. The remaining authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
32. Which sagittal plane assessment method is most predictive of complications after adult spinal deformity surgery?
- Author
-
Pizones J, Hills J, Kelly M, Yilgor C, Moreno-Manzanaro L, Perez-Grueso FJS, Kleinstück F, Obeid I, Alanay A, and Pellisé F
- Subjects
- Humans, Female, Retrospective Studies, Male, Middle Aged, Adult, Aged, Spinal Curvatures surgery, Spinal Curvatures diagnostic imaging, Thoracic Vertebrae surgery, Lumbar Vertebrae surgery, Follow-Up Studies, Postoperative Complications etiology, Postoperative Complications epidemiology, Spinal Fusion adverse effects, Spinal Fusion methods
- Abstract
Purpose: Different methods of sagittal alignment assessment compete for predicting adverse events after adult spinal deformity (ASD) surgery. We wanted to study which method provides greater benefit., Methods: Retrospective study of 391 patients operated for ASD, with > 6 instrumented levels, fused to the pelvis, and 2 years of follow-up. Three alignment methods were analyzed 6-week postoperatively: (1) Roussouly mismatch; (2) GAP score/GAP categories; (3) T4-L1-Hip axis. Binary logistic regression generated models that best predict the following adverse events: mechanical complications (MC): in general and isolated (PJK, PJF, rod breakage); reinterventions (in general and after MC); and readmissions. ROC/AUC analysis was also implemented. In a second regression round, we added different variables that were selected on univariate analysis-demographic, surgical, and radiographic-to complete the models., Results: The best predictor parameters in most models were T4-L1PA mismatch and GAP score; we could not prove a predictive ability of the Roussouly mismatch. The T4-L1PA mismatch best predicted general MC, PJK, PJK + PJF, and readmission, while the GAP score best predicted PJF and reinterventions (for MC and for any complication). However, the variance explained by these models was limited (Nagelkerke's R2 = 0.031-0.113), with odds ratios ranging from 1.070 to 1.456. ROC curves plotted an AUC between 0.57 and 0.70. Introducing additional variables (demographic, surgical, and radiographic) improved prediction in all the models (Nagelkerke's R2 = 0.082-0.329) and allowed predicting rod breakage., Conclusion: The T4-L1-Hip axis and GAP score show potential in predicting adverse events, surpassing the Roussouly method. Despite partial efficacy in complication anticipation, recognizing postoperative sagittal alignment as a key modifiable risk factor, the crucial need arises to integrate diverse variables, both modifiable and non-modifiable, for enhanced predictive accuracy., Level of Evidence: Level IV., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)
- Published
- 2024
- Full Text
- View/download PDF
33. Anterior vertebral body tethering shows clinically comparable shoulder balance outcomes to posterior spinal fusion.
- Author
-
Meyers J, Eaker L, Samdani A, Miyanji F, Herrera M, Wilczek A, Alanay A, Yilgor C, Hoernschemeyer D, Shah S, Newton P, and Lonner B
- Subjects
- Humans, Retrospective Studies, Adolescent, Female, Male, Treatment Outcome, Vertebral Body surgery, Vertebral Body diagnostic imaging, Child, Postural Balance physiology, Spinal Fusion methods, Scoliosis surgery, Scoliosis diagnostic imaging, Scoliosis physiopathology, Shoulder surgery, Shoulder diagnostic imaging, Shoulder physiopathology
- Abstract
Purpose: Posterior spinal fusion (PSF) is the current gold standard in surgical treatment for adolescent idiopathic scoliosis. Vertebral body tethering (VBT) is a fusionless alternative. Shoulder balance is an important metric for outcomes and patient satisfaction. Here we compare shoulder balance outcomes between PSF and VBT., Methods: In this retrospective review, the pre-operative and post-operative absolute radiographic shoulder height (|RSH|) of 45 PSF patients were compared to 46 VBT patients. Mean values were compared and then collapsed into discrete groups (|RSH| GROUP) and compared. Patients were propensity score matched. Regression models based on pretest-posttest designs were used to compare procedure type on post-operative outcomes., Results: Pre-operatively there were no differences in |RSH| between PSF and VBT, however, at latest post-operative follow-up PSF maintained a larger |RSH| imbalance compared to VBT (0.91 cm vs 0.63 cm, p = 0.021). In an ANCOVA regression, PSF was associated with a larger |RSH| imbalance compared to VBT, F(1, 88) = 5.76, p = 0.019. An ordinal logistic regression found that the odds ratio of being in a worse |RSH| GROUP for PSF vs VBT is 2.788 (95% CI = 1.099 to 7.075), a statistically significant effect χ
2 (1) = 4.658, p = 0.031. Results were similar in subgroup analyses of Lenke 1 and Lenke 2 patients, though to less statistical significance., Conclusion: While PSF was found to be associated with worse |RSH| outcomes, the actual numbers (2-3 mm) are unlikely to be clinically meaningful. Thus, in this analysis, VBT can be said to show comparable shoulder balance outcomes to PSF., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)- Published
- 2024
- Full Text
- View/download PDF
34. Double major curvature treated with vertebral body tethering of both curves: how do outcomes compare to posterior spinal fusion?
- Author
-
Lonner B, Eaker L, Hoernschemeyer D, Zhang J, Wilczek A, Elliot P, Boeyer ME, Fletcher ND, Alanay A, Yilgor C, Newton P, and Miyanji F
- Subjects
- Humans, Female, Male, Treatment Outcome, Adolescent, Radiography, Retrospective Studies, Lumbar Vertebrae surgery, Lumbar Vertebrae diagnostic imaging, Spinal Fusion methods, Vertebral Body surgery, Vertebral Body diagnostic imaging, Thoracic Vertebrae surgery, Thoracic Vertebrae diagnostic imaging, Scoliosis surgery, Scoliosis diagnostic imaging, Kyphosis surgery, Kyphosis diagnostic imaging
- Abstract
Purpose: Vertebral body tethering (VBT) is a non-fusion alternative to posterior spinal fusion (PSF). There have been few reports on VBT of two curvatures. We aim to compare the radiographic outcomes between VBT and PSF in patients with double curvatures in which both curves were instrumented., Methods: 29 AIS patients matched by Lenke, age (± 2 years), triradiate cartilage closure status, major Cobb angle (± 8°), and T5-T12 kyphosis (± 10°). Variables were compared using Wilcoxon rank-sum tests, Student's t tests, and chi-Square. Clinical success was defined as major curve < 35°., Results: Group baseline demographics were similar. Major thoracic (T) curve types had significantly better major (VBT 51.5 ± 7.9° to 31.6 ± 12.0° [40%] vs. PSF 54.3 ± 7.4° to 17.4 ± 6.5° [68%]; p = 0.0002) and secondary curve correction in the PSF group. 71% of major T VBT patients were clinically successful versus 100% of PSF. Major thoracolumbar (TL) curve types experienced comparable major (VBT 52.3 ± 7.0° to 18.3 ± 11.4° (65%) vs. PSF 53.0 ± 5.2° to 23.8 ± 10.9° (56%); p = 0.2397) and secondary curve correction. 92% of major TL VBT patients were clinically successful versus 75% in the PSF group. There was no difference in T5-12 kyphosis or lumbar lordosis between groups for any curve type. There were 4 patients (13.8%) with major complications in the VBT group compared to 0 (0%) in the PSF., Conclusion: Patients with double major AIS who underwent VBT with major T curve types had less correction than PSF; however, those with major TL curves experienced similar radiographic outcomes regardless of procedure. Complications were greater for VBT., (© 2024. The Author(s), under exclusive licence to Scoliosis Research Society.)
- Published
- 2024
- Full Text
- View/download PDF
35. Twelve to Twenty-year Follow-up of Dega Acetabuloplasty in Patients With Developmental Dysplasia of the Hip: Is it as Effective as Expected?
- Author
-
Danişman M, Dursun G, Koçyiğit İA, Yilgor C, and Aksoy MC
- Subjects
- Humans, Young Adult, Adult, Child, Preschool, Follow-Up Studies, Retrospective Studies, Radiography, Treatment Outcome, Acetabulum diagnostic imaging, Acetabulum surgery, Acetabuloplasty, Developmental Dysplasia of the Hip diagnostic imaging, Developmental Dysplasia of the Hip surgery, Hip Dislocation, Congenital diagnostic imaging, Hip Dislocation, Congenital surgery, Hip Dislocation diagnostic imaging
- Abstract
Background: Although Dega acetabuloplasty is widely used for the treatment of developmental dysplasia of the hip, there is a paucity of data on long-term outcomes. The purpose of the study was to evaluate the rate of residual acetabular dysplasia after Dega acetabuloplasty., Methods: Patients of a previously reported consecutive series of 35 patients (43 hips) operated by a single surgeon were recontacted for long-term follow-up. Of these, 25 patients (32 hips) consented, with a follow-up rate of 71% (74% of hips). The mean age at the time of surgery was 35 (18 to 65) months. The presence of residual dysplasia was noted according to the lateral center-edge angle of Wiberg, femoral head extrusion index, and Tönnis angle. The latest radiographic outcome was evaluated according to the Severin classification and patients were clinically evaluated according to the modified McKay criteria., Results: The mean follow-up duration of 16.5 (12 to 20) years yielded an average age of 19.2 (14 to 23) years at the time of analysis. According to lateral center-edge angle, femoral head extrusion index, and Tönnis angle, 5 (15.6%) hips were dysplastic and 2 (6.3%) hips were reoperated for resubluxation. Thus, a total of 7 hips (21.9%) were considered to have residual dysplasia. With the exception of 2 hips that underwent further osteotomies, no other hips were re-subluxated or redislocated. Overcoverage was noted in 6 (18.7%) hips. There were 26 Severin group I and II (81.3%), 4 Severin group III (12.5%), and 2 Severin group IV (6.2%) hips. According to modified McKay criteria, 20 (62.5%) hips were excellent, 7 (21.9%) hips were good, and 5 (15.6%) were fair. Severin classification and modified McKay criteria were correlated with dysplasia ( P < 0.05)., Conclusions: Seventy-eight percent of the hips treated by Dega acetabuloplasty for developmental dysplasia of the hip did not have acetabular dysplasia at a mean follow-up of 16 years. Even in well-treated asymptomatic hips, patients should be followed regularly, especially for residual dysplasia., Level of Evidence: Level IV., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
36. Relationship between pelvic incidence-adjusted relative spinopelvic parameters, global sagittal alignment and lower extremity compensations.
- Author
-
Yucekul A, Ozpinar A, Kilickan FDB, Dalla M, Muthiah N, Zulemyan T, Yavuz Y, Pizones J, Obeid I, Kleinstück F, Pérez-Grueso FJS, Pellisé F, Yilgor C, and Alanay A
- Subjects
- Humans, Adult, Middle Aged, Aged, Retrospective Studies, Pelvis diagnostic imaging, Lower Extremity diagnostic imaging, Sacrum, Lordosis diagnostic imaging, Lordosis surgery
- Abstract
Purpose: In response to sagittal malalignment, compensatory spinal and lower extremity mechanisms are recruited. Thoracolumbar realignment surgery has been shown to yield reciprocal changes in these compensations. Thus, whole-body radiographic assessment has come to the fore. This study aimed to evaluate the relationship between spinopelvic parameters and lower extremity compensation angles and to examine their coupled change with deformity correction., Methods: This was a multicenter retrospective analysis of patients who had ≥ 4 levels posterior fusion, whole-body radiographs, and ≥ 2 years follow-up. Relative Pelvic Version (RPV), Relative Lumbar Lordosis (RLL), Relative Spinopelvic Alignment (RSA), Femoral Obliquity Angle (FOA), Knee Flexion Angle (KFA) and Global Sagittal Axis (GSA) were measured preoperatively and 6 week postoperatively. Kruskal-Wallis tests were performed to assess the relation of relative spinopelvic parameters to global sagittal alignment and lower extremity compensation angles. Spearman's correlations were performed to assess correlations of pre-to-postoperative changes., Results: 193 patients (156F, 37 M) were included. The mean age was 57.2 ± 16.6 years. The mean follow-up duration was 50.6 (24-90) months. On average, 10.3 ± 3.8 levels were fused. Among the cohort, 124 (64.2%) had a sacral or sacroiliac fixation, and 43 (22.3%) had 3-column osteotomies. Preoperative FOA, KFA and GSA significantly differed between RPV, RLL and RSA categories. Significant weak-to-strong correlations were observed between spinopelvic parameters, global sagittal alignment and lower extremity compensation angles (rho range: - 0.351 to 0.767)., Conclusions: PI-adjusted relative spinopelvic parameters significantly correlated with measurements of the lower extremity compensation. Postoperative changes in RPV, RLL and RSA reflected changes in FOA, KFA and GSA. These measurements may serve as a valuable proxy for surgical planning when whole-body imaging is not available., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2023
- Full Text
- View/download PDF
37. AO Spine Adult Spinal Deformity Patient Profile: A Paradigm Shift in Comprehensive Patient Evaluation in Order to Optimize Treatment and Improve Patient Care.
- Author
-
Naresh-Babu J, Kwan KYH, Wu Y, Yilgor C, Alanay A, Cheung KMC, Polly DW Jr, Park JB, Ito M, Lenke LG, van Hooff ML, and Kleuver M
- Abstract
Study Design: Modified Delphi study., Objective: Adult spinal deformity (ASD) is an increasingly recognized condition, comprising a spectrum of pathologies considerably impacting patients' health and functional status. Patients present with a combination of pain, disability, comorbidities and radiological deformity. The study aims to propose a systematic approach of gathering information on the factors that drive decision-making by developing a patient profile., Methods: The present study comprises of 3 parts. Part 1: Development of prototype of patient profile: The data from the Core Outcome Study on SCOlisis (COSSCO) by Scoliosis Research Society (SRS) was categorized into a conceptual framework. Part 2: Modified Delphi study: Items reaching >70% agreement were included in a 4 round iterative process with 51 panellists across the globe. Part 3: Pilot testing-feasibility: Content validity and usability were evaluated quantitatively., Results: The profile consisted of 4 domains. 1. General health with demographics and comorbidities, 2.Spine-specific health with spine related health and neurological status, 3. Imaging with radiographic and MRI parameters and 4. Deformity type . Each domain consisted of 1 or 2 components with various factors and their measuring instruments. Profile was found to have an excellent content validity (I-CVI
r 0.78-1.00; Ave-CVI 0.92) appropriateness, relevance and usefulness., Conclusions: The present study, is first to provide a universally applicable multimodal ASD patient profile to methodically describe patients. Physicians are encouraged to assess ASD patients holistically using this profile and not just based on radiographic findings.- Published
- 2023
- Full Text
- View/download PDF
38. Sagittal realignment: surgical restoration of the global alignment and proportion score parameters: a subgroup analysis. What are the consequences of failing to realign?
- Author
-
Raganato R, Pizones J, Yilgor C, Moreno-Manzanaro L, Vila-Casademunt A, Sánchez-Márquez JM, Fernández-Baíllo N, Sánchez Pérez-Grueso FJ, Kleinstück F, Alanay A, Obeid I, and Pellisé F
- Subjects
- Adult, Humans, Treatment Outcome, Prospective Studies, Retrospective Studies, Quality of Life, Postoperative Complications epidemiology, Postoperative Complications etiology, Lordosis surgery
- Abstract
Introduction: The Global Alignment and Proportion (GAP) score incorporates three domains directly modified with surgery (relative pelvic version-RPV, relative lumbar lordosis-RLL, lumbar distribution index-LDI) and one indirectly restored (relative spinopelvic alignment-RSA). We analyzed our surgical realignment performance and the consequences of domain-specific realignment failure on mechanical complications and PROMs., Materials and Methods: From an adult spinal deformity prospective multicenter database, we selected patients: fused to pelvis, upper instrumented vertebra at or above L1, and 2 years of follow-up. Descriptive, univariate and multivariate analyses were employed., Results: The sample included 333 patients. RLL-6w showed the highest success rate (58.3% aligned), but 16.5% of patients were classified in the "Severe hypolordosis" and "Hyperlordosis" subgroups. RPV-6w was the most challenging to realign, with 51.6% moderate or severe retroversion. Regarding RSA-6w, 21.9% had severe positive malalignment. Correct alignment of RPV-6w (p = 0.025) and RSA-6w (p = 0.002) proved to be protective factors against the development of mechanical complications. Severe pelvic retroversion (p = 0.026) and severe positive malalignment (p = 0.007) were risk factors for mechanical complications. RSA-6w "Severe positive malalignment" was associated with less improvement in PROMs: ∆ODI (8.83 vs 17.2; p = 0.011), ∆SRS-22 total (0.54 vs 0.87; p = 0.007), and ∆SF-36PCS (3.47 vs 7.76; p = 0.04); MCID for ODI (37.0 vs 55.5%; p = 0.023), and SRS-22 (40.8 vs 60.1%; p = 0.015); and PASS for ODI (17.6 vs 31.7%; p = 0.047)., Conclusions: RPV was the most underperformed modifiable parameter. Severe pelvic retroversion and severe positive malalignment influenced the occurrence of mechanical complications. Severe positive malalignment affected PROMs improvement., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2023
- Full Text
- View/download PDF
39. Engineered Vasculature for Cancer Research and Regenerative Medicine.
- Author
-
Nguyen HT, Peirsman A, Tirpakova Z, Mandal K, Vanlauwe F, Maity S, Kawakita S, Khorsandi D, Herculano R, Umemura C, Yilgor C, Bell R, Hanson A, Li S, Nanda HS, Zhu Y, Najafabadi AH, Jucaud V, Barros N, Dokmeci MR, and Khademhosseini A
- Abstract
Engineered human tissues created by three-dimensional cell culture of human cells in a hydrogel are becoming emerging model systems for cancer drug discovery and regenerative medicine. Complex functional engineered tissues can also assist in the regeneration, repair, or replacement of human tissues. However, one of the main hurdles for tissue engineering, three-dimensional cell culture, and regenerative medicine is the capability of delivering nutrients and oxygen to cells through the vasculatures. Several studies have investigated different strategies to create a functional vascular system in engineered tissues and organ-on-a-chips. Engineered vasculatures have been used for the studies of angiogenesis, vasculogenesis, as well as drug and cell transports across the endothelium. Moreover, vascular engineering allows the creation of large functional vascular conduits for regenerative medicine purposes. However, there are still many challenges in the creation of vascularized tissue constructs and their biological applications. This review will summarize the latest efforts to create vasculatures and vascularized tissues for cancer research and regenerative medicine.
- Published
- 2023
- Full Text
- View/download PDF
40. Long-term opioid medication profile of European adult spinal deformity patients: minimum five years follow-up study.
- Author
-
Abul K, Yilgor C, Yucekul A, Alanay NA, Yavuz Y, Zulemyan T, Boissiere L, Bourghli A, Obeid I, Pizones J, Kleinstueck F, Perez-Grueso FJS, Pellise F, and Alanay A
- Subjects
- Humans, Adult, Analgesics, Opioid adverse effects, Follow-Up Studies, Retrospective Studies, Spine surgery, Opioid-Related Disorders etiology, Spinal Fusion adverse effects
- Abstract
Background Context: There remains significant variability in the use of postoperative opioids. On one end, it is proven that appropriate pain control is a critical aspect of patient management; on the other end, past few decades have been associated with major increases in opioid-related overdoses and addiction treatment. We hypothesized that several pre- and postoperative risk factors affecting long-term opioid use could be identified., Purpose: Evaluation of factors associated with minimum 5-year postoperative opioid use following adult spinal deformity surgery., Study Design/setting: Prospectively followed study group database., Patient Sample: Adult spinal deformity patients who underwent elective spine surgery between 2009 and 2016 were included., Outcome Measures: Opioid usage or otherwise at minimum 5 years follow-up. Use of nonopioid analgesics, weak and strong opioids METHODS: Retrospective analysis of patients undergoing elective spinal deformity surgery. A total of 37 factors comprising patient characteristics, radiographic measurements, operative details, preoperative and early postoperative opioid use, and mechanical complications and revisions were analyzed. Details on identified factors were provided., Results: A total of 265 patients (215F, 50M) from five sites were included. The mean follow-up duration was 68.4±11.7 (60-102) months. On average, 10.6±3.5 levels were fused. Preoperatively, 64 (24.2%) patients were using opioids. The rate of opioid users increased to 33.6% at 6 weeks and decreased to 21.5% at 6 months. During follow-up, there were patients who discontinued opioids, while others have started and/or restarted using opioids. As a result, 59 (22.3%) patients were still on opioids at the latest follow-up. Multivariate analyses showed that factors independently affecting opioid use at an average of 68 months postoperatively, in order of significance, were opioid use at sixth weeks, preoperative opioid use and opioid use at sixth months with the odds ratios of 2.88, 2.51, and 2.38 respectively. At these time points, factors such as age, number of comorbidities, tobacco use, the time of the last prior spine surgery and postoperative sagittal plane alignment affected opioid usage rates., Conclusions: Opioid usage at 6 weeks was found to be more predictive of long-term opioid use compared to preoperative use. Patients should be well informed to have realistic expectations regarding opioid use when considering adult spinal deformity surgery., Competing Interests: Declarations of Competing Interests One or more of the authors declare financial or professional relationships on ICMJE-NASSJ disclosure forms., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
41. Use of the Global Alignment and Proportion score to predict postoperative health-related quality of life in adult spinal deformity surgery.
- Author
-
Ye J, Yin TC, Gupta S, Farooqi AS, Wan W, Yilgor C, Sides BA, and Gupta MC
- Subjects
- Adult, Humans, Quality of Life, Retrospective Studies, Treatment Outcome, Lumbar Vertebrae surgery, Pain, Lordosis surgery, Scoliosis surgery
- Abstract
Objective: The purpose of this study was to validate the Global Alignment and Proportion (GAP) score as a predictor of health-related quality of life (HRQOL) outcomes for patients undergoing adult spinal deformity (ASD) surgery., Methods: This was a retrospective cohort study of patients with ASD undergoing long-segment spine fusions (≥ 5 vertebrae fused) at a single institution over a 2-year period (n = 85). Radiographic parameters were measured at preoperative, 6-week postoperative, 1-year postoperative, and 2-year postoperative visits. GAP scores were calculated using 4 sagittal parameters: relative pelvic version, relative lumbar lordosis, lordosis distribution index, and relative spinopelvic alignment. Patients were stratified into 3 GAP categories at each time point: proportioned (score 0-2), moderately disproportioned (score 3-6), and severely disproportioned (score ≥ 7). HRQOL outcomes were collected at preoperative, 1-year postoperative, and 2-year postoperative visits; these measures included patient self-reported outcome measures (i.e., PROMIS), Scoliosis Research Society-22 spinal deformity questionnaire (SRS-22), and Oswestry Disability Index (ODI) scores., Results: Overall, 42% of cases were revision surgeries and 96.5% of patients underwent fusion to the sacrum. The mean preoperative GAP score significantly improved from preoperative (7.84) to immediate postoperative (3.31) assessment (p < 0.001). Similarly, the percentage of patients categorized as proportioned improved from 9.4% at preoperative to 45.9% at immediate postoperative evaluation. The preoperative GAP score or category was not significantly associated with any preoperative HRQOL outcome metrics. The immediate postoperative GAP score was not correlated with any 1-year HRQOL outcomes. However, the immediate postoperative GAP score was significantly associated with 2-year SRS-22 outcomes, including SRS-22 function (r = -0.35, p < 0.01), self-image (r = -0.27, p = 0.044), and subtotal (r = -0.35, p < 0.01) scores. As compared to severely disproportioned patients, proportioned patients had better SRS-22 pain (4.08 vs 3.17, p = 0.04), satisfaction (4.40 vs 3.50, p = 0.02), and subtotal (4.01 vs 3.27, p = 0.036) scores. The immediate postoperative GAP score was also significantly associated with 2-year PROMIS outcomes, including PROMIS pain (r = 0.31, p = 0.023) and physical function (r = -0.35, p < 0.01) scores. As compared to severely disproportioned patients, proportioned patients had better PROMIS pain (53.18 vs 63.60, p = 0.025) and physical function (41.66 vs 34.18, p = 0.017) scores. Postoperative GAP score or category did not predict any ODI outcomes., Conclusions: The postoperative GAP score is a predictor of long-term HRQOL outcomes following ASD surgery, and proportioned patients are more likely to have less pain and be satisfied with their surgery. However, the postoperative GAP score does not predict outcomes as measured by ODI.
- Published
- 2022
- Full Text
- View/download PDF
42. Prevalence of benign bone lesions of the lower extremity in the pediatric spinal disorders: a whole-body imaging study.
- Author
-
Yucekul A, Karaytug K, Bakircioglu S, Zulemyan T, Sirin BK, Karaarslan E, Yilgor C, and Alanay A
- Subjects
- Child, Female, Humans, Lower Extremity pathology, Male, Prevalence, Retrospective Studies, Whole Body Imaging, Bone Neoplasms diagnostic imaging, Bone Neoplasms epidemiology, Bone Neoplasms pathology, Cartilage Diseases, Soft Tissue Neoplasms, Spinal Diseases
- Abstract
There is a paucity of knowledge about benign bone lesions. The advances in imaging methods can screen bone lesions incidentally, and missing information can be provided. The aim of the study is to collect information about the prevalence and natural history of benign bone lesions with the use of whole-body biplanar slot-scanning imaging (EOS). EOS images acquired between 2015 and 2020 were retrospectively analyzed. Anatomical locations of lesions, number of lesions with polyostotic involvement and radiographic features of each were recorded. Fibrous lesions were further categorized according to the transition stages. The natural course was noted as remained in the same stage, progressed and disappeared during follow-up. A total of 1944 EOS images of 1378 (936 women and 442 men) patients were analyzed. The mean age was 12.3 (5-18) years. Bone lesions of the lower extremities were found in 278 scans (14.3%) of 196 (139 women and 57 men) patients (14.2%). Monostotic lesions were observed in 172 patients, and 24 had polyostotic lesions. The prevalence of lesions was 10.5%, 1.8%, 1.7%, 1.7% and 1.4‰ for fibrous cortical defect (FCD), nonossifying fibroma (NOF), osteochondroma, bone island and simple bone cyst, respectively. Among 145 FCDs, 55.2% of the lesions were stage A, 27.6% were stage B, 9.6% were stage C and 7.5% were stage D. EOS images acquired predominantly for spinal pathologies revealed a prevalence of 14% of benign bone tumors in the lower extremities. With the developments in imaging methods, the probability of encountering incidental lesion increases, and information about bone pathologies can be gathered., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
43. Spinal deformity surgery is accompanied by serious complications: report from the Morbidity and Mortality Database of the Scoliosis Research Society from 2013 to 2020.
- Author
-
Bivona LJ, France J, Daly-Seiler CS, Burton DC, Dolan LA, Seale JJ, de Kleuver M, Ferrero E, Gurd DP, Konya D, Lavelle WF, Sarwahi V, Suratwala SJ, Yilgor C, and Li Y
- Subjects
- Humans, Retrospective Studies, Postoperative Complications epidemiology, Morbidity, Societies, Medical, Vision Disorders, Blindness, Scoliosis surgery, Spondylolisthesis, Kyphosis, Neuromuscular Diseases
- Abstract
Purpose: The Morbidity and Mortality (M&M) report of the Scoliosis Research Society (SRS) has been collected since 1965 and since 1968 submission of complications has been required of all members. Since 2009, the SRS has collected information on death, blindness, and neurological deficit, with acute infection being added in 2012 and unintentional return to the operating room (OR) being added in 2017. In this report, we use the most recent data submitted to the SRS M&M database to determine the rate of neurological deficit, blindness, acute infection, unintentional return to the OR, and death, while also comparing this information to previous reports., Methods: The SRS M&M database was queried for all cases from 2013 to 2020. The rates of death, vision loss, neurological deficit, acute infection, and unintentional return to the OR were then calculated and analyzed. The rates were compared to previously published data if available. Differences in complication rates between years were analyzed with Poisson regression with significance set at α = 0.05., Results: The total number of cases submitted per year varied with a maximum of 49,615 in 2018 and a minimum of 40,464 in 2020. The overall reported complication rate from 2013 to 2020 was 2.86%. The overall mortality rate ranged from 0.09% in 2018 to 0.14% in 2015. The number of patients with visual impairment ranged from 4 to 13 between 2013 and 2015 (no data on visual impairment were collected after 2015). The overall infection rate varied from 0.95 in 2020 to 1.30% in 2015. When the infection rate was analyzed based on spinal deformity group, the neuromuscular scoliosis group consistently had the highest infection rate ranging from 3.24 to 3.94%. The overall neurological deficit rate ranged from 0.74 to 0.94%, with the congenital kyphosis and dysplastic spondylolisthesis groups having the highest rates. The rates of unintentional return to the OR ranged from 1.60 to 1.79%. Multiple groups showed a statistically significant decreasing trend for infection, return to the operating room, neurologic deficit, and death., Conclusions: Neuromuscular scoliosis had the highest infection rate among all spinal deformity groups. Congenital kyphosis and dysplastic spondylolisthesis had the highest rate of neurological deficit postoperatively. This is similar to previously published data. Contrary to previous reports, neuromuscular scoliosis did not have the highest annual death rate. Multiple groups showed a statistically significant decreasing trend in complication rates during the reporting period, with only mortality in degenerative spondylolisthesis significantly trending upwards., Level of Evidence: Level III., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
44. An age and sex matched study on the effect of obesity on the functional outcomes and complication rates in patients with adult spinal deformity undergoing primary multi-level thoracolumbar spinal fusion.
- Author
-
Kieser DC, Wyatt MC, Boissiere L, Hayashi K, Cawley DT, Yilgor C, Larrieu D, Alanay A, Acaroglu E, Kleinstueck F, Pellisé F, Perez-Grueso FJS, Bourghli A, Vital JM, Gille O, and Obeid I
- Abstract
Background: The objective of this study was to determine the effect of obesity on the functional outcomes and complication rates of patients with adult spinal deformity (ASD) undergoing multi-level thoracolumbar fusion., Methods: An age and sex matched comparison of functional outcomes [Numeric Rating Scale (NRS) back and leg scores, Core Outcome Measurement Index (COMI) back scores, Scoliosis Research Society 22 (SRS22) satisfaction and total scores, Short Form 36 (SF36) general health scores, Physical Component Score (PCS), Mental Component Score (MCS), Oswestry Disability Index (ODI) (including all domains)] at 6 months, 1, 2, 3 and 4 years and the complication rates at final follow-up between obese [body mass index (BMI) >30] and normal BMI (18.5-24.9) patients undergoing more than 3 levels of thoracolumbar fusion with a minimum 2-year follow-up. Patients who had undergone any previous spinal surgery were excluded., Results: Thirty patients were included in each arm of the study. Baseline demographics, including the number of levels fused, were similar between the groups. Estimated blood loss (EBL) was higher in obese patients (1,916 vs. 1,099 mL, P=0.001), but operative time was similar (282 vs. 320 min, P=0.351). The functional outcomes and satisfaction scores were consistently poorer in the obese group at all time-points, but their satisfaction scores were similar. Obese patients had a higher complication rate (OR 3.05, P=0.038) predominantly due to dural tears and nerve root injuries, but a similar reoperation rate., Conclusions: In patients with ASD undergoing multi-level thoracolumbar fusion, obesity results in a higher blood loss, poorer sagittal correction, poorer post-operative functional scores and higher complication rates than patients with a normal BMI. However, obesity does not affect operative times, length of hospital stay or reoperation rates. Furthermore, patients with obesity have similar post-operative satisfaction scores to patients with normal BMIs., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-22-14/coif). The authors have no conflicts of interest to declare., (2022 Annals of Joint. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
45. Correction to: The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM.
- Author
-
Negrini S, Aulisa AG, Cerny P, de Mauroy JC, McAviney J, Mills A, Donzelli S, Grivas TB, Hresko MT, Kotwicki T, Labelle H, Marcotte L, Matthews M, O'Brien J, Parent EC, Price N, Manuel R, Stikeleather L, Vitale MG, Wong MS, Wood G, Wynne J, Zaina F, Bruno MB, Würsching SB, Yilgor C, Cahill P, Dema E, Knott P, Lebel A, Lein G, Newton PO, and Smith BG
- Published
- 2022
- Full Text
- View/download PDF
46. Osteotomies for the Treatment of Adult Spinal Deformities: A Critical Analysis Review.
- Author
-
Yilgor C, Kindan P, Yucekul A, Zulemyan T, and Alanay A
- Subjects
- Adult, Humans, Neurosurgical Procedures, Traction, Treatment Outcome, Osteotomy methods, Spine diagnostic imaging, Spine surgery
- Abstract
»: Spinal osteotomies are powerful deformity correction techniques that may be associated with serious complications., »: The anatomical spinal osteotomy classification system proposes 6 grades of resection corresponding to different anatomic bone, disc, facet, and ligament interventions., »: Surgeons should be aware of the nuances of 3-column osteotomies with regard to spinal level selection, construct composition, and posterior column reconstruction and closure techniques., »: There is a global tendency toward avoiding 3-column osteotomies as much as possible because of the growing evidence regarding the effectiveness of posterior column osteotomies and halo-gravity traction., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A840)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)
- Published
- 2022
- Full Text
- View/download PDF
47. The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM.
- Author
-
Negrini S, Aulisa AG, Cerny P, de Mauroy JC, McAviney J, Mills A, Donzelli S, Grivas TB, Hresko MT, Kotwicki T, Labelle H, Marcotte L, Matthews M, O'Brien J, Parent EC, Price N, Manuel R, Stikeleather L, Vitale MG, Wong MS, Wood G, Wynne J, Zaina F, Bruno MB, Würsching SB, Yilgor C, Cahill P, Dema E, Knott P, Lebel A, Lein G, Newton PO, and Smith BG
- Subjects
- Consensus, Humans, Orthotic Devices, Treatment Outcome, Braces, Scoliosis therapy
- Abstract
Purpose: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types., Methods: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM., Results: The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction-valves (monocot, bivalve, multisegmented), construction-closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups., Conclusion: The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
48. Compensatory mechanisms recruited against proximal junctional kyphosis by patients instrumented from the thoracolumbar junction to the iliac.
- Author
-
Pizones J, Perez-Grueso FJS, Moreno-Manzanaro L, Escámez F, Yilgor C, Vila-Casademunt A, Fernández-Baíllo N, Sánchez-Márquez JM, Obeid I, Kleinstück F, Alanay A, and Pellisé F
- Subjects
- Adult, Humans, Postoperative Complications etiology, Postoperative Period, Retrospective Studies, Risk Factors, Kyphosis etiology, Spinal Fusion adverse effects
- Abstract
Purpose: The compensatory mechanisms recruited by un-instrumented patients against sagittal imbalance are well documented. However, there is a lack of information regarding instrumented patients., Material and Methods: We performed a retrospective analysis of data collected prospectively in a multicenter adult spinal deformity database. We included patients suffering PJK/PJF after (T8-L2) to iliac instrumentation with minimum two-year follow-up. We measured quantitative sagittal spinopelvic and qualitative sagittal distribution parameters in the immediate postoperative period (6w) and at the time of PJK/PJF appearance. We analyzed how these parameters changed comparing these two time points with univariate and multivariate logistic regression analyses., Results: A total of 69 patients were included. Two different patterns at PJK/PJF were found: 36 patients activated compensation (defined as an increase in pelvic retroversion (ΔRPV > 5º), and 33 did not (ΔRPV < 5º). The difference in behavior relied mostly on the amount of not surgically restored pelvic rotation at 6w (OR: 0.6; CI95%: 0.4-9.2; P = 0.017). Non-compensators had less rotation reserve (PTx100/PI = 33.9% vs 47.8%;P < 0.001) associated with worse 6w relative pelvic version and lower lumbar arc restoration, worse 6w relative sagittal alignment and GAP-score, compared with compensators (P < 0.001). Compensators' response was based on pelvic retroversion, causing lower lumbar arc decrease, lumbar apex caudal migration, and upper lumbar arc posterior inclination. Despite compensation, a thoracic kyphosis increase in both upper and lower arches gradually evolved into a PJK/PJF. Non-compensators did not react to PJK/PJF, which forced them into kyphosis from the lumbar apex and extending cranially, mainly throughout the upper thoracic arc., Conclusions: In patients fused from the TL junction to the iliac, those having greater postoperative pelvic rotation reserve showed greater capacity to recruit compensatory mechanisms against PJK/PJF., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2022
- Full Text
- View/download PDF
49. Does vertebral body tethering cause disc and facet joint degeneration? A preliminary MRI study with minimum two years follow-up.
- Author
-
Yucekul A, Akpunarli B, Durbas A, Zulemyan T, Havlucu I, Ergene G, Senay S, Yalinay Dikmen P, Turgut Balci S, Karaarslan E, Yavuz Y, Yilgor C, and Alanay A
- Subjects
- Adolescent, Follow-Up Studies, Humans, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae surgery, Magnetic Resonance Imaging, Retrospective Studies, Treatment Outcome, Vertebral Body, Intervertebral Disc diagnostic imaging, Intervertebral Disc surgery, Intervertebral Disc Degeneration diagnostic imaging, Intervertebral Disc Degeneration surgery, Zygapophyseal Joint diagnostic imaging, Zygapophyseal Joint surgery
- Abstract
Background Context: Vertebral body tethering (VBT), a flexible compression-based growth modulation technique, was claimed to prevent disc degeneration due to its less rigid nature compared to other growth-friendly techniques. Yet, the consequences of VBT surgery on discs and facet joints have not been precisely acknowledged., Purpose: The purpose of this study was to determine the changes in the intermediate and adjacent levels at least 2 years after surgery., Study Design/setting: Prospectively-followed consecutive patient cohort PATIENT SAMPLE: Adolescent idiopathic scoliosis patients who underwent thoracoscopic VBT between 2014 and 2017 were included., Outcome Measures: Degeneration of the intervertebral discs using the Pfirrmann classification; Degeneration of facet joints using a scale of 0 to 3., Methods: Demographic, perioperative, clinical, radiographic data were collected. Skeletal maturity and height gain were assessed in every follow-up. Overcorrection, tether breakage, mechanical and pulmonary complications as well as readmission and reoperations were recorded. MRIs taken before surgery and at a minimum of 2 years follow-up were evaluated for degeneration at the intermediate and adjacent segment intervertebral discs and facet joints by a blinded senior radiologist and compared., Results: Twenty-five patients with a mean of 38.6±10.6 months (24-62) of follow-up were included. The mean age at surgery was 12.2 (10-14), and the median Sanders stage was 3 (1-7). A mean of 7.7±1.1 (6-11) levels were tethered. The mean preoperative main thoracic curve magnitude of 46°±7.7° was corrected to 23.3°±5.9° postoperatively, which was subsequently modulated to 12° ±11.5° during the follow-up. At the time of the MRI (mean 29±9.5 (24-62) months), the median Sanders stages was 7 (5-8). A total of 217 levels of discs and bilateral facet joints were evaluated in the preoperative and follow-up MRI images. Analyses of disc and facet scores revealed no significant differences between patients. Deterioration of previously degenerated discs was noted in one patient (from grade 2 to 3), while previously healthy lower adjacent facet joints were degenerated (grade 2) in another patient., Conclusions: Intermediate discs and facet joints were preserved after growth modulation with VBT surgery at a mean of 29 months of follow-up. Studies in larger cohorts with longer follow-up are warranted to have more in-depth analyses of the effects of relative stabilization and altered biomechanical loads., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
50. Evaluation of global alignment and proportion score in an independent database.
- Author
-
Gupta MC, Yilgor C, Moon HJ, Lertudomphonwanit T, Alanay A, Lenke L, and Bridwell KH
- Subjects
- Adult, Humans, Pelvis, Postoperative Complications, Postoperative Period, Retrospective Studies, Lordosis, Spinal Fusion adverse effects
- Abstract
Background Context: Sagittal spinopelvic alignment has been associated with patient-reported outcome measures and mechanical complication rates. Recently, it was claimed that linear numerical values of pelvic tilt and lumbar lordosis measurements may be misleading for patients that have different magnitudes of pelvic incidence. The use of "relative" measurements embedded in a weighted scoring of Global Alignment and Proportion (GAP) was proposed., Purpose: The purpose was to evaluate the GAP scorein an independent database., Study Design/setting: Retrospective Cohort Study PATIENT SAMPLE: Adult spinal deformity patients who underwent ≥7 levels posterior fusion to the pelvis between 2004 and 2014 were included., Outcome Measures: Mechanical Complication Rates., Methods: Demographic, clinical, surgical and radiographic patient characteristics were recorded. Cochran-Armitage tests were used to compare mechanical complication rates in GAP categories. Uni and multivariable logistic regression analyses were used to obtain crude and adjusted Odds Ratios, of predictor (GAP categories) and the outcome (mechanical complication), and Risk Ratios were calculated. The diagnostic performance of the GAP score was tested using the area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value and accuracy in predicting mechanical complications., Results: A total of 322 patients (285F, 37M) with a mean age of 58.2±9.6 were analyzed. Mean follow-up was 69.7 months (range 24 to 177). Mechanical complications occurred in 52.2% of the patients. Mechanical complication rates in proportioned (GAP-P), moderately (GAP-MD) and severely disproportioned (GAP-SD) patients were 21.8%, 55.1%, and 70.4%, respectively. AUC for the GAP score, at 2 years, was 0.682 (95% CI, 0.624 to 0.741, p<.001). AUC at minimum 5 years follow-up was similar at 0.708, while AUC at minimum 7- and 12-year follow-up were 78.5 and 90.7, respectively. Having a postoperative spinopelvic alignment of GAP-MD and GAP-SD resulted in 2.5 and 3.2 folds of relative risk in incurring a mechanical complication when compared to having a proportioned spinopelvic state, respectively., Conclusions: This study reports an association between the GAP Score and mechanical complications in an independent database. Increased association was noted as the years of follow-up increased. Aiming to achieve proportionate GAP Score postoperatively seems to be a viable option as lower GAP scores were associated with lower rates of mechanical complications, and vice versa., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.