Incidence and risk factors of iatrogenic coronal malalignment after adult spinal deformity surgery: a single-center experience

作者：Scott L. Zuckerman, Christopher Lai, Yong Shen, Nathan J. Lee, Mena G. Kerolus, Alex Ha, Ian A. Buchanan, Eric Leung, Meghan Cerpa, Ronald A. Lehman, Lawrence G. Lenke · 发表于：Journal of Neurosurgery Spine · 年份：2021 · DOI：10.3171/2021.6.spine21575 · 被引用次数：17 · 研究领域：Scoliosis diagnosis and treatment、Spine and Intervertebral Disc Pathology、Cervical and Thoracic Myelopathy

OBJECTIVE: The authors' objectives were: 1) to evaluate the incidence and risk factors of iatrogenic coronal malalignment (CM), and 2) to assess the outcomes of patients with all three types of postoperative CM (iatrogenic vs unchanged/worsened vs improved but persistent). METHODS: A single-institution, retrospective cohort study was performed on adult spinal deformity (ASD) patients who underwent > 6-level fusion from 2015 to 2019. Iatrogenic CM was defined as immediate postoperative C7 coronal vertical axis (CVA) ≥ 3 cm in patients with preoperative CVA < 3 cm. Additional subcategories of postoperative CM were unchanged/worsened CM, which was defined as immediate postoperative CVA within 0.5 cm of or worse than preoperative CVA, and improved but persistent CM, which was defined as immediate postoperative CVA that was at least 0.5 cm better than preoperative CVA but still ≥ 3 cm; both groups included only patients with preoperative CM. Immediate postoperative radiographs were obtained when the patient was discharged from the hospital after surgery. Demographic, radiographic, and operative variables were collected. Outcomes included major complications, readmissions, reoperations, and patient-reported outcomes (PROs). The t-test, Kruskal-Wallis test, and univariate logistic regression were performed for statistical analysis. RESULTS: In this study, 243 patients were included, and the mean ± SD age was 49.3 ± 18.3 years and the mean number of instrumented levels was 13.5 ± 3.9...