Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity

作者：Dominika Ignasiak, Pascal Behm, Anne F. Mannion, Fabio Galbusera, Frank Kleinstück, T. Fekete, Daniel Haschtmann, Dezsö Jeszenszky, Laura Zimmermann, S. Richner-Wunderlin, Alba Vila-Casademunt, Ferrán Pellisé, Ibrahim Obeid, Javier Pizones, Francisco Sánchez Pérez-Grueso, Muhammed İlkay Karaman, Ahmet Alanay, Çağlar Yılgör, Stephen J. Ferguson, Markus Loibl, ESSG European Spine Study Group · 发表于：European Spine Journal · 年份：2022 · DOI：10.1007/s00586-022-07477-4 · 被引用次数：24 · 研究领域：Scoliosis diagnosis and treatment、Spine and Intervertebral Disc Pathology、Spinal Fractures and Fixation Techniques

PURPOSE: Sagittal malalignment is a risk factor for mechanical complications after surgery for adult spinal deformity (ASD). Spinal loads, modulated by sagittal alignment, may explain this relationship. The aims of this study were to investigate the relationships between: (1) postoperative changes in loads at the proximal segment and realignment, and (2) absolute postoperative loads and postoperative alignment measures. METHODS: A previously validated musculoskeletal model of the whole spine was applied to study a clinical sample of 205 patients with ASD. Based on clinical and radiographic data, pre-and postoperative patient-specific alignments were simulated to predict loads at the proximal segment adjacent to the spinal fusion. RESULTS: Weak-to-moderate associations were found between pre-to-postop changes in lumbar lordosis, LL (r = - 0.23, r = - 0.43; p < 0.001), global tilt, GT (r = 0.26, r = 0.38; p < 0.001) and the Global Alignment and Proportion score, GAP (r = 0.26, r = 0.37; p < 0.001), and changes in compressive and shear forces at the proximal segment. GAP score parameters, thoracic kyphosis measurements and the slope of upper instrumented vertebra were associated with changes in shear. In patients with T10-pelvis fusion, moderate-to-strong associations were found between postoperative sagittal alignment measures and compressive and shear loads, with GT showing the strongest correlations (r = 0.75, r = 0.73, p < 0.001). CONCLUSIONS: Spinal loads were estimated for...