Functional outcome and radiographic correction after spinal osteotomy.
METHODS
A prospective clinical trial to study the radiographic parameters and functional outcome in patients undergoing spinal osteotomy.


OBJECTIVE
To determine whether correction of specific radiographic parameters is associated with improved functional outcome.


BACKGROUND
Although vertebral osteotomies have been shown to improve functional outcome in patients with spinal deformity, no prospective reports have studied whether correction of specific radiographic parameters is associated with improvement in functional outcome.


METHODS
Eighty-three patients with fixed sagittal and/or coronal deformity were followed over a 7-year period. Patients were evaluated clinically and radiographically and completed a SF-36 Health Survey and American Academy of Orthopedic Surgeons Modems Instrument questionnaire. Spearman correlation analysis was used to determine the association between correction of radiographic parameters and functional outcome.


RESULTS
Mean preoperative lumbar lordosis measured -14.2 degrees (i.e., kyphosis) with an average postoperative correction of 27.9 degrees. Mean preoperative lumbar scoliosis measured 40.1 degrees with an average postoperative correction of 15.1 degrees. Mean preoperative plumb sagittal and coronal plane alignment was 8.37 cm and 4.22 cm, respectively; after surgery they improved to 3.33 cm and 2.31 cm, respectively. A significant association was found between sagittal angular correction and physical function (P = 0.034) and role-physical (P = 0.01) when postoperative lumbar lordosis was >25 degrees. A significant association was also found between plumb coronal correction and physical function (P = 0.041), vitality (P = 0.05), and social function (P = 0.047) when postoperative plumb coronal alignment was <2.5 cm.


CONCLUSIONS
Correction of sagittal and coronal deformity is important in the treatment of spinal deformity. A significant association was found between outcomes and radiographic correction of coronal and/or sagittal deformity if postoperative sagittal lordosis was >25 degrees and if postoperative plumb coronal alignment was <2.5 cm. Therefore, these radiographic parameters should be the goal of a spinal osteotomy. The surgery has a relatively high complication rate.
Ahn
Uri M
UM
Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Ahn
Nicholas U
NU
Buchowski
Jacob M
JM
Kebaish
Khaled M
KM
Lee
Ji-Ho
JH
Song
Edward S
ES
Lemma
Mesfin A
MA
Sieber
Ann N
AN
Kostuik
John P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D016014:Linear Models; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D013131:Spine / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome