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. 2022 May;12(4):631-637.
doi: 10.1177/2192568220960753. Epub 2020 Sep 25.

Supine Imaging Is a Superior Predictor of Long-Term Alignment Following Adult Spinal Deformity Surgery

Jonathan Charles Elysee  1 , Francis Lovecchio  1 , Renaud Lafage  1 , Bryan Ang  1 , Alex Huang  1 , Mathieu Bannwarth  1 , Han Jo Kim  1 , Frank Schwab  1 , Virginie Lafage  1
Affiliations

Supine Imaging Is a Superior Predictor of Long-Term Alignment Following Adult Spinal Deformity Surgery

Jonathan Charles Elysee et al. Global Spine J. 2022 May.

Abstract

Study design: Retrospective cohort study.

Objective: To investigate correlations between preoperative supine imaging and postoperative alignment.

Methods: A retrospective review was conducted of a single-institution database of patients with adult spinal deformity (ASD). Patients were stratified by fusion location in the lumbar or thoracic spine. Outcomes of interest were postoperative lumbar lordosis (LL) and thoracic kyphosis (TK). Sagittal alignment parameters were compared and correlation analyses were performed. Multilinear stepwise regression was conducted to identify independent predictors of postoperative LL or TK. Regression analyses were repeated within the lumbar and thoracic fusion cohorts.

Results: A total of 99 patients were included (mean age 63.2 years, 83.1% female, mean body mass index 27.3 kg/m2). Scoliosis Research Society classification demonstrated moderate to severe sagittal and/or coronal deformity (pelvic tile modifier, 18.2% ++; sagittal vertical axis, 27.3% ++, pelvic incidence minus lumbar lordosis mismatch, 29.3% ++, SRS type, 29.3% N type curve and 68.7% L or D type curve). A total of 73 patients (73.7%) underwent lumbar fusion and 50 (50.5%) underwent thoracic fusion. Correlation analyses demonstrated a significant association between pre- and postoperative LL and TK. Multilinear regression demonstrated that LL supine and pelvic incidence were significant predictors of postoperative LL (r2 = 0.568, P < .001). LL supine, TK supine, and age were significant predictors of postoperative TK (r2 = 0.490, P < .001).

Conclusion: Preoperative supine films are superior to standing in predicting postoperative alignment at 1-year follow-up. Anticipation of undesired alignment changes through supine imaging may be useful in mitigating the risk of iatrogenic malalignment.

Keywords: lumbar fusion; postoperative alignment; supine imaging; thoracic fusion.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Example of supine radiographs. Preoperative standing (A), preoperative supine (B), postoperative standing (C).
See this image and copyright information in PMC

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