Oluwatobi O Onafowokan, Oscar Krol, Virginie Lafage, Renaud Lafage, Justin S Smith, Breton Line, Shaleen Vira, Alan H Daniels, Bassel Diebo, Andrew J Schoenfeld, Jeffrey Gum, Khaled Kebaish, Khoi Than, Han Jo Kim, Richard Hostin, Munish Gupta, Robert Eastlack, Douglas Burton, Frank J Schwab, Christopher Shaffrey, Eric O Klineberg, Shay Bess, Peter G Passias
{"title":"Which components of the global alignment proportionality score have the greatest impact on outcomes in adult spinal deformity corrective surgery?","authors":"Oluwatobi O Onafowokan, Oscar Krol, Virginie Lafage, Renaud Lafage, Justin S Smith, Breton Line, Shaleen Vira, Alan H Daniels, Bassel Diebo, Andrew J Schoenfeld, Jeffrey Gum, Khaled Kebaish, Khoi Than, Han Jo Kim, Richard Hostin, Munish Gupta, Robert Eastlack, Douglas Burton, Frank J Schwab, Christopher Shaffrey, Eric O Klineberg, Shay Bess, Peter G Passias","doi":"10.1007/s00586-024-08540-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the impact of the Global Alignment and Proportion (GAP) score components on patient outcomes in Adult Spine Deformity (ASD) surgery.</p><p><strong>Methods: </strong>Patients included underwent assessment via the GAP score and its individual components: pelvic version (GAP PV), lumbar lordosis (GAP LL), lumbar distribution index (GAP LDI) and spinopelvic component (GAP SP). Multivariable analyses assessed the association between alignment in these components and clinical outcomes in ASD patients.</p><p><strong>Results: </strong>762 ASD patients met inclusion criteria. Alignment in GAP SP independently predicted meeting MCID for SR-22S and ODI and was associated with a lower likelihood of developing mechanical complications. Patients aligned in GAP SP were less likely to develop proximal junctional kyphosis (OR 0.42, 0.26-0.73, p = 0.01) and PJF (OR 0.3, 0.13-0.74, p = 0.01). Proportioned alignment in GAP SP with disproportioned alignment in GAP LDI contributed to an increased risk of PJK and PJF (OR 2.67, 95% CI 1.95-6.82, p = 0.045). There was no significant association of GAP SP proportionality and GAP RPV (OR 1.1, 0.86-2.15, p = 0.253) or GAP LL (OR 1.34, 0.78-4.23, p = 0.673) disproportionality with outcomes. Disproportioned alignment in GAP SP but proportioned alignment in both GAP LL and GAP LDI was associated with decreased likelihood of PJK (OR 0.53, 95% CI 0.39-0.94, p = 0.02) and PJF (OR 0.31, 95% CI 0.19-0.67, p = 0.001).</p><p><strong>Conclusion: </strong>The spinopelvic component of the GAP score is the most significant independent predictor of clinical outcomes. Its interaction with the other components of the GAP score also aids assessment of the risk for mechanical complications.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00586-024-08540-y","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: To investigate the impact of the Global Alignment and Proportion (GAP) score components on patient outcomes in Adult Spine Deformity (ASD) surgery.
Methods: Patients included underwent assessment via the GAP score and its individual components: pelvic version (GAP PV), lumbar lordosis (GAP LL), lumbar distribution index (GAP LDI) and spinopelvic component (GAP SP). Multivariable analyses assessed the association between alignment in these components and clinical outcomes in ASD patients.
Results: 762 ASD patients met inclusion criteria. Alignment in GAP SP independently predicted meeting MCID for SR-22S and ODI and was associated with a lower likelihood of developing mechanical complications. Patients aligned in GAP SP were less likely to develop proximal junctional kyphosis (OR 0.42, 0.26-0.73, p = 0.01) and PJF (OR 0.3, 0.13-0.74, p = 0.01). Proportioned alignment in GAP SP with disproportioned alignment in GAP LDI contributed to an increased risk of PJK and PJF (OR 2.67, 95% CI 1.95-6.82, p = 0.045). There was no significant association of GAP SP proportionality and GAP RPV (OR 1.1, 0.86-2.15, p = 0.253) or GAP LL (OR 1.34, 0.78-4.23, p = 0.673) disproportionality with outcomes. Disproportioned alignment in GAP SP but proportioned alignment in both GAP LL and GAP LDI was associated with decreased likelihood of PJK (OR 0.53, 95% CI 0.39-0.94, p = 0.02) and PJF (OR 0.31, 95% CI 0.19-0.67, p = 0.001).
Conclusion: The spinopelvic component of the GAP score is the most significant independent predictor of clinical outcomes. Its interaction with the other components of the GAP score also aids assessment of the risk for mechanical complications.
期刊介绍：
"European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts.
Official publication of EUROSPINE, The Spine Society of Europe
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