Factors associated with postoperative coronal imbalance in adult patients with severe and rigid scoliosis: a retrospective study.

Abstract

Background: Extensive studies examined coronal imbalance (CIB) in adolescent and adult degenerative scoliosis; however, few studies addresses on CIB in adult with severe rigid scoliosis (SRS). Therefore, we analyzed postoperative SRS patients to identify factors associated with postoperative CIB.

Methods: In this retrospective study, we investigated SRS patients undergoing one-stage posterior column osteotomy (PCO) and fusion at our hospital between August 2012 and January 2019. The preoperative, postoperative and follow-up whole-spine anteroposterior (AP) radiographs were evaluated. Potential risk factors for postoperative CIB were analyzed using the LASSO regression, and independent risk factors were identified using binary logistic regression. A nomogram prediction model was constructed and validated.

Results: Ninety eligible SRS patients were included. Postoperative radiographs showed a main curve correction rate of 54.17 ± 14.02%; however, follow-up CIB persisted in 26.67% of patients. Three independent variables affecting follow-up CIB were identified by LASSO regression, including preoperative CIB+ [OR = 12.414 (95% CI: 2.228, 69.162), P = 0.004], major curve flexibility index < 10% [OR = 14.300 (95% CI: 2.200, 92.957), P = 0.005], and immediate postoperative CIB [OR = 5.169 (95% CI: 1.387, 19.263), P = 0.014]. ROC and DCA analysis demonstrated that the nomogram had good predictive performance.

Conclusions: Preoperative CIB+, major curve flexibility index < 10%, and immediate postoperative CIB were significantly associated with postoperative CIB. These findings offer valuable guidance to improve surgical outcomes and reduce complications.