Background context: Baseline severities of sagittal malalignment and degrees of pelvic compensation may affect postsurgical outcomes differently after adult spinal deformity (ASD) surgery, even if the patients achieved optimal correction of sagittal malalignment.
Purpose: To investigate whether postsurgical outcomes vary according to baseline sagittal alignment and pelvic compensation status in patients achieving adequate correction relative to age-adjusted alignment target in ASD surgery.
Study design/setting: Retrospective study PATIENT SAMPLE: Patients who underwent ≥ 5-level fusion to the pelvis for ASD; achieved matched correction relative to age-adjusted pelvic incidence (PI)-lumbar lordosis (LL); and completed ≥ 2-year follow-up.
Outcome measures: Radiographic results, mechanical failures, and clinical outcomes METHODS: Patients were divided into three groups based on baseline sagittal vertical axis (SVA) and pelvic tilt (PT)/PI ratio (median value of PT/PI ratio = 0.61): Group A (SVA < 5 cm), Group B (SVA ≥ 5 cm and PT/PI ratio <0.61, and Group C (SVA ≥ 5 cm and PT/PI ratio ≥ 0.61). Radiographic results, mechanical failures, and clinical outcomes were compared among the three groups.
Results: A total of 153 patients were included in the study. They were predominantly female (89.5%), with a mean age of 68.3 years. The mean follow-up duration was 49.0 months. There were 50 patients in group A (SVA < 5cm), 53 in group B (SVA ≥ 5cm and low PT/PI), and 50 in group C (SVA ≥ 5cm and high PT/PI). No significant differences were observed in all radiographic parameters at six weeks. At the last follow-up, the PI-LL was comparable among the three groups; however, the SVA was significantly greater in groups B and C than in group A (46.5mm and 46.9mm vs. 31.5mm, p=.039). The PT at the last follow-up was significantly lower in group B than in group A and C (22.4° vs. 26.0° and 28.2°, respectively, p=.001). The rates of mechanical failure and subsequent revision surgery and did not differ among the groups. The final clinical outcomes were comparable among the three groups.
Conclusions: This study revealed that patients in groups B and C were likely to have a suboptimal sagittal alignment status at the last follow-up compared with those in group A. Tailored approaches considering patient's baseline alignment and compensatory status are recommended to optimize the final sagittal alignment status.
Background context: The effect of romosozumab administration in patients undergoing corrective spinal fusion surgery has not yet been analyzed.
Purpose: To examine the effect of romosozumab administration on reducing the incidence of proximal junctional kyphosis (PJK), particularly PJK due to fractures (PJK-Fx), in patients undergoing spinal corrective fusion surgery.
Design: Retrospective cohort study PATIENT SAMPLE: A total of 111 patients aged >50 years underwent corrective fusion surgery (>2 vertebrae) for adult spinal deformity or vertebral compression fracture between June 2010 and July 2023.
Outcome measures: The primary outcome was the incidence of PJK, whereas the secondary outcomes were changes in Hounsfield unit (HU) values, surgical complications, and clinical outcomes measured using the Japanese Orthopaedic Association (JOA) and visual analog scale scores.
Methods: The patients were divided into the romosozumab (n=32) and non-romosozumab groups (n=79). Romosozumab was typically administered 2 months before surgery in the romosozumab group. Demographic data, surgery-related factors, and radiographic parameters were analyzed. HU values at the upper instrumented vertebra+1 (UIV+1) were measured preoperatively and at 1 year postoperatively. After the univariate analysis of preoperative factors associated with PJK, multivariate logistic regression was used to identify factors associated with PJK.
Results: Romosozumab significantly increased the HU values at UIV+1 (-1.22% vs. 13.60%, p<0.001) and reduced the incidence of PJK (39.24% vs. 18.75%, p=0.046), particularly PJK-Fx (26.58% vs. 6.25%, p=0.019) and osteoporosis-related complications (55.70% vs. 34.38%, p=0.011). The multivariate analysis showed a significantly lower incidence of PJK (adjusted odds ratio = 0.32, p=0.033), particularly PJK-Fx (adjusted odds ratio = 0.15, p=0.018). There was a tendency for better JOA scores at 1 year postoperatively in the romosozumab group (21.49 vs. 23.62, p=0.071).
Conclusion: Romosozumab administration effectively increased bone density and reduced the risk of PJK, particularly PJK-Fx, and osteoporosis-related complications in patients undergoing corrective spinal fusion surgery. Administration of romosozumab 2 months before surgery enhanced bone mineral density and strength, leading to better surgical outcomes and fewer complications. Further long-term studies are needed to confirm these findings and optimize treatment protocols.