Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance

A meta-analysis

Chang Hyun Lee, Chun Kee Chung, Jee Soo Jang, Sung Min Kim, Dong Kyu Chin, Jung Kil Lee, Seung Hwan Yoon, Jae Taek Hong, Yoon Ha, Chi Heon Kim, Seung Jae Hyun

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

OBJECTIVE: As life expectancy continues to increase, primary degenerative sagittal imbalance (PDSI) is diagnosed in an increasing number of elderly people. Although corrective surgery for this sagittal deformity is becoming more popular, the effectiveness of the procedure remains unclear. The authors aimed to collate the available evidence on the effectiveness and complications of deformity-correction surgery in patients with PDSI. METHODS: The authors carried out a meta-analysis of clinical studies regarding deformity correction in patients with PDSI. The studies were identified through searches of the PubMed, Embase, Web of Science, and Cochrane databases. Surgery outcomes were evaluated and overall treatment effectiveness was assessed in terms of the minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) values and pain levels according to visual analog scale (VAS) scores and in terms of restoration of spinopelvic parameters to within a normal range. Data are expressed as mean differences with 95% CIs. RESULTS: Ten studies comprising 327 patients were included. The VAS and ODI values improved after deformity-correction surgery. The smallest treatment effect exceeded the MCID for VAS values (4.15 [95% CI 3.48-4.82]) but not for ODI values (18.11 [95% CI 10.99-25.23]). At the final follow-up visit, the mean lumbar lordosis angle (-38.60° [95% CI-44.19° to -33.01°]), thoracic kyphosis angle (31.10° [95% CI 24.67°-37.53°]), C-7 sagittal vertical axis (65.00 mm [95% CI 35.27-94.72 mm]), and pelvic tilt angle (30.82° [95% CI 24.41°-37.23°]) remained outside their normal ranges. Metaregression analyses revealed a significant effect of ODI change in relation to lumbar lordosis change (p = 0.004). After a mean of 2 years after deformity correction, the mean lumbar lordosis angle and C-7 sagittal vertical axis decreased by 5.82° and 38.91 mm, respectively, and the mean thoracic kyphosis angle increased by 4.7°. The incidences of proximal junctional kyphosis and pseudarthrosis were 23.7% and 12.8%, respectively. CONCLUSIONS: Deformity correction substantially relieves back pain for about 2 years in adult patients with PDSI. Sufficient surgical restoration of lumbar lordosis can lead to substantial improvement in patient disability and reduced decompensation. Deformity correction represents a viable therapeutic option for patients with PDSI, but further technical advancements are necessary to achieve sufficient lumbar lordosis and reduce complication rates.

Original languageEnglish
Pages (from-to)540-551
Number of pages12
JournalJournal of Neurosurgery: Spine
Volume27
Issue number5
DOIs
Publication statusPublished - 2017 Nov 1

Fingerprint

Lordosis
Meta-Analysis
Kyphosis
Visual Analog Scale
Reference Values
Thorax
Pseudarthrosis
Back Pain
Life Expectancy
PubMed
Databases
Pain
Incidence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Lee, C. H., Chung, C. K., Jang, J. S., Kim, S. M., Chin, D. K., Lee, J. K., ... Hyun, S. J. (2017). Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: A meta-analysis. Journal of Neurosurgery: Spine, 27(5), 540-551. https://doi.org/10.3171/2017.3.SPINE161134
Lee, Chang Hyun ; Chung, Chun Kee ; Jang, Jee Soo ; Kim, Sung Min ; Chin, Dong Kyu ; Lee, Jung Kil ; Yoon, Seung Hwan ; Hong, Jae Taek ; Ha, Yoon ; Kim, Chi Heon ; Hyun, Seung Jae. / Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance : A meta-analysis. In: Journal of Neurosurgery: Spine. 2017 ; Vol. 27, No. 5. pp. 540-551.
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title = "Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: A meta-analysis",
abstract = "OBJECTIVE: As life expectancy continues to increase, primary degenerative sagittal imbalance (PDSI) is diagnosed in an increasing number of elderly people. Although corrective surgery for this sagittal deformity is becoming more popular, the effectiveness of the procedure remains unclear. The authors aimed to collate the available evidence on the effectiveness and complications of deformity-correction surgery in patients with PDSI. METHODS: The authors carried out a meta-analysis of clinical studies regarding deformity correction in patients with PDSI. The studies were identified through searches of the PubMed, Embase, Web of Science, and Cochrane databases. Surgery outcomes were evaluated and overall treatment effectiveness was assessed in terms of the minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) values and pain levels according to visual analog scale (VAS) scores and in terms of restoration of spinopelvic parameters to within a normal range. Data are expressed as mean differences with 95{\%} CIs. RESULTS: Ten studies comprising 327 patients were included. The VAS and ODI values improved after deformity-correction surgery. The smallest treatment effect exceeded the MCID for VAS values (4.15 [95{\%} CI 3.48-4.82]) but not for ODI values (18.11 [95{\%} CI 10.99-25.23]). At the final follow-up visit, the mean lumbar lordosis angle (-38.60° [95{\%} CI-44.19° to -33.01°]), thoracic kyphosis angle (31.10° [95{\%} CI 24.67°-37.53°]), C-7 sagittal vertical axis (65.00 mm [95{\%} CI 35.27-94.72 mm]), and pelvic tilt angle (30.82° [95{\%} CI 24.41°-37.23°]) remained outside their normal ranges. Metaregression analyses revealed a significant effect of ODI change in relation to lumbar lordosis change (p = 0.004). After a mean of 2 years after deformity correction, the mean lumbar lordosis angle and C-7 sagittal vertical axis decreased by 5.82° and 38.91 mm, respectively, and the mean thoracic kyphosis angle increased by 4.7°. The incidences of proximal junctional kyphosis and pseudarthrosis were 23.7{\%} and 12.8{\%}, respectively. CONCLUSIONS: Deformity correction substantially relieves back pain for about 2 years in adult patients with PDSI. Sufficient surgical restoration of lumbar lordosis can lead to substantial improvement in patient disability and reduced decompensation. Deformity correction represents a viable therapeutic option for patients with PDSI, but further technical advancements are necessary to achieve sufficient lumbar lordosis and reduce complication rates.",
author = "Lee, {Chang Hyun} and Chung, {Chun Kee} and Jang, {Jee Soo} and Kim, {Sung Min} and Chin, {Dong Kyu} and Lee, {Jung Kil} and Yoon, {Seung Hwan} and Hong, {Jae Taek} and Yoon Ha and Kim, {Chi Heon} and Hyun, {Seung Jae}",
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language = "English",
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Lee, CH, Chung, CK, Jang, JS, Kim, SM, Chin, DK, Lee, JK, Yoon, SH, Hong, JT, Ha, Y, Kim, CH & Hyun, SJ 2017, 'Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: A meta-analysis', Journal of Neurosurgery: Spine, vol. 27, no. 5, pp. 540-551. https://doi.org/10.3171/2017.3.SPINE161134

Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance : A meta-analysis. / Lee, Chang Hyun; Chung, Chun Kee; Jang, Jee Soo; Kim, Sung Min; Chin, Dong Kyu; Lee, Jung Kil; Yoon, Seung Hwan; Hong, Jae Taek; Ha, Yoon; Kim, Chi Heon; Hyun, Seung Jae.

In: Journal of Neurosurgery: Spine, Vol. 27, No. 5, 01.11.2017, p. 540-551.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance

T2 - A meta-analysis

AU - Lee, Chang Hyun

AU - Chung, Chun Kee

AU - Jang, Jee Soo

AU - Kim, Sung Min

AU - Chin, Dong Kyu

AU - Lee, Jung Kil

AU - Yoon, Seung Hwan

AU - Hong, Jae Taek

AU - Ha, Yoon

AU - Kim, Chi Heon

AU - Hyun, Seung Jae

PY - 2017/11/1

Y1 - 2017/11/1

N2 - OBJECTIVE: As life expectancy continues to increase, primary degenerative sagittal imbalance (PDSI) is diagnosed in an increasing number of elderly people. Although corrective surgery for this sagittal deformity is becoming more popular, the effectiveness of the procedure remains unclear. The authors aimed to collate the available evidence on the effectiveness and complications of deformity-correction surgery in patients with PDSI. METHODS: The authors carried out a meta-analysis of clinical studies regarding deformity correction in patients with PDSI. The studies were identified through searches of the PubMed, Embase, Web of Science, and Cochrane databases. Surgery outcomes were evaluated and overall treatment effectiveness was assessed in terms of the minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) values and pain levels according to visual analog scale (VAS) scores and in terms of restoration of spinopelvic parameters to within a normal range. Data are expressed as mean differences with 95% CIs. RESULTS: Ten studies comprising 327 patients were included. The VAS and ODI values improved after deformity-correction surgery. The smallest treatment effect exceeded the MCID for VAS values (4.15 [95% CI 3.48-4.82]) but not for ODI values (18.11 [95% CI 10.99-25.23]). At the final follow-up visit, the mean lumbar lordosis angle (-38.60° [95% CI-44.19° to -33.01°]), thoracic kyphosis angle (31.10° [95% CI 24.67°-37.53°]), C-7 sagittal vertical axis (65.00 mm [95% CI 35.27-94.72 mm]), and pelvic tilt angle (30.82° [95% CI 24.41°-37.23°]) remained outside their normal ranges. Metaregression analyses revealed a significant effect of ODI change in relation to lumbar lordosis change (p = 0.004). After a mean of 2 years after deformity correction, the mean lumbar lordosis angle and C-7 sagittal vertical axis decreased by 5.82° and 38.91 mm, respectively, and the mean thoracic kyphosis angle increased by 4.7°. The incidences of proximal junctional kyphosis and pseudarthrosis were 23.7% and 12.8%, respectively. CONCLUSIONS: Deformity correction substantially relieves back pain for about 2 years in adult patients with PDSI. Sufficient surgical restoration of lumbar lordosis can lead to substantial improvement in patient disability and reduced decompensation. Deformity correction represents a viable therapeutic option for patients with PDSI, but further technical advancements are necessary to achieve sufficient lumbar lordosis and reduce complication rates.

AB - OBJECTIVE: As life expectancy continues to increase, primary degenerative sagittal imbalance (PDSI) is diagnosed in an increasing number of elderly people. Although corrective surgery for this sagittal deformity is becoming more popular, the effectiveness of the procedure remains unclear. The authors aimed to collate the available evidence on the effectiveness and complications of deformity-correction surgery in patients with PDSI. METHODS: The authors carried out a meta-analysis of clinical studies regarding deformity correction in patients with PDSI. The studies were identified through searches of the PubMed, Embase, Web of Science, and Cochrane databases. Surgery outcomes were evaluated and overall treatment effectiveness was assessed in terms of the minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) values and pain levels according to visual analog scale (VAS) scores and in terms of restoration of spinopelvic parameters to within a normal range. Data are expressed as mean differences with 95% CIs. RESULTS: Ten studies comprising 327 patients were included. The VAS and ODI values improved after deformity-correction surgery. The smallest treatment effect exceeded the MCID for VAS values (4.15 [95% CI 3.48-4.82]) but not for ODI values (18.11 [95% CI 10.99-25.23]). At the final follow-up visit, the mean lumbar lordosis angle (-38.60° [95% CI-44.19° to -33.01°]), thoracic kyphosis angle (31.10° [95% CI 24.67°-37.53°]), C-7 sagittal vertical axis (65.00 mm [95% CI 35.27-94.72 mm]), and pelvic tilt angle (30.82° [95% CI 24.41°-37.23°]) remained outside their normal ranges. Metaregression analyses revealed a significant effect of ODI change in relation to lumbar lordosis change (p = 0.004). After a mean of 2 years after deformity correction, the mean lumbar lordosis angle and C-7 sagittal vertical axis decreased by 5.82° and 38.91 mm, respectively, and the mean thoracic kyphosis angle increased by 4.7°. The incidences of proximal junctional kyphosis and pseudarthrosis were 23.7% and 12.8%, respectively. CONCLUSIONS: Deformity correction substantially relieves back pain for about 2 years in adult patients with PDSI. Sufficient surgical restoration of lumbar lordosis can lead to substantial improvement in patient disability and reduced decompensation. Deformity correction represents a viable therapeutic option for patients with PDSI, but further technical advancements are necessary to achieve sufficient lumbar lordosis and reduce complication rates.

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