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Neurospine > Volume 18(3); 2021 > Article |
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BD (consulting fees from Stryker outside of the submitted work), MG (institutional grants from K2M and Medtronic outside of the submitted work), the remaining authors report no conflicts of interest.
Variable | Normal (LDI: 50–80) (n = 93) | Hypolordosis (LDI < 50) (n = 36) | Hyperlordosis (LDI > 80) (n = 20) | Total (n = 149) | p-value† | p-value‡ | |
---|---|---|---|---|---|---|---|
Preoperative radiographic measurements | |||||||
Pelvic incidence (°) | 54.5 ± 13.7 | 58.8 ± 13.5 | 47.1 ± 11.2 | 54.6 ± 13.7 | 0.007* | 0.112 | |
Pelvic tilt (°) | 16.5 ± 8.1 | 22.3 ± 10.1 | 18 ± 6 | 18.1 ± 8.7 | 0.002* | 0.003* | |
Pelvic tilt > 20° | 27 (29.0) | 18 (50.0) | 7 (35.0) | 52 (34.9) | 0.081 | 0.039* | |
Sacral slope (°) | 38 (11.4) | 36.6 (8.2) | 29.1 (10.9) | 36.5 (11) | 0.003* | 0.426 | |
Global lordosis (°) | 55.7 ± 14.7 | 50.8 ± 13.2 | 43.9 ± 10.9 | 53 ± 14.4 | 0.001* | 0.069 | |
SVA (mm)§ | 34.5 ± 49 | 61.1 ± 51.5 | 47.3 ± 32.6 | 43.3 ± 47.8 | 0.111 | 0.064 | |
SVA > 40 mm§ | 15 (33.3) | 11 (57.9) | 7 (46.7) | 33 (41.8) | 0.174 | 0.096 | |
PI–LL (°) | 0.1 ± 11.5 | 11.7 ± 17.2 | 8 ± 11.7 | 4 ± 14 | < 0.001* | < 0.001* | |
PI–LL ≥ 10° | 12 (12.9) | 16 (44.4) | 7 (35.0) | 35 (23.5) | < 0.001* | < 0.001* | |
LDI | 65.2 ± 14.4 | 38.5 ± 24.8 | 85.8 ± 15.7 | 61.5 ± 22.9 | < 0.001* | < 0.001* | |
LDI groups | < 0.001* | < 0.001* | |||||
50–80 | 69 (74.2) | 9 (25.7) | 5 (25.0) | 83 (56.1) | |||
< 50 | 12 (12.9) | 25 (71.4) | 0 (0.0) | 37 (25.0) | |||
> 80 | 12 (12.9) | 1 (2.9) | 15 (75.0) | 28 (18.9) | |||
Postoperative radiographic measurements | |||||||
Pelvic incidence (°) | 54.6 ± 14.1 | 58.5 ± 13.5 | 47 ± 10.8 | 54.5 ± 13.9 | 0.009* | 0.145 | |
Pelvic tilt (°) | 17.8 ± 7.9 | 25.1 ± 11.2 | 20.8 ± 5.5 | 20 ± 9 | < 0.001* | < 0.001* | |
Pelvic tilt > 20° | 38 (40.9) | 22 (61.1) | 12 (60.0) | 72 (48.3) | 0.063 | 0.049* | |
Sacra slope (°) | 36.9 ± 10.1 | 33.5 ± 8.9 | 26.2 ± 9.7 | 34.6 ± 10.4 | < 0.001* | 0.065 | |
Global lordosis (°) | 52.2 ± 12 | 45.3 ± 12.6 | 40.6 ± 11.3 | 48.9 ± 12.8 | < 0.001* | 0.007* | |
SVA (mm)§ | 68.8 ± 54.4 | 127.5 ± 41.9 | 88.7 ± 51.8 | 91.4 ± 53.1 | 0.195 | 0.092 | |
SVA > 40 mm§ | 4 (66.7) | 4 (100.0) | 3 (100.0) | 11 (84.6) | 0.252 | 0.467 | |
PI–LL (°) | 3.2 ± 11.1 | 16.1 ± 16.9 | 11 ± 11.4 | 7.4 ± 13.9 | < 0.001* | < 0.001* | |
PI–LL ≥ 10° | 21 (22.6) | 19 (52.8) | 11 (55.0) | 51 (34.2) | < 0.001* | 0.001* | |
LDI | 63 ± 8.6 | 32.8 ± 22.3 | 90.6 ± 8.5 | 59.4 ± 22 | < 0.001* | < 0.001* |
Values are presented as mean±standard deviation or number (%).
SVA, sagittal vertical axis; PI–LL, pelvic incidence minus lumbar lordosis.
A p-value was derived using †analysis of variance comparing all 3 LDI groups, followed by pairwise comparison of the ‡“normal” and “low (LDI<50)” LDI groups using either Student t-test or Fisher exact test.
Variable | Normal (LDI: 50–80) (n = 93) | Hypolordosis (LDI < 50) (n = 36) | Hyperlordosis (LDI > 80) (n = 20) | Total (n = 149) | p-value† | p-value‡ | |
---|---|---|---|---|---|---|---|
Complications | |||||||
Early (< 3 mo) | 33 (35.5) | 16 (44.4) | 7 (35.0) | 56 (37.6) | 0.621 | 0.419 | |
Late (> 3 mo) | 43 (46.2) | 13 (36.1) | 8 (40.0) | 64 (43.0) | 0.558 | 0.328 | |
Minor | 45 (48.4) | 16 (44.4) | 7 (35.0) | 68 (45.6) | 0.544 | 0.700 | |
Major | 36 (38.7) | 16 (44.4) | 10 (50.0) | 62 (41.6) | 0.600 | 0.556 | |
Mechanical complications | |||||||
Major | 5 (5.4) | 5 (13.9) | 3 (15.0) | 13 (8.7) | 0.126 | 0.140 | |
Minor | 2 (2.2) | 1 (2.8) | 0 (0) | 3 (2.0) | 1.00 | 1.00 | |
Any | 7 (7.5) | 6 (16.7) | 3 (15) | 16 (10.7) | 0.229 | 0.188 | |
Adjacent segment disease | |||||||
Major | 8 (8.6) | 3 (8.3) | 0 (0) | 11 (7.4) | 0.587 | 1.00 | |
Minor | 1 (1.1) | 0 (0.0) | 0 (0) | 1 (0.7) | 1.00 | 1.00 | |
Any | 9 (9.7) | 3 (8.3) | 0 (0) | 12 (8.1) | 0.550 | 1.00 | |
Any complication | 57 (61.3) | 25 (69.4) | 12 (60.0) | 94 (63.1) | 0.659 | 0.422 | |
Revision§ | |||||||
Revision 1 yr | 6 (6.5) | 7 (19.4) | 3 (15.0) | 16 (10.7) | 0.082 | 0.046* | |
Revision 2 yr | 15 (16.1) | 10 (27.8) | 7 (35.0) | 32 (21.5) | 0.100 | 0.143 | |
Revision any time | 27 (29) | 12 (33.3) | 9 (45.0) | 48 (32.0) | 0.378 | 0.672 |
Variable |
Univariable |
Multivariable |
|||
---|---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-value | ||
Age (yr) | 1.04 (0.99–1.09) | 0.140 | - | - | |
Male sex | 1.57 (0.53–4.50) | 0.398 | - | - | |
CCI | 1.06 (0.78–1.38) | 0.688 | - | - | |
ASA PS classification | 1.27 (0.52–3.08) | 0.590 | - | - | |
Surgery time (min) | 1.00 (0.99–1.01) | 0.784 | - | - | |
Interbody cage | 0.53 (0.18–1.82) | 0.282 | - | - | |
Instrumented vertebra (per 1 increase) | 0.71 (0.28–1.26) | 0.374 | 0.71 (0.27–1.33) | 0.398 | |
Sacral fusion | 0.75 (0.07–8.55) | 0.820 | |||
Previous spine surgery | 1.37 (0.48–3.95) | 0.548 | - | - | |
Length of hospital stay | 1.10 (1.02–1.18) | 0.010* | - | - | |
Preoperative radiographic measurements | |||||
Pelvic incidence | 1.01 (0.97–1.04) | 0.752 | 1.00 (0.96–1.04) | 0.906 | |
Pelvic tilt | 1.05 (0.99–1.11) | 0.108 | - | - | |
Pelvic tilt ≥ 20 | 2.69 (0.94–7.99) | 0.065 | - | - | |
Sacral Slope | 0.97 (0.92–1.02) | 0.263 | - | - | |
Global lordosis | 0.97 (0.93–1.00) | 0.065 | - | - | |
SVA (mm) | 1.01 (1.00–1.03) | 0.024* | - | - | |
SVA ≥ 40 | 3.94 (1.15–15.82) | 0.036* | - | - | |
PI–LL | 1.04 (1.00–1.07) | 0.029* | - | - | |
PI–LL ≥ 10 | 1.56 (0.46–4.66) | 0.441 | - | - | |
LDI | 0.98 (0.96–1.00) | 0.104 | - | - | |
LDI groups (reference: 50-80) | - | - | - | - | |
LDI < 50 | 2.10 (0.63–6.82) | 0.213 | - | - | |
LDI > 80 | 0.84 (0.12–3.72) | 0.829 | - | - | |
Postoperative radiographic measurements | |||||
Pelvic incidence | 1.00 (0.97–1.04) | 0.853 | - | - | |
Pelvic tilt | 1.05 (1.00–1.11) | 0.058 | - | - | |
Pelvic tilt ≥ 20 | 3.65 (1.20–13.59) | 0.032* | - | - | |
Sacral Slope | 0.96 (0.91–1.01) | 0.144 | - | - | |
Global lordosis | 0.95 (0.91–0.99) | 0.024* | - | - | |
SVA (mm) | 1.01 (0.98–1.03) | 0.574 | - | - | |
SVA ≥ 40 | NA | 0.997 | - | - | |
PI–LL | 1.03 (1.00–1.07) | 0.076 | - | - | |
PI–LL ≥ 10 | 3.74 (1.30–11.64) | 0.016* | - | - | |
LDI | 0.99 (0.97–1.02) | 0.596 | - | - | |
LDI groups (reference: 50–80) | - | - | - | - | |
LDI < 50 | 3.50 (1.08–11.70) | 0.036* | 3.37 (1.03–11.39) | 0.043* | |
LDI > 80 | 2.56 (0.50–10.75) | 0.213 | 2.72 (0.52–11.98) | 0.198 |