Re: New Research of Interest-Ken

[Guest guest]

Ken,

This posting is an example of the kind of information that you can use to learn from published research what experience your prospective surgeon might have. It is why I advocate the "hard way" of selecting a surgeon!

Here in red is how I might read this abstract:

SUMMARY OF BACKGROUND DATA: To our knowledge, no study onpostoperative sagittal balance following long adult spinalinstrumentation and fusion to L5 or S1 has been published. METHODS: Aclinical and radiographic assessment of 80 patients (Hmmmm, these guys have managed the surgeries of at least 80 patients fused to L5 or to S-1)with adult lumbardeformity (average age 53.4 years) who underwent long (average 7.6vertebrae, 5-11 vertebrae) segmenta (and geez, they have been following them for 8 years...so they have been pefecting their technique for at least that long)l posterior spinal instrumentation and fusion from the thoracolumbar spine to the L5-S1 (average 4.5years, 2-15.8-year follow-up( ) was performed.....

later..

Risk factors that were statistically significant for the suboptimal sagittal balance group> included pelvic incidence compared with lumbar lordosis (> or = 45> degrees) before surgery (vs. < 45 degrees, P = 0.009), smaller lumbar> lordosis compared with thoracic kyphosis (< 20 degrees) at 8 weeks> postoperatively (vs. > or = 20 degrees, P = 0.013) (hmmm...these are factors I can't control myself....they are factors that a well qualified surgeon has to figure out but, and older than 55> years of age at surgery I can decide to have my surgery before I am 55..(vs. 55 years or younger, P = 0.024).

Full text again is below. Sorry if it is confusing.

Take Care, Cam

>> pine. 2006 Sep 15;31(20):2343-52.> An analysis of sagittal spinal alignment following long adult> lumbar instrumentation and fusion to L5 or S1: can we predict ideal> lumbar lordosis?> > * Kim YJ,> * Bridwell KH,> * Lenke LG,> * Rhim S,> * Cheh G.> > Washington University Medical Center, St. Louis, MO, USA.> > STUDY DESIGN: A retrospective study. OBJECTIVE: To determine> factors controlling sagittal spinal balance after long adult lumbar> instrumentation and fusion from the thoracolumbar spine to L5 or S1.> SUMMARY OF BACKGROUND DATA: To our knowledge, no study on> postoperative sagittal balance following long adult spinal> instrumentation and fusion to L5 or S1 has been published. METHODS: A> clinical and radiographic assessment of 80 patients with adult lumbar> deformity (average age 53.4 years) who underwent long (average 7.6> vertebrae, 5-11 vertebrae) segmental posterior spinal instrumentation> and fusion from the thoracolumbar spine to the L5-S1 (average 4.5> years, 2-15.8-year follow-up) was performed. We defined the optimal> sagittal balance (n = 42) group, the distance from C7 plumb to> superior posterior endplate of S1 < or = 3.0 cm, and the suboptimal> sagittal balance (n = 38) group, the distance from C7 plumb to> superior posterior endplate of S1 > 3.0 cm at ultimate follow-up.> RESULTS: The optimal sagittal balance group (C7 plumb, average -0.6> +/- 2.5 cm) had the larger average angle differences between lumbar> lordosis and thoracic kyphosis (P < 0.0001), preoperative smaller> pelvic incidence (P = 0.007), smaller average thoracolumbar junctional> angle (T10-L2) increase (P < 0.0001), and bigger lumbar lordosis angle> increase (P = 0.014) at ultimate follow-up. Patients with optimal> sagittal balance at ultimate follow-up had significantly higher total> Scoliosis Research Society 24 outcome scores than those with> suboptimal sagittal balance (P = 0.015). Risk factors that were> statistically significant for the suboptimal sagittal balance group> included pelvic incidence compared with lumbar lordosis (> or = 45> degrees) before surgery (vs. < 45 degrees, P = 0.009), smaller lumbar> lordosis compared with thoracic kyphosis (< 20 degrees) at 8 weeks> postoperatively (vs. > or = 20 degrees, P = 0.013), and older than 55> years of age at surgery (vs. 55 years or younger, P = 0.024).> CONCLUSION: A sagittal Cobb angle difference between lumbar lordosis> and thoracic kyphosis of > 20 degrees (higher lumbar lordosis) is> advisable in most circumstances to achieve optimal sagittal balance.>