713448 - Mitigating Pelvic Non-response to Surgery by Incorporating BMI into Alignment Targets for Operative Adult Spinal Deformity Patients

Thursday, February 27, 2020

8:10 AM – 8:15 AM

Location: 208

Participants should be aware of the following financial/non-financial relationships:

Michael J. Moses, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Peter G. Passias, MD: AlloSource (Individual(s) Involved: Self, Products/Services: Financial Support): Financial Support; Globus Medical (Individual(s) Involved: Self, Products/Services: Paid Presenter or Speaker): Paid Presenter or Speaker; Medicrea (Individual(s) Involved: Self, Products/Services: N/a): Paid consultant; SpineWave (Individual(s) Involved: Self, Products/Services: Paid Consultant): Paid consultant; The Cervical Spine Research Society (Individual(s) Involved: Self, Products/Services: Grant): Grant; Zimmer Biomet (Individual(s) Involved: Self, Products/Services: Paid Presenter or Speaker): Paid Presenter or Speaker

Cole Bortz, BA: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Avery Brown: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Haddy Alas, BS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Katherine E. Pierce, BS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Aaron J. Buckland, MD: EOS imaging (Individual(s) Involved: Self, Products/Services: Consultancy): Consultancy; Medtronic (Individual(s) Involved: Self, Products/Services: Consultancy): Consultancy; NuVasive (Individual(s) Involved: Self, Products/Services: Consultancy): Consultancy; Stryker Spine (Individual(s) Involved: Self, Products/Services: Consutancy): Consultancy

Frank Schwab, MD: Globus Medical (Individual(s) Involved: Self, Products/Services: product design): consulting; International Spine Study Group (Individual(s) Involved: Self, Products/Services: n/a): advisory board; K2 Medical, LLC (Individual(s) Involved: Self, Products/Services: Royalties): Royalties; Medicrea (Individual(s) Involved: Self, Products/Services: n/a): Royalties; Medtronic (Individual(s) Involved: Self, Products/Services: Royalties): Royalties

Renaud Lafage, MS: Nemaris (Individual(s) Involved: Self, Products/Services: Ownership interest):

Irene Chern: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Waleed Ahmad, MS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Sara Naessig, BS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Brendan H. Jackson-Fowl, ScM: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Virginie Lafage, PhD: Depuy Spine (Individual(s) Involved: Self, Products/Services: n/a): Speaking/teaching arrangements; Globus Medical (Individual(s) Involved: Self, Products/Services: n/a): consulting; International Spine Study Group (Individual(s) Involved: Self, Products/Services: n/a): advisory board; NuVasive (Individual(s) Involved: Self, Products/Services: n/a): consulting

Background: Previous research shows that, compared to non-obese patients, obese patients with sagittal malalignment show less compensatory pelvic motion (perhaps from increased weight bearing in proximity to the pelvis, which physiologically restricts or exhausts pelvic motion). Though ideal age and BMI-specific sagittal alignment targets for surgical spine patients have recently been proposed, it is unclear whether meeting these targets is associated with superior lumbopelvic alignment outcomes.

Purpose: Compare alignment outcomes of ASD patients that meet age- and BMI-specific postop alignment goals to patients that do not.

Study Design/Setting: Single center retrospective review

Patient Sample: 136 patients

Outcome Measures: Sagittal alignment

Methods: Included: surgical ASD patients with full-spine x-ray imaging at baseline (BL) and early postop follow-up (30mg/m2) patients.

Results: Included: 146 ASD patients (61±14yr, 65% F, 27±7 kg/m2). Mean follow-up was 5±3 months. Overall preop alignment was: PT (27°±12), PI-LL (22°±20), SVA (79mm±67), TK (-35°±19), TPA (28°±15). At baseline, 27% of patients qualified as obese. Overall, mean fusion length was 11±4 levels, 89% of patients had posterior surgical approach, 11% had combined approach, and 86% of patients underwent osteotomy, including 50% pedicle subtraction osteotomy. Following surgery, the overall cohort showed significant improvement in alignment (PT, PI-LL, SVA, TK, TPA, all p<0.001); 23% of patients met age and BMI-specific ideal postop alignment for PT, 19% for SVA, 15% for PI-LL, and 27% for TPA. Patients that matched ideal postop PT alignment showed superior pre-to postop changes in SS (ideal: 15° vs non-ideal: 8°, p=0.007), PT (-7° vs -2°, p=0.007), and SVA (-65mm vs -36, p=0.007) than patients that did not reach ideal alignment. Patients that reached ideal TPA alignment also showed superior pre- to postop changes in PI-LL (p=0.004), SVA (p=0.005), and PT (p=0.016). There were significantly lower rates of pelvic non-responders for patients that reached ideal age- and BMI-adjusted postoperative alignment for PT (ideal: 24% vs non-ideal: 52%, p=0.004) and TPA (30% vs 51%, p=0.023). Obese showed signficantly lower rates of pelvic non-responders for patients that met ideal postop alignment for PT and TPA (both 25% vs 69%, p=0.009); non-obese patients did not.

Conclusions: Both overall and for patients with obesity undergoing ASD-corrective surgery, reaching age- and BMI-specific postop alignment targets was associated with significantly lower rates of pelvic non-response. These results suggest that BMI, in addition to age, should be incorporated into the planning of postop alignment.

Presenting Author(s)

Michael J. Moses, MD

Resident
NYU Langone Orthopaedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Peter G. Passias, MD

Associate Professor NYU School of Medicine
NYU Langone Orthopedic Hospital

Disclosure: AlloSource : Financial Support (Status: Ongoing); Globus Medical : Paid Presenter or Speaker (Status: Ongoing); Medicrea : Paid consultant (Status: Ongoing); SpineWave : Paid consultant (Status: Ongoing); The Cervical Spine Research Society : Grant (Status: Ongoing); Zimmer Biomet : Paid Presenter or Speaker (Status: Ongoing)
Cole Bortz, BA

Research Fellow
NYU Langone Orthopedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Avery Brown

Medical Student
NYU Langone Orthopedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Haddy Alas, BS

Medical Student
NYU Langone Orthopaedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Katherine E. Pierce, BS

Research Fellow
NYU Langone Orthopedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Aaron J. Buckland, MD

Associate Professor of Orthopedic Surgery, Director of Spine Research
NYU Langone Health

Disclosure: EOS imaging : Consultancy (Status: Ongoing); Medtronic : Consultancy (Status: Ongoing); NuVasive : Consultancy (Status: Ongoing); Stryker Spine : Consultancy (Status: Ongoing)
Frank Schwab, MD

attending surgeon
Hospital for Special Surgery

Disclosure: Globus Medical : consulting (Status: Ongoing); International Spine Study Group : advisory board (Status: Ongoing); K2 Medical, LLC : Royalties (Status: Ongoing); Medicrea : Royalties (Status: Ongoing); Medtronic : Royalties (Status: Ongoing)
Renaud Lafage, MS

Scientist
Hospital For Special Surgery

Disclosure: Nemaris (Individual(s) Involved: Self, Products/Services: Ownership interest):
Irene Chern

Research Assistant
NYU Langone Orthopaedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Waleed Ahmad, MS

N/A
NYU Langone Orthopedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Sara Naessig, BS

Researcher
New York University Langone Medical Center

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Brendan H. Jackson-Fowl, ScM

Intern
NYU Langone Orthopedic Spine Surgery

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Virginie Lafage, PhD

Senior Director Spine Research
Hospital for Special Surgery
Hospital for Special Surgery

Disclosure: Depuy Spine : Speaking/teaching arrangements (Status: Ongoing); Globus Medical : consulting (Status: Ongoing); International Spine Study Group : advisory board (Status: Ongoing); NuVasive : consulting (Status: Ongoing)