Anales de la RANM

186 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 THORACOLUMBAR ROTATIONAL KYPHOSIS Pizones J, et al. An RANM. 2022;139(02): 186 - 195 THE IMPACT OF ADULT SCOLIOSIS SURGICAL CORRECTION ON THORACOLUMBAR ROTATIONAL KYPHOSIS EL DESTINO DE LA CIFOSIS ROTACIONAL TORACOLUMBAR TRAS CIRUGÍA DE CORRECCIÓN EN ESCOLIOSIS DEL ADULTO Javier Pizones 1 ; Francisco Javier Sánchez Perez-Grueso 1 ; Lucía Moreno-Manzanaro 1 ; Ibrahim Obeid 2 ; Frank Kleinstück 3 ; Ahmet Alanay 4 ; Ferran Pellisé 5 ; on behalf of the European Spine Study Group 6 1 Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain 2 Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France 3 Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland 4 Acibadem Mehmet Ali Aydinlar University, Department of Orthopedics and Traumatology, Istanbul, Turkey 5 Spine Surgery Unit, Hospital Universitario Vall d’Hebron, Barcelona, Spain 6 Spine Research Unit, Vall d’Hebron Institute of Research, Barcelona, SpainAcadémico correspondiente de la Reial Acadèmia de Medicina de Catalunya, Barcelona Abstract Objective: Adult scoliosis (AS) is often associated with rotational thoracolumbar (TL) kyphosis. The impact of surgical correction on lumbar sagittal distribution, ideal sagittal plane matching, and mechanical complications is still underexplored. Methods: In this retrospective study, prospectively collected data were analyzed from a multicenter adult deformity database. Inclusion criteria were surgical patients with AS and TL/L curves > 30°, T10-L2 sagittal kyphosis (TLK) > 20°, and at least a 2-year follow-up. We analyzed preoperative and postoperative variables and studied the consequences of TL sagittal change on ideal type mismatch and on mechanical compli- cations using univariate and multivariate logistic regression analyses, and compared patients with high pelvic incidence (PI > 50°) versus those with low PI (PI < 50°). Results: A total of 171 patients were included. The TLK segment flattened by a mean of 20° after surgery. The residual TLK kyphosis matched that expected by PI. The TL sagittal change was not directly associated with complications or ideal shape mismatch. Mechanical complications were associated only with older age and pelvic instrumenta- tion. Patients with low and high PI were found to have similar Cobb angle correction, TLK correction, and rate of mechanical complications. However, it was more challen- ging to restore an ideal sagittal profile in patients with high PI and in patients fused to the pelvis. Conclusions: Surgical correction of adult TL scoliosis flattens the TL segment by about 20°, automatically adjusting to the ideal parameters dictated by patients’ PI. The TL segment change lengthens the upper lumbar arc by one segment, shifting the inflec- tion point cranially. However, this change has no direct impact on mechanical compli- cations or final sagittal shape matching. Resumen Objetivos: La escoliosis del adulto asocia con frecuencia una cifosis toracolumbar (TL) rotacional. Desconocemos el efecto que produce su corrección quirúrgica con respecto a la distribución de la lordosis, el ajuste con el plano sagital ideal y las compli- caciones mecánicas. Métodos: Análisis retrospectivo de datos recogidos de manera prospectiva de una base de datos de deformidad del adulto. Incluimos pacientes tratados quirúrgicamente por curvas TL/lumbares > 30°, con cifosis T10-L2 (CTL) > 20° y al menos dos años de seguimiento. Analizamos variables preoperatorias y postoperatorias, estudiando las consecuencias derivadas del cambio sagital del segmento TL con respecto al desajuste del tipo sagital ideal y a las complicaciones mecánicas usando análisis univariante y multivariante de regresión logística. Comparamos pacientes con incidencia pélvica alta (PI > 50°) vs baja (PI < 50°). Resultados: Incluimos 171 pacientes. El segmento de CTL se aplanaba una media de 20° con la cirugía. La cifosis TL residual se ajustaba a la ideal esperada por la Keywords: Adult Scoliosis; Scoliosis Correction; Sagittal Plane; Thoracolumbar Kyphosis; Lordosis Distribution; Mechanical Complications. Palabras clave: Escoliosis del Adulto; Corrección de la Escoliosis; Plano Sagital; Cifosis Toracolumbar; Distribución de la Lordosis; Complicaciones Mecánicas. Autor para la correspondencia Javier Pizones Departamento de Cirugía Ortopédica y Traumatología, Hospital La Paz. Paseo de la Castellana, 261 · 28046. Madrid, Spain. Tlf.: +34 616 644 876 | E-Mail: javierpizones@gmail.com DOI: 10.32440/ar.2022.139.02. org02 O R I G I N A L Enviado: 26.04.22 | Revisado: 30.04.22 | Aceptado: 14.05.22