J Korean Neurosurg Soc.  2018 Nov;61(6):723-730. 10.3340/jkns.2018.0125.

Total Deformity Angular Ratio as a Risk Factor for Complications after Posterior Vertebral Column Resection Surgery

• Lee BH
• Hyun SJ
• Han S
• Jeon SI
• Kim KJ
• Jahng TA
• Kim HJ

• KMID: 2428114
• DOI: http://doi.org/10.3340/jkns.2018.0125

Abstract

OBJECTIVE
The aim of the present study was to identify whether the deformity angular ratio (DAR) influences the occurrence of complications after posterior vertebral column resection (PVCR) and to establish the DAR cut-off value.
METHODS
Thirty-six consecutive patients undergoing PVCR from December 2010 to October 2016 were reviewed. The relationships between the total, sagittal, and coronal DAR and complications were assessed using receiver operator characteristics curves. The patients were divided into two groups according to a reference value based on the cut-off value of DAR. Demographic, surgical, radiological, and clinical outcomes were compared between the groups.
RESULTS
There were no significant differences in the patient demographic and surgical data between the groups. The cut-off values for the total DAR (T-DAR) and the sagittal DAR (S-DAR) were 20.2 and 16.4, respectively (p=0.018 and 0.010). Both values were significantly associated with complications (p=0.016 and 0.005). In the higher T-DAR group, total complications (12 vs. 21, p=0.042) and late-onset complications (3 vs. 9, p=0.036) were significantly correlated with the T-DAR. The number of patients experiencing complications (9 vs. 11, p=0.029) and the total number of complications (13 vs. 20, p=0.015) were significantly correlated with the S-DAR. Worsening intraoperative neurophysiologic monitoring was more frequent in the higher T-DAR group (2 vs. 4) than in the higher S-DAR group (3 vs. 3). There was no difference in neurological deterioration between the groups after surgery.
CONCLUSION
Both the T-DAR and the S-DAR are risk factors for complications after PVCR. Those who had a T-DAR >20.2 or S-DAR >16.4 experienced a higher rate of complications after PVCR.

Keyword

Posterior; Vertebral column; Deformity; Risk factors; Complications

MeSH Terms

Congenital Abnormalities*
Humans
Intraoperative Neurophysiological Monitoring
Reference Values
Risk Factors*
Spine*

Figure

• 

  Fig. 1. The DAR. A case of 103.52° scoliosis from T9 to L3 (7 vertebrae) and 101.49° kyphosis from T9 to L2 (6 vertebrae). A : C-DAR is 14.79 (103.52 divided by 7). B : S-DAR is 16.92 (101.49 divided by 6). T-DAR is 31.71 (T-DAR=C-DAR+S-DAR; 24.54=14.79+16.92). DAR : deformity angular ratio, C-DAR : coronal-DAR, S-DAR : sagittal-DAR, T-DAR : total-DAR.

• 

  Fig. 2. The ROC curve for the DAR. The area under the ROC curve is 0.731 (T-DAR), 0.753 (S-DAR), and 0.600 (C-DAR). DAR : deformity angular ratio, ROC : receiver operator characteristics, C-DAR : coronal-DAR, S-DAR : sagittal-DAR, T-DAR : total-DAR.

Reference

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