J Korean Orthop Assoc.  2019 Feb;54(1):1-8. 10.4055/jkoa.2019.54.1.1.

Surgical Decision for Elderly Spine Deformity Patient

• Kim YC
• Juh HS
• Lee K

• KMID: 2438951
• DOI: http://doi.org/10.4055/jkoa.2019.54.1.1

Abstract

Globally, the elderly population is increasing rapidly, which means that the number of deformity correction operations for elderly spine deformity patient has increased. On the other hand, for aged patients with deformity correction operation, preoperative considerations to reduce the complications and predict a good clinical outcome are not completely understood. First, medical comorbidity needs to be evaluated preoperatively with the Cumulative Illness Rating Scale for Geriatrics or the Charlson Comorbidity Index scores. Medical comorbidities are associated with the postoperative complication rate. Managing these comorbidities preoperatively decreases the complications after a spine deformity correction operation. Second, bone densitometry need to be checked for osteoporosis. Many surgical techniques have been introduced to prevent the complications associated with posterior instrumentation for osteoporosis patients. The preoperative use of an osteogenesis inducing agent - teriparatide was also reported to reduce the complication rate. Third, total body sagittal alignment need to be considered. Many elderly spine deformity patients accompanied degenerative changes and deformities at their lower extremities. In addition, a compensation mechanism induces the deformed posture of the lower extremities. Recently, some authors introduced a parameter including total body sagittal alignment, which can predict the clinical outcome better than previous parameters limited to the spine or pelvis. As a result, total body sagittal alignment needs to be considered for elderly spine deformity patients after a deformity correction operation. In conclusion, for elderly spine deformity patients, medical comorbidities and osteoporosis need to be evaluated and managed preoperatively to reduce the complication rate. In addition, total body sagittal alignment needs to be considered, which is associated with better clinical outcomes than the previous parameters limited to the spine or pelvis.

Keyword

elderly spine deformity patient; deformity correction operation; osteoporosis; medical comorbidity; total body sagittal alignment

MeSH Terms

Aged*
Comorbidity
Compensation and Redress
Congenital Abnormalities*
Densitometry
Geriatrics
Hand
Humans
Lower Extremity
Osteogenesis
Osteoporosis
Pelvis
Postoperative Complications
Posture
Spine*
Teriparatide
Teriparatide

Figure

• 

  Figure 1 (A) Postoperative simple radiography of a 72-year-old female after 2 weeks of L1-S1 anterior interbody fusion and T10-S1 posterior fixation. (B) Postoperative simple radiography after 4 weeks with a T10 fracture (Circle indicated recent T10 vertebral fracture with vertebral height loss.). (C) Postoperative simple radiography after 2 months with conservative treatment (teriparatide and brace apply) (Circle indicated no change of healed T10 vertebral fracture.). (D, E) Postoperative simple radiography (Circle indicated no change of healed T10 vertebral fracture.) and computed tomography after 2 months with a healed fracture (Arrow indicated healed T10 vertebral fracture.).

• 

  Figure 2 (A) Postoperative simple radiography of an 80-year-old female 8 months after L3-S1 anterior interbody fusion and L1-S1 posterior fixation, presents proximal junction failure and kyphosis. (B) The patient underwent a T12 posterior vertebral column resection and T9-L1 posterior rod extension.

• 

  Figure 3 Schematic drawing depicting the 5 landmarks used in the novel parameters for an assessment of the total body sagittal alignment. Center of gravity of the head (a), sacrum (b), hip (c), knee (d), and ankle (e). Cited from the article of Kim et al. (Eur Spine J. 2017;26:2167-75).50)

• 

  Figure 4 Schematic diagram showing the four distance parameters for an assessment of total body sagittal alignment. CrSVA-S (1); CrSVA-H (2); CrSVA-K (3); CrSVA-A or ‘global SVA’ (4). CrSVA-S indicates cranial sagittal vertical axis-sacrum; -H, -hip; -K, -knee; -A, -ankle. The CrSVA is a perpendicular line from the cranial center of mass (defined as the midpoint of the nasion-inion line, above and slightly in front of the external auditory meatus). Cited from the article of Kim et al. (Eur Spine J. 2017;26:2167-75).50)

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