Dataset Information

Evaluation of Sagittal Spinopelvic Balance in Spinal Cord Stimulator Patients.

ABSTRACT:

Objective

Spinal cord stimulation (SCS) has become a popular nonopioid pain intervention. However, the treatment failure rate for SCS remains significantly high and many of these patients have poor sagittal spinopelvic balance, which has been found to correlate with increased pain and decreased quality of life. The purpose of this study was to determine if poor sagittal alignment is correlated with SCS treatment failure.

Materials and methods

Comparative retrospective analysis was performed between two cohorts of patients who had undergone SCS placement, those who had either subsequent removal of their SCS system (representing a treatment failure cohort) and those that underwent generator replacement (representing a successful treatment cohort). The electronic medical record was used to collect demographic and surgical characteristics, which included radiographic measurements of lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Also included were data on pain medication usage including opioid and nonopioid therapies.

Results

Eighty-one patients met inclusion criteria, 31 had complete removal, and 50 had generator replacements. Measurement of sagittal balance parameters demonstrated that many patients had poor alignment, with 34 outside normal range for LL (10 vs 24 in removal and replacement cohorts, respectively), 30 for PI (12 [38.7%] vs 18 [36.0%]), 46 for PT (18 [58.1%] vs 28 [56.0%]), 38 for SS (18 [58.1%] vs 20 [40.0%]), and 39 for PI-LL mismatch (14 [45.2%] vs 25 [50.0%]). There were no significant differences in sagittal alignment parameters between the two cohorts.

Conclusions

This retrospective cohort analysis of SCS patients did not demonstrate any relationship between poor sagittal alignment and failure of SCS therapy. Further studies of larger databases should be performed to determine how many patients ultimately go on to have additional structural spinal surgery after failure of SCS and whether or not those patients go on to have positive outcomes.

SUBMITTER: Woodroffe RW

PROVIDER: S-EPMC8655314 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

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Publications

Evaluation of Sagittal Spinopelvic Balance in Spinal Cord Stimulator Patients.

Woodroffe Royce W RW Perez Eli A EA Seaman Scott C SC Park Brian J BJ Nockels Russ P RP Howard Matthew A MA Wilson Saul S

Neuromodulation : journal of the International Neuromodulation Society 20210609 5

<h4>Objective</h4>Spinal cord stimulation (SCS) has become a popular nonopioid pain intervention. However, the treatment failure rate for SCS remains significantly high and many of these patients have poor sagittal spinopelvic balance, which has been found to correlate with increased pain and decreased quality of life. The purpose of this study was to determine if poor sagittal alignment is correlated with SCS treatment failure.<h4>Materials and methods</h4>Comparative retrospective analysis was ...[more]

PMID: 35803682

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Project description:IntroductionSagittal balance and fatty infiltration of paraspinal muscle are important factors in patients with lumbar spinal stenosis (LSS) that may affect patients' quality of life. Sagittal spinopelvic parameters and fatty infiltration may be associated with the severity of LSS. The purpose of this study was to test the hypothesis that severity of fatty infiltration correlates with severity of LSS and with sagittal pelvic alignment independent of age.MethodsAge and body mass index (BMI) were extracted. Fatty infiltration was rated according to Goutallier classification and the severity of LSS was graded according to Schizas at five intervertebral disc levels. Overall fatty infiltration was computed as average fatty infiltration (aFI) and severity of LSS was defined as the highest severity of LSS of all segments. The sagittal spinopelvic parameters pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL) and PI-LL were measured. Associations among parameters were assessed using Spearman correlation coefficients adjusted for age (α = 0.05).Results165 LSS patients with a median age of 69 years were included. All parameters correlated with age (R>0.162, P<0.05) except BMI and LL (R<0.007, P>0.05). aFI correlated with PI, PT and PI-LL before (R>0.371, P<0.05) and after (R>0.180, P<0.05) adjusting for age. Severity of LSS correlated with PI, PT and PI-LL before (R>0.187, P<0.05) but not after (R<0.130, P>0.05) adjusting for age. aFI correlated with severity of LSS before (R=0.349, P<0.05) but not (R=0.114, P>0.05) after adjusting for age.ConclusionsThe correlation of aFI with sagittal spinopelvic parameters indicates that there might be a relationship between muscle characteristics and the sagittal alignment. Sagittal spinopelvic parameters and fatty infiltration of paraspinal muscles are not associated with radiological severity of LSS. Whether they are associated with clinical manifestation of LSS remains to be investigated.

Project description:ImportanceThe results of studies evaluating spinal cord stimulation (SCS) for postlaminectomy syndrome (PLS) have yielded mixed results. This has led to an increased emphasis on objective outcome measures such as opioid prescribing.ObjectiveTo determine the association between SCS and long-term opioid therapy (LOT) for PLS.Design, setting, and participantsIn this cohort study, adults with PLS were identified using the TriNetx Diamond Network and separated based on whether they underwent SCS. Patients were stratified according to baseline opioid use (opioid-naive or receiving LOT) and subsequent opioid therapy over the 12-month period ranging from 3 to 15 months post-SCS implantation or post-PLS index date. Statistical analysis was performed from June to December 2021.ExposureSCS.Main outcomes and measuresThe main outcome was cessation of opioid use among patients receiving LOT or abstinence from opioids among opioid-naive patients. Opioid-naive patients were defined as those receiving at most 2 opioid prescriptions per year, and patients on LOT were those receiving at least 6 opioid prescriptions per year.ResultsAmong 552 937 eligible patients treated between December 2015 and May 2021, 26 179 with PLS received an SCS implant. The median (IQR) patient age was 60 (51-69) years; 305 802 patients (55.3%) were female. Among those reporting racial identify (37.0% [204 758 patients]), 9.3% (18 971 patients) were African American, 0.3% (648 patients) were Asian, and 90.4% (185 139 patients) were White. Compared with those who did not receive an SCS, individuals who received an SCS were more likely to be using opioids preimplantation (mean [SD] prescriptions: 4.3 [8.5] vs 4.1 [9.3]; P < .001) but less likely to be using opioids after SCS implantation (mean [SD] prescriptions: 3.8 [8.2] vs 4.0 [9.4]; P = .006). In the 12-month study period, similar proportions in the SCS and no-SCS groups receiving baseline LOT remained on LOT (70.3% [n = 74 585] vs 69.2% [n = 3882], respectively; P = .10). In opioid-naive patients, SCS was associated with a small decreased likelihood of patients subsequently receiving LOT (7.6% vs 7.0%; difference, -0.6% [95% CI, -1.0% to -0.2%]; P = .003). In multivariable analysis, SCS was associated with an increased likelihood of not being on opioids in both opioid-naive (adjusted odds ratio [OR], 0.90 [95% CI, 0.85-0.96]; P < .001) and LOT patients (adjusted OR, 0.93 [95% CI, 0.88-0.99]; P = .02). White patients were significantly more likely to be diagnosed with PLS (ie, underwent surgery) (90.4% vs 85.2%; difference, 5.2% [95% CI, 5.1%-5.4%]; P < .001) and receive an SCS (93.7% vs 90.3%; difference, 3.4% [95% CI, 2.9% to 4.0%]; P < .001) than patients of other racial identities.Conclusions and relevanceThese findings suggest that under real-life conditions, SCS was associated with small, clinically questionable associations with opioid discontinuation and not starting opioids in the context of PLS.

Project description:BackgroundTotal hip arthroplasty (THA) instability is influenced by acetabular component positioning, spinopelvic function and sagittal spinal alignment. Obesity is considered as a risk factor of THA instability, but the causal relationship remains unknown. This study aimed to investigate the influence of BMI on (1) spinopelvic function (lumbar flexibility, pelvic mobility and hip motion), (2) sagittal spinal alignment pre- and postoperatively and (3) acetabular cup position postoperatively in primary THA patients in a prospective setting.MethodsOne hundred ninety patients receiving primary total hip arthroplasty were enrolled in a prospective cohort study and retrospectively analysed. All patients received stereoradiography (EOS) in standing and relaxed sitting position pre-and postoperatively. C7-sagittal vertical axis (C7-SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), anterior plane pelvic tilt (APPT), and pelvic femoral angle (PFA) were assessed. Key parameters of the spinopelvic function were defined as lumbar flexibility (∆ LL = LLstanding - LLsitting), pelvic mobility (∆ PT = PTstanding - PTsitting) and hip motion (∆ PFA = PFAstanding - PFAsitting). Pelvic mobility was further defined based on ∆ PT as stiff, normal and hypermobile (∆ PT < 10°; 10°-30°; > 30°). The patients were stratified to BMI according to WHO definition: normal BMI ≥ 18.5-24.9 kg/m2 (n = 68), overweight ≥ 25.0-29.9 kg/m2 (n = 81) and obese ≥ 30-39.9 kg/m2 (n = 41). Post-hoc analysis according to Hochberg's GT2 was applied to determine differences between BMI groups.ResultsStanding cup inclination was significant higher in the obese group compared to the normal BMI group (45.3° vs. 40.1°; p = 0.015) whereas standing cup anteversion was significantly decreased (22.0° vs. 25.3°; p = 0.011). There were no significant differences for spinopelvic function key parameter lumbar flexibility (∆ LL), pelvic mobility (∆ PT) and hip motion (∆ PFA) in relation to BMI stratified groups. The obese group demonstrated significant enhanced pelvic retroversion compared to the normal BMI group (APPT - 1.8° vs. 2.4°; p = 0.028). The preoperative proportion of stiff pelvic mobility was decreased in the obese group (12.2%) compared to normal (25.0%) and overweight (27.2%) groups. Spinal sagittal alignment in C7-SVA and PI-LL mismatch demonstrated significantly greater imbalance in the obese group compared to the normal BMI group (68.6 mm vs. 42.6 mm, p = 0.002 and 7.7° vs. 1.2°, p = 0.032, respectively) The proportion of patients with imbalanced C7-SVA was higher in the obese (58.5%) than in the normal BMI group (44.1%).ConclusionsThe significantly increased spinal sagittal imbalance with altered pelvic mechanics is a potential cause for the reported increased risk of THA dislocations in obese patients. Consequently, the increased spinal sagittal imbalance in combination with normal pelvic mobility need to be taken into account when performing THA in obese patients.

Project description:Background:This study aims to determine if (1) loss of lumbar lordosis (LL), often associated with degenerative scoliosis (DS), is structural or rather largely due to positional factors secondary to spinal stenosis; (2) only addressing the symptomatic levels with a decompression and posterolateral fusion in carefully selected patients will result in improvement of sagittal malalignment; and (3) degree of sagittal plane correction achieved with such a local fusion could be predicted by routine pre-operative imaging. Methods:A retrospective study design with prospectively collected imaging data of a consecutive series of surgically treated DS patients who underwent decompression and instrumented fusion at only symptomatic levels was performed. Pre- and post-operative plain radiographs and pre-operative magnetic resonance imaging (MRIs) of the spinopelvic region were analyzed. LL, pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were assessed in all patients. As a requirement for the surgical strategy, all patients presented with a pre-operative PI-LL mismatch greater than 10°. Post-operative complications were assessed. Results:Pre-operative MRIs and lumbar extension radiographs revealed a mean LL of 42° (range 10-66°) and 48° (range 20-74°), respectively, in 68 patients (mean follow-up 29?months). LL post-operatively was corrected to a mean PI-LL of 10°. Of patients who achieved PI-LL mismatch within 10o on their pre-operative extension lateral lumbar radiographs, 62.5% were able to maintain a PI-LL mismatch within 10° on their initial post-operative films. Only 37.5% were not able to achieve that mismatch on extension radiographs (p?=?0.001, OR?=?9.58). Similarly, 54.2% were able to achieve a PI-LL?<?10° on initial post-operative radiographs, when pre-operative MRI revealed a PI-LL mismatch within 10°. In contrast, only 20.5% achieved that goal post-operatively if their mismatch was greater than 10o on their MRI (p?=?0.003, OR?=?4.25). Conclusion:With a decompression and instrumented fusion of only the symptomatic levels in symptomatic DS patients, we were able to achieve a PI-LL mismatch to within 10°. The loss of LL observed pre-operatively may be largely positional rather than structural. The amount of LL correction observed immediately after surgery can be predicted from pre-operative lumbar extension radiographs and supine sagittal MRI.

Dataset Information

Evaluation of Sagittal Spinopelvic Balance in Spinal Cord Stimulator Patients.

Objective

Materials and methods

Results

Conclusions

Publications

Evaluation of Sagittal Spinopelvic Balance in Spinal Cord Stimulator Patients.

Similar Datasets

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