PMID- 28799837 OWN - NLM STAT- MEDLINE DCOM- 20171103 LR - 20171103 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 27 IP - 5 DP - 2017 Nov TI - Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: a meta-analysis. PG - 540-551 LID - 10.3171/2017.3.SPINE161134 [doi] AB - OBJECTIVE As life expectancy continues to increase, primary degenerative sagittal imbalance (PDSI) is diagnosed in an increasing number of elderly people. Although corrective surgery for this sagittal deformity is becoming more popular, the effectiveness of the procedure remains unclear. The authors aimed to collate the available evidence on the effectiveness and complications of deformity-correction surgery in patients with PDSI. METHODS The authors carried out a meta-analysis of clinical studies regarding deformity correction in patients with PDSI. The studies were identified through searches of the PubMed, Embase, Web of Science, and Cochrane databases. Surgery outcomes were evaluated and overall treatment effectiveness was assessed in terms of the minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) values and pain levels according to visual analog scale (VAS) scores and in terms of restoration of spinopelvic parameters to within a normal range. Data are expressed as mean differences with 95% CIs. RESULTS Ten studies comprising 327 patients were included. The VAS and ODI values improved after deformity-correction surgery. The smallest treatment effect exceeded the MCID for VAS values (4.15 [95% CI 3.48-4.82]) but not for ODI values (18.11 [95% CI 10.99-25.23]). At the final follow-up visit, the mean lumbar lordosis angle (-38.60 degrees [95% CI -44.19 degrees to -33.01 degrees ]), thoracic kyphosis angle (31.10 degrees [95% CI 24.67 degrees -37.53 degrees ]), C-7 sagittal vertical axis (65.00 mm [95% CI 35.27-94.72 mm]), and pelvic tilt angle (30.82 degrees [95% CI 24.41 degrees -37.23 degrees ]) remained outside their normal ranges. Meta-regression analyses revealed a significant effect of ODI change in relation to lumbar lordosis change (p = 0.004). After a mean of 2 years after deformity correction, the mean lumbar lordosis angle and C-7 sagittal vertical axis decreased by 5.82 degrees and 38.91 mm, respectively, and the mean thoracic kyphosis angle increased by 4.7 degrees . The incidences of proximal junctional kyphosis and pseudarthrosis were 23.7% and 12.8%, respectively. CONCLUSIONS Deformity correction substantially relieves back pain for about 2 years in adult patients with PDSI. Sufficient surgical restoration of lumbar lordosis can lead to substantial improvement in patient disability and reduced decompensation. Deformity correction represents a viable therapeutic option for patients with PDSI, but further technical advancements are necessary to achieve sufficient lumbar lordosis and reduce complication rates. FAU - Lee, Chang-Hyun AU - Lee CH AD - Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang. FAU - Chung, Chun Kee AU - Chung CK AD - Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine. AD - Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul. FAU - Jang, Jee-Soo AU - Jang JS AD - Department of Neurosurgery, Nanoori Suwon Hospital, Suwon. FAU - Kim, Sung-Min AU - Kim SM AD - Department of Neurosurgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul. FAU - Chin, Dong-Kyu AU - Chin DK AD - Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul. FAU - Lee, Jung-Kil AU - Lee JK AD - Department of Neurosurgery, Chonnam University Hospital, Chonnam University College of Medicine, Gwangju. FAU - Yoon, Seung Hwan AU - Yoon SH AD - Department of Neurosurgery, Inha University Hospital, Inha University College of Medicine, Incheon. FAU - Hong, Jae Taek AU - Hong JT AD - Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon. FAU - Ha, Yoon AU - Ha Y AD - Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, Seoul; and. FAU - Kim, Chi Heon AU - Kim CH AD - Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine. AD - Clinical Research Institute, Seoul National University Hospital. FAU - Hyun, Seung-Jae AU - Hyun SJ AD - Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. LA - eng PT - Journal Article PT - Meta-Analysis DEP - 20170811 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Humans MH - Spinal Curvatures/*surgery OTO - NOTNLM OT - LL = lumbar lordosis OT - MCID = minimum clinically important difference OT - ODI = Oswestry Disability Index OT - PDSI = primary degenerative sagittal imbalance OT - PI = pelvic incidence OT - PJK = proximal junctional kyphosis OT - PT = pelvic tilt OT - SVA = sagittal vertical axis OT - TK = thoracic kyphosis OT - VAS = visual analog scale OT - deformity OT - degenerative OT - imbalance OT - lumbar OT - meta-analysis OT - sagittal EDAT- 2017/08/12 06:00 MHDA- 2017/11/04 06:00 CRDT- 2017/08/12 06:00 PHST- 2017/08/12 06:00 [pubmed] PHST- 2017/11/04 06:00 [medline] PHST- 2017/08/12 06:00 [entrez] AID - 10.3171/2017.3.SPINE161134 [doi] PST - ppublish SO - J Neurosurg Spine. 2017 Nov;27(5):540-551. doi: 10.3171/2017.3.SPINE161134. Epub 2017 Aug 11.