• Sleiman Haddad, Eva Jacobs, Susana Núñez Pereira, Aleix Ruiz de Villa, Anika Pupak, Maggie Barcheni, Manuel Ramírez Valencia, Javier Pizones, Frank S Kleinstück, Francisco Sánchez Pérez Grueso, Ahmet Alanay, Ibrahim Obeid, Ferran Pellisé, and European Spine Study Group.
• Spine Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain.
• Spine. 2024 Sep 5.

Study DesignRetrospective analysis of a prospective multicenter Adult Spinal Deformity (ASD) registry.ObjectiveAssess whether spinal alignment deteriorates post-surgery in absence of mechanical complications and evaluate the long-term outcomes of ASD surgery over a five-year period.Summary Of Background DataASD is prevalent among older adults, leading to significant pain and disability. Surgical intervention, although increasingly popular, is associated with complications, high costs, and uncertain long-term outcomes beyond two years. Mechanical failure and alignment loss often necessitate revision surgeries, but the natural progression of spinal alignment post-surgery without complications remains unclear.MethodsClinical and radiological data were analyzed from surgical patients in a multicenter ASD registry who maintained alignment within the instrumented region and completed a 5-year follow-up. The study evaluated patient demographics, surgical details, radiological parameters, and quality of life (QoL) outcomes. Sub-analyses were conducted to compare patients with different initial postoperative alignments and fixation levels.ResultsThe study included 79 patients (83.5% women, average age 61.9 years) with a mean of 10.7 fused levels. Of these, 29.1% underwent three-column osteotomies (3CO), and 88.6% had a posterior-only approach. While 65% showed favorable alignment at 6 weeks post-surgery, there was a progressive deterioration in global sagittal alignment (Global Tilt/RSA) and thoracic kyphosis over five years (P<0.05), along with increased pelvic compensation (PT SS/RPV). These changes did not correlate with worsening Health-Related Quality of Life outcomes (P>0.05). Older age was linked to greater progression in T2-T12 kyphosis, and osteoporosis was associated with increased SVA and RPV. Optimal immediate postoperative sagittal alignment did not prevent this "aging effect."ConclusionsASD surgery and achieving ideal postoperative alignment do not prevent the ongoing "aging" of the non-instrumented spine. Both thoracic and global sagittal alignments deteriorate over time. Although no functional decline has been observed, the implications of these changes for surgical planning remain uncertain.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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