• Peter G Passias, Samantha R Horn, Nicholas J Frangella, Gregory W Poorman, Dennis Vasquez-Montes, Bassel G Diebo, Cole A Bortz, Frank A Segreto, John Y Moon, Peter L Zhou, Shaleen Vira, Akhila Sure, Bryan Beaubrun, Jared C Tishelman, Subaraman Ramchandran, Cyrus M Jalai, Wesley Bronson, Charles Wang, Virginie Lafage, Aaron J Buckland, and Thomas J Errico.
• Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York, USA. Electronic address: Peter.Passias@nyumc.org.
• World Neurosurg. 2018 Jun 1; 114: e775-e784.

BackgroundPrevious studies have built a foundation for understanding compensation in patients with adult spinal deformity (ASD) by using full-body stereographic assessments. These mechanisms, in relation to age-adjusted alignment targets, have yet to be studied fully. The aim of this study was to assess lower-limb compensatory mechanisms of patients failing to meet age-adjusted alignment goals.MethodsPatients with ASD ≥40 years with full body baseline and follow-up radiographs were included. Patients were stratified by age (40-65 years, >65 years) and spinopelvic correction. Lower-limb compensation parameters (pelvic shift, hip extension, knee flexion [KA], ankle flexion [AA], and global sagittal angle [GSA]) for patients who matched and failed to match age-adjusted alignment targets were compared with analysis of variance and t-test analysis.ResultsIn total, 108 patients were included. At 1 year, AA increased with age in the "match" pelvic tilt (PT) and spinopelvic mismatch (PI-LL) cohorts (PT: AA, 5.6-7.8, P = 0.041; PI-LL: 4.9-8.8, P = 0.026). KA, AA, and GSA increased with age in the "match" sagittal vertical axis (SVA) cohort (KA: 3.8-13.1, P = 0.002; AA: 5.8-10.2, P = 0.008; GSA: 3.9-7.8, P < 0.001), as did KA and GSA in the "match" T1 pelvic angle group (KA: 1.8-8.7, P = 0.020; GSA: 2.6-5.7, P = 0.004).ConclusionsGreater compensation captured by KA and GSA was associated with age progression in the "match" SVA and T1 pelvic angle cohorts. In addition, older SVA, PT, and PI-LL "match" cohorts used increased AA, suggesting that ideal postoperative alignment of aged individuals with ASD involves increased compensation.Copyright © 2018 Elsevier Inc. All rights reserved.

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