Publications by authors named "Virginie Lafage"
Article Synopsis
- The study investigates how different reasons for revision surgery in adult spinal deformity (ASD) patients affect their postoperative outcomes, revealing a high incidence of reoperations.
- A sample of 891 ASD patients was analyzed retrospectively, categorizing their revisions by cause, and assessing complications, radiographic results, and disability metrics.
- Findings suggest that different etiologies (mechanical, infection, wound, and SI pain) lead to varying outcomes, with mechanical issues showing less improvement over time compared to others.
Background And Objectives: The spectrum of patients requiring adult spinal deformity (ASD) surgery is highly variable in baseline (BL) risk such as age, frailty, and deformity severity. Although improvements have been realized in ASD surgery over the past decade, it is unknown whether these carry over to high-risk patients. We aim to determine temporal differences in outcomes at 2 years after ASD surgery in patients stratified by BL risk.
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- The study was a cross-sectional analysis aimed at evaluating if degenerative cervical myelopathy (DCM) contributes to the risk of major fragility fractures, particularly hip fractures, in older patients.
- Researchers targeted patients aged over 65 who had experienced hip fractures, finding that 15.6% showed signs of myelopathy, and the confirmed prevalence of DCM was estimated at 10.5%.
- The findings suggest that specific clinical signs such as hypertonic reflexes and cervical pain are important for diagnosing DCM, indicating a potentially significant link between DCM and hip fractures in the elderly.
Objective: The objective of this study was to identify baseline patient and surgical factors predictive of optimal outcomes in staged versus same-day combined-approach surgery.
Methods: Adult spinal deformity (ASD) patients with baseline and perioperative (by 6 weeks) data were stratified based on single-stage (same-day) or multistage (staged) surgery, excluding planned multiple hospitalizations. Means comparison analyses were used to assess baseline demographic, radiographic, and surgical differences between cohorts.
Unlabelled: BACKGROUND : The use of bone morphogenic protein (BMP-2) in adult spine deformity (ASD) surgery remains controversial more than two decades following its approval for clinical application in spine surgery. This study was performed to assess outcomes in patients undergoing ASD surgery with BMP application compared with a combination of bone marrow aspirate, cancellous bone chips and i-Factor.
Methods: This was a retrospective cohort study.
Purpose: To investigate the impact of the Global Alignment and Proportion (GAP) score components on patient outcomes in Adult Spine Deformity (ASD) surgery.
Methods: Patients included underwent assessment via the GAP score and its individual components: pelvic version (GAP PV), lumbar lordosis (GAP LL), lumbar distribution index (GAP LDI) and spinopelvic component (GAP SP). Multivariable analyses assessed the association between alignment in these components and clinical outcomes in ASD patients.
Aims: The aim of this study was to investigate the impact of the level of upper instrumented vertebra (UIV) in frail patients undergoing surgery for adult spine deformity (ASD).
Methods: Patients with adult spinal deformity who had undergone T9-to-pelvis fusion were stratified using the ASD-Modified Frailty Index into not frail, frail, and severely frail categories. ASD was defined as at least one of: scoliosis ≥ 20°, sagittal vertical axis (SVA) ≥ 5 cm, or pelvic tilt ≥ 25°.
The Implications of Sacralized Transitional Vertebra on Spinal Alignment.
Spine (Phila Pa 1976)
October 2024
Study Design: Retrospective study of a multicentric prospective database.
Objective: This study aimed to determine, in a cohort of healthy volunteers, the impact of sacralized lumbo-sacral transitional vertebra (LSTV) on spinal alignment according to its grade, particularly regarding lumbar lordosis magnitude and distribution, and the implications for spinopelvic parameters measurement.
Summary Of Background Data: There is little data regarding spinopelvic alignment assessment in LSTV patients.
Purpose: Understanding the mechanism and extent of preoperative deformity in revision procedures may provide data to prevent future failures in lumbar spinal fusion patients.
Methods: ASD patients without prior spine surgery (PRIMARY) and with prior short (SHORT) and long (LONG) fusions were included. SHORT patients were stratified into modes of failure: implant, junctional, malalignment, and neurologic.
Article Synopsis
- The study is a retrospective cohort analysis aimed at assessing the surgical outcomes of adult spinal deformity using AI-based clustering to categorize patients into different deformity types, including Moderate Sagittal, Severe Sagittal, Coronal, and Hyper-Thoracic Kyphosis.
- A total of 1062 patients were analyzed, showing that while all deformity clusters experienced similar improvements in health-related quality of life after surgery, those in the Severe Sagittal cluster had notably higher complication rates, especially regarding major complications, reoperations, and implant failures.
- Despite varying complication rates among clusters, the types of complications did not show significant differences, indicating that all clusters benefit equally from surgical interventions, achieving comparable rates of minimal clinically important difference in quality
Determining the utility of three-column osteotomies in revision surgery compared with primary surgeries in the thoracolumbar spine: a retrospective cohort study in the United States.
Asian Spine J
October 2024
Study Design: Retrospective cohort study.
Purpose: To determine the incidence and success of three-column osteotomies (3COs) performed in primary and revision adult spine deformity (ASD) corrective surgeries.
Overview Of Literature: 3COs are often required to correct severe, rigid ASD presentations.
Article Synopsis
- - The study is a secondary data analysis of an NIH-sponsored research focusing on cost-effectiveness between surgical and non-surgical treatments for Adult Symptomatic Lumbar Scoliosis (ASLS) eight years post-enrollment.
- - Previous analyses at the five-year mark showed a cost-effectiveness ratio (ICER) of $44,033 (As-Treated) and $27,480 (Intent-to-treat), while the current eight-year data suggests that surgical treatment is more economically favorable, with an ICER of $20,569 per Quality Adjusted Life Year (QALY) gained.
- - The conclusion highlights that operative treatment for ASLS presents a more cost-effective option compared to non-operative treatment, as indicated
Article Synopsis
- A recent study examined how preoperative factors impact recovery outcomes after cervical spine surgery, focusing specifically on patient-reported outcome measures (PROMs) to predict postoperative success in pain relief and functionality.
- The research analyzed data from 139 patients who underwent surgery, using measures like the Neck Disability Index (NDI) and PROMIS assessments before and after the procedure.
- Findings indicated that for overall patients, a 1-point increase in preoperative disability scores decreased the odds of achieving a satisfactory symptom state post-surgery, especially among those with radiculopathy, while showing different results for myelopathy patients.
Article Synopsis
- Tranexamic acid (TXA) is used in adult spinal deformity surgery to reduce blood loss, but there's no agreed-upon dosing method.
- A study analyzed data from 265 complex ASD patients, categorizing them into low, medium, and high TXA dose groups and measuring blood loss, complications, and RBC transfusions.
- Findings revealed that lower TXA doses resulted in significantly higher blood loss and increased RBC transfusions compared to high doses, suggesting that higher TXA dosing may be more effective in minimizing blood loss during surgery.
Article Synopsis
- This multicentric retrospective study aimed to establish normative values for proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, using data from healthy volunteers for comparison.
- The study analyzed data from 721 healthy individuals and 824 ASD surgery patients, assessing the rates of abnormal PJA values and comparing them with the rates of proximal junctional kyphosis (PJK) using different definitions.
- Findings revealed significant differences in PJK rates based on the criteria used, highlighting the need for more precise level-adjusted assessments of PJA values to better define abnormalities and challenge traditional definitions of PJK.
Summary Of Background Data: Yilgor et al developed the lumbar Lordosis Distribution Index to individualize the pelvic mismatch to each patient's pelvic incidence. The cervical lordosis distribution in relation to its apex has not been characterized.
Objective: Tailor correction of cervical deformity by incorporating the cervical apex into a distribution index(CLDI) to maximize clinical outcomes while lowering rates of junctional failure.
Study Design: Case-based survey.
Objectives: This study aims to investigate what a group of surgeons learned from their own revisions, and what they would do differently today.
Methods: A multi-center database of ASD surgical patients was queried to identify those with at least 2 surgical procedures performed by the same surgeon between 2009 and 2019.
Background: Our understanding of the relationship between sagittal alignment and mechanical complications is evolving. In normal spines, the L1-pelvic angle (L1PA) accounts for the magnitude and distribution of lordosis and is strongly associated with pelvic incidence (PI), and the T4-pelvic angle (T4PA) is within 4° of the L1PA. We aimed to examine the clinical implications of realignment to a normal L1PA and T4-L1PA mismatch.
View Article and Find Full Text PDFObjective: Correction of mild flexible cervical deformity (CD) via the posterior approach has been described with and without the use of posterior osteotomies (POs), despite a lack of clarity regarding their necessity or risks. The purpose of this study was to determine whether the use of POs when correcting mild flexible CD leads to improved clinical or radiographic outcomes, as well as defining the relative risks in utilizing them.
Methods: A prospective multicenter registry of operative CD patients was analyzed.
Purpose: To evaluate the variability in intraoperative fluid management during adult spinal deformity (ASD) surgery, and analyze the association with complications, intensive care unit (ICU) requirement, and length of hospital stay (LOS).
Methods: Multicenter comparative cohort study. Patients ≥ 18 years old and with ASD were included.
Objective: The purpose of this study was to assess how various realignment strategies affect mechanical failure and clinical outcomes in pelvic incidence (PI)-stratified cohorts following adult spinal deformity (ASD) surgery.
Methods: Median and interquartile range statistics were calculated for demographics and surgical details. Further statistical analysis was used to define subsets within PI generating significantly different rates of mechanical failure.