Introduction: The Obeid classification for coronal malalignment treatment based on the flexibility of coronal deformity and location has yet to be evaluated in the American population.
Methods: Primary operative ASD patients with UIV at T7-L1 fused to the sacrum, with two-year follow-up, were included. Patients with PJF, as defined by Lafage et al. as a change of >22° from baseline, along with an angle >28°, were excluded. Focal thoracic and unfused TC were explored with predictive modeling to determine factors correlative to its development. Operative ASD patients with coronal malalignment (CM) of >20mm and 2Y follow-up. Patients were stratified based on adherence to Obeid classification treatment recommendations. Those that adhered (A) were compared to those not adhering to treatment recommendations (NA) and were evaluated for postoperative CM trends to 2Y. Mechanical complications and clinical outcomes were assessed.
Results: 168 patients met inclusion. 64±9 yrs, 78% F, 27.5±5.1 kg/m2, CCI 1.9±1.7, frailty 3.5±1.5). By Obeid type, 15% were type 1A1, 14% type 1A2, 25% type 1B, 18% type 2A1, 18% type 2A2, and 10% type 2B. 52% of cases adhered, while 48% did not. NA had greater age, CCI, and osteoporosis rates. Maximum coronal Cobb angle was higher in A preoperatively (p <.05). Adhered had a higher rate of resolution of coronal malalignment postoperatively, however no difference was seen at 2Y on univariate analysis. Postoperative alignment is depicted in table 1. Those NA had higher rates of rod fracture and vertebral body fracture, while A had higher rates of patient satisfaction at 2-year postop (p <.05), however no difference in pain or overall disability was seen at 2Y.
Conclusion : Adherence to the Obeid classification treatment guidelines improved patient outcomes and reduced complications, however, this was seen in a select group of patients.
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