Photo Credit: urguplu

The following is a summary of “Role of Supine Imaging In Assessing Failure Of Pelvic Compensation And Its Impact On Surgical Outcomes In Patients With Adult Spinal Deformity,” published in the February 2025 issue of the Journal of Orthopaedic Surgery and Research by Wang et al.

This study aimed to assess the influence of failure of pelvic compensation (FPC), defined by inadequate spinopelvic adaptation when transitioning from a supine to an upright position, on surgical outcomes in patients with adult spinal deformity (ASD). A total of 125 patients with ASD who underwent posterior corrective surgery with a minimum follow-up of two years were retrospectively analyzed. Radiographic parameters, including thoracic kyphosis, lumbar lordosis, sacral slope (SS), pelvic tilt (PT), pelvic incidence, T1-pelvic angle, and sagittal vertical axis (SVA), were measured using lateral whole-spine radiographs. Postoperative realignment was assessed using the sagittal age-adjusted score (SAAS). Patient-reported outcomes were evaluated through the Scoliosis Research Society-22R (SRS-22R) questionnaire, with a focus on the proportion achieving the minimum clinically important difference (MCID). 

The incidence of proximal junctional kyphosis (PJK) following surgery was also recorded. FPC was defined as a change in SS of less than 3.9° between supine and upright positions. Patients were divided into two cohorts: the pelvic compensation (PC) group (n = 88) and the FPC group (n = 37). Postoperatively, patients with FPC exhibited significantly lower PT (22.44° vs. 28.57°, p < 0.001) and higher SVA (57.49 mm vs. 32.57 mm, p = 0.008) compared to the PC cohort. Additionally, the FPC group demonstrated inferior patient-reported outcomes, including a lower SRS-22R subtotal score (3.68 vs. 3.89, p = 0.035) and a significantly reduced proportion achieving MCID (45.95% vs. 65.91%, p = 0.038). Although the incidence of PJK was higher among patients with FPC, this difference was not statistically significant (40.54% vs. 29.55%, p = 0.232). 

However, correction aligned with SAAS standards was associated with a significantly lower risk of PJK ([OR]: 6.50, 95% [CI]: 1.18–35.84) and an increased likelihood of achieving MCID (OR: 4.50, 95% CI: 1.05–19.22) in patients with FPC. These findings suggest that patients with ASD with preoperative FPC are more likely to experience suboptimal postoperative outcomes and an increased risk of mechanical complications. Therefore, individualized preoperative planning that incorporates SAAS-guided correction strategies may enhance surgical success and improve long-term functional outcomes in this patient population.

Source: josr-online.biomedcentral.com/articles/10.1186/s13018-025-05608-3