Height Gain Following Correction of Adult Spinal Deformity
Authors: Diebo Bassel G. , Tataryn Zachary , Alsoof Daniel , Lafage Renaud , Hart Robert A. , Passias Peter G. , Ames Christopher P. , Scheer Justin K. , Lewis Stephen J. , Shaffrey Christopher I. , Burton Douglas C. , Deviren Vedat , Line Breton G. , Soroceanu Alex , Hamilton D. Kojo , Klineberg Eric O. , Mundis Gregory M. , Kim Han Jo , Gum Jeffrey L. , Smith Justin S. , Uribe Juan S. , Kelly Michael P. , Kebaish Khaled M. , Gupta Munish C. , Nunley Pierce D. , Eastlack Robert K. , Hostin Richard , Protopsaltis Themistocles S. , Lenke Lawrence G. , Schwab Frank J. , Bess Shay , Lafage Virginie , Daniels Alan H. ,   the International Spine Study Group
Published: July 2023

Background:
Height gain following a surgical procedure for patients with adult spinal deformity (ASD) is incompletely understood, and it is unknown if height gain correlates with patient-reported outcome measures (PROMs).

Methods:
This was a retrospective cohort study of patients undergoing ASD surgery. Patients with baseline, 6-week, and subanalysis of 1-year postoperative full-body radiographic and PROM data were examined. Correlation analysis examined relationships between vertical height differences and PROMs. Regression analysis was utilized to preoperatively estimate T1-S1 and S1-ankle height changes.

Results:
This study included 198 patients (mean age, 57 years; 69% female); 147 patients (74%) gained height. Patients with height loss, compared with those who gained height, experienced greater increases in thoracolumbar kyphosis (2.81° compared with −7.37°; p < 0.001) and thoracic kyphosis (12.96° compared with 4.42°; p = 0.003). For patients with height gain, sagittal and coronal alignment improved from baseline to postoperatively: 25° to 21° for pelvic tilt (PT), 14° to 3° for pelvic incidence − lumbar lordosis (PI-LL), and 60 mm to 17 mm for sagittal vertical axis (SVA) (all p < 0.001). The full-body mean height gain was 7.6 cm, distributed as follows: sella turcica-C2, 2.9 mm; C2-T1, 2.8 mm; T1-S1 (trunk gain), 3.8 cm; and S1-ankle (lower-extremity gain), 3.3 cm (p < 0.001). T1-S1 height gain correlated with the thoracic Cobb angle correction and the maximum Cobb angle correction (p = 0.002). S1-ankle height gain correlated with the corrections in PT, PI-LL, and SVA (p < 0.001). T1-ankle height gain correlated with the corrections in PT (p < 0.001) and SVA (p = 0.03). Trunk height gain correlated with improved Scoliosis Research Society (SRS-22r) Appearance scores (r = 0.20; p = 0.02). Patient-Reported Outcomes Measurement Information System (PROMIS) Depression scores correlated with S1-ankle height gain (r = −0.19; p = 0.03) and C2-T1 height gain (r = −0.18; p = 0.04). A 1° correction in a thoracic scoliosis Cobb angle corresponded to a 0.2-mm height gain, and a 1° correction in a thoracolumbar scoliosis Cobb angle resulted in a 0.25-mm height gain. A 1° improvement in PI-LL resulted in a 0.2-mm height gain.

Conclusions:
Most patients undergoing ASD surgery experienced height gain following deformity correction, with a mean full-body height gain of 7.6 cm. Height gain can be estimated preoperatively with predictive ratios, and height gain was correlated with improvements in reported SRS-22r appearance and PROMIS scores.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.