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This study compares the ability of postoperative T4-L1PA mismatch to predict mechanical complications and reoperations against traditional measures T4PA and L1PA.

May 29, 2026Spine1 citations

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Assessing the Comparative Ability of Early Postoperative T4-L1PA Mismatch versus L1PA or T4PA Alone for Predicting Mechanical Complications or Spinal Reoperations

ABAnthony N. BaumannCleveland Clinic KCKyriakos ChatzisDuke University ESEdward SonNortheast Ohio Medical University

Key Points

This study compares the ability of postoperative T4-L1PA mismatch to predict mechanical complications and reoperations against traditional measures T4PA and L1PA.
Retrospective analysis of a prospective single-center database with 486 surgical patients for ASD with pelvic fixation.
Primary outcomes included mechanical complications and reoperation rates, assessed two years post-surgery.
Statistical analyses utilized receiver operating curve and multivariable regression for predictor assessments.
88 mechanical complications (18.1%) and 125 reoperations (25.7%) were identified in the patient cohort.
Adding six-week T4-L1PA mismatch did not significantly improve the predictive model for mechanical complications (P=0.698).
For spinal reoperations, six-week T4PA and T4-L1PA mismatch improved the regression model (P=0.036 and P=0.049, respectively).

Abstract

Study Design. Retrospective single-center study Objective. We aim to compare the prognostic capacity of postoperative T4-L1PA mismatch versus T4PA and L1PA alone. Summary of Background Data. The assessment of T4-L1PA mismatch, the difference between traditional radiographic parameters T4PA and L1PA, is a newer radiographic measurement that has generated interest due to the potential ability to predict complications. Methods. We performed a retrospective analysis of a prospective single-center database and included surgical patients for ASD with pelvic fixation with complete baseline and two-year follow-up. Primary outcomes included mechanical complications and reoperation rates. Secondary outcomes included proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Predictors included were six-week T4-L1PA mismatch, T4PA, L1PA, corrected T4-L1PA mismatch defined by pelvic incidence, SAAS score, and SRS-Schwab Score. We utilized receiver operating curve bivariable analyses and multivariable regression analyses for adjustment of confounding. Results. A total of 486 patients (mean age: 63.7 y; 75.5% female; mean preoperative T4-L1PA mismatch: 9.7 degrees; mean number of levels fused: 11.9 levels) had 88 mechanical complications (18.1%) and 125 reoperations (25.7%). In a multivariable regression model for mechanical complications, adding six-week T4-L1PA mismatch did not improve the model ( P =0.698) in contrast to six-week T4PA (Δ-2LL: 6.9), L1PA (Δ-2LL: 7.5), and SAAS score (Δ-2LL: 6.4) ( P 0.05). Among patients with inadequate preoperative T4-L1PA mismatch (n=401), adding six-week L1PA improved model fit for mechanical complications (Δ-2LL: 4.7; P =0.031); however, six-week T4PA or T4-L1PA mismatch did not improve the model ( P >0.05). Six-week L1PA consistently outperformed T4-L1PA mismatch on bivariable analysis. Conclusion. Early postoperative T4-L1PA mismatch may not serve as a greatly enhanced radiographic predictor of all-type mechanical complications or spinal reoperations, especially in comparison to either six-week T4PA or L1PA alone. Level of Evidence. III

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Cite This Study

Baumann et al. (Thu,) studied this question.

synapsesocial.com/papers/6a192d13fab5b468c4415e2d https://doi.org/https://doi.org/10.1097/brs.0000000000005752

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