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Purpose To investigate the effectiveness of sagittal deformity angular distance ratio (S-DADR; sagittal Cobb angle divided by the distance, in centimeters, between the midpoint of the upper endplate of the upper end vertebrae and the midpoint of the lower endplate of the lower end vertebrae) in evaluating neurological risks in patients with post-tuberculous kyphosis (PTK). Methods A consecutive series of 102 patients with PTK who underwent corrective surgery between September 2010 and June 2024 were included. Measurements derived from preoperative radiographs were utilized to compute S-DADR. Potential risk factors of postoperative neurological deficits (PNDs) were assessed through univariate and multivariate analyses. Binary logistic regression was used to model the relationship between identified independent risk factors and PNDs, and the model was evaluated by the area under receiver operating characteristic curve (AUC). Results The mean age of the 102 patients was 49.5 ± 12.1 years, and the incidence of PNDs was 22.5%. Univariate logistic regression revealed a positive correlation between the incidence of PNDs and S-DADR (OR = 1.103, P  = 0.003), preoperative sagittal Cobb angle (OR = 1.025, P  = 0.007), number of vertebrae resected (OR = 1.661, P  = 0.024), operative time (OR = 1.005, P  = 0.048) and total instrumented vertebrae (OR = 1.391, P  = 0.014). Multivariate logistic regression identified S-DADR (OR = 1.091, P  = 0.025) as an independent factor of PNDs. Patients with S-DADR ≥ 21.4 exhibited a 30% incidence of PNDs, which increased to 50% with an S-DADR of 30.0. The overall predictive performance of S-DADR (AUC = 0.720) for PNDs was deemed satisfactory. Conclusions S-DADR can be used to quantify the severity of the deformity in patients with PTK, which is an independent risk factor for PNDs during corrective surgery. Patients with S-DADR ≥ 21.4 face a 30% incidence of developing PNDs after corrective surgery.

Background Intraoperative neuromonitoring (IONM) alerts are critical concerns for surgeons performing spinal deformity corrective surgeries, as they indicate a heighteded risk of postoperative neurological deficits. Previous studies have demonstrated that patients with large Cobb angle or elevated deformity angular ratio (DAR) are at an increased risk of IONM alerts. However, spinal curves with similar Cobb angles and DARs may exhibit significantly different risks of IONM alerts during surgery. Current methods for evaluating spinal deformity fail to comprehensively and accurately reflect its severity. The purpose of this study was to investigate whether the deformity angular distance ratio (DADR) serves as an independent predictor of IONM alerts during corrective surgery for spinal deformity. Methods This study analyzed a consecutive series of 404 patients undergoing corrective surgery at a single academic center. Preoperative radiographs were used to calculate the DAR and DADR. Twelve clinically relevant candidate variables were selected for univariable analysis. Multivariable logistic regression analysis was then conducted to identify independent predictors of IONM alerts. Results The incidence of IONM alerts in this cohort was 25.2%. Univariable analysis identified several factors potentially associated with IONM alerts, including older age, type-III spinal cord morphology, location of apex, etiological diagnosis, preoperative sagittal Cobb angle, sagittal DAR, sagittal DADR, coronal DADR, total DAR, total DADR, three-column osteotomy, and preoperative neurological deficits. Multivariable analysis revealed that an apex location at C7-T4, preoperative neurological deficits, sagittal DADR, and total DADR were independent predictors of IONM alerts. Conclusions Among patients undergoing corrective surgeries for spinal deformities, the DADR is a robust measure of spinal deformity severity and is strongly correlated with the risk of IONM alerts. Compared to other deformity parameters, DADR is an independent predictor of IONM alerts. Additional independent predictors include the location of the apex and the presence of preoperative neurological deficits.