Upper Thoracic Versus Lower Thoracic Upper Instrumented Vertebrae Endpoints Have Similar Outcomes and Complications in Adult Scoliosis at Two-Year Follow-Up

Spine (Impact Factor: 2.3). 04/2014; 13(9). DOI: 10.1097/BRS.0000000000000339
Source: PubMed


Study Design. Retrospective Review - Multicenter DatabaseObjective. The purpose of this study was to compare the UT and lower thoracic (LT) UIV in long fusions to the sacrum for Adult Scoliosis.Summary of Background Data. The optimal upper instrumented vertebrae (UIV) for stopping long fusions to the sacrum/pelvis are controversial. While a upper thoracic (UT) endpoint may lead to greater operative times, blood loss and higher rates of pseudarthrosis, the risk for the development of proximal junctional kyphosis (PJK) and need for revision surgery is likely lower.Methods. Retrospective analysis of a prospective database of adult spinal deformity patients, Patients were selected based on fusions to the sacrum/pelvis with UIV of T1-6 (UT Group) and those with a UIV of T9-L1 (LT group). Demographic data, operative details and radiographic outcomes with Scoliosis Research Society Scores (SRS) and Oswestry Disability Index (ODI) were collected as well as complication data were compared. Fisher Exact T-tests were used for statistical analysis.Results. A total of 198 patients (UT = 91, LT = 107) with the mean age of 61.6 were followed for an average of 2.5 yrs. Demographic variables were similar between groups except for higher numbers of females in the UT group and a slightly higher BMI in the LT group. Pre-operatively, the UT group demonstrated significant more lumbar scoliosis, thoracic scoliosis and thoracolumbar kyphosis. The UT group demonstrated a higher number of fused segments length of stay (LOS) and longer operative times. There was slightly higher blood loss in the UT group.The total number of complications and number of revision surgeries were similar between groups. The UT group had a higher percentage of patients with ≥2 complications. Both groups had similar PJK angles and number of cases requiring revision for PJK. SRS and ODI Outcomes were similar between groups.Conclusion. UT and LT groups had similar outcomes. The UT group may have a higher rate of total complications, but major complications requiring return to the operative room were similar. The LOS and operative times were higher in the UT group but may have been necessary evidenced by the significantly higher coronal deformity and greater thoracolumbar kyphosis in the UT group.

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Available from: Virginie Lafage, Aug 10, 2014
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