Upper Thoracic Versus Lower Thoracic Upper Instrumented Vertebrae Endpoints Have Similar Outcomes and Complications in Adult Scoliosis at Two-Year Follow-Up
ABSTRACT 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.
[Show abstract] [Hide abstract]
ABSTRACT: Proximal junctional kyphosis (PJK) is a common radiographic finding following long spinal fusions. Whether PJK leads to negative clinical outcome is currently debatable. A systematic review was performed to assess the prevalence, risk factors, and treatments of PJK. Literature search was conducted on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials using the terms 'proximal junctional kyphosis' and 'proximal junctional failure'. Excluding reviews, commentaries, and case reports, we analyzed 33 studies that reported the prevalence rate, risk factors, and discussions on PJK following spinal deformity surgery. The prevalence rates varied widely from 6 to 61.7 %. Numerous studies reported that clinical outcomes for patients with PJK were not significantly different from those without, except in one recent study in which adult patients with PJK experienced more pain. Risk factors for PJK included age at operation, low bone mineral density, shorter fusion constructs, upper instrumented vertebrae below L2, and inadequate restoration of global sagittal balance. Prevalence of PJK following long spinal fusion for adult spinal deformity was high but not clinically significant. Careful and detailed preoperative planning and surgical execution may reduce PJK in adult spinal deformity patients.European Spine Journal 09/2014; 23(12). DOI:10.1007/s00586-014-3531-4 · 2.47 Impact Factor