Upper-thoracic versus lower-thoracic upper instrumented vertebra in adult spinal deformity patients undergoing fusion to the pelvis : surgical decision-making and patient outcomes
OBJECTIVE: Optimal patient selection for upper-thoracic (UT) versus lower-thoracic (LT) fusion during adult spinal deformity (ASD) correction is challenging. Radiographic and clinical outcomes following UT versus LT fusion remain incompletely understood. The purposes of this study were: 1) to evaluate demographic, radiographic, and surgical characteristics associated with choice of UT versus LT fusion endpoint; and 2) to evaluate differences in radiographic, clinical, and health-related quality of life (HRQOL) outcomes following UT versus LT fusion for ASD.
METHODS: Retrospective review of a prospectively collected multicenter ASD database was performed. Patients with ASD who underwent fusion from the sacrum/ilium to the LT (T9-L1) or UT (T1-6) spine were compared for demographic, radiographic, and surgical characteristics. Outcomes including proximal junctional kyphosis (PJK), reoperation, rod fracture, pseudarthrosis, overall complications, 2-year change in alignment parameters, and 2-year HRQOL metrics (Lumbar Stiffness Disability Index, Scoliosis Research Society-22r questionnaire, Oswestry Disability Index) were compared after controlling for confounding factors via multivariate analysis.
RESULTS: Three hundred three patients (169 LT, 134 UT) were evaluated. Independent predictors of UT fusion included greater thoracic kyphosis (odds ratio [OR] 0.97 per degree, p = 0.0098), greater coronal Cobb angle (OR 1.06 per degree, p < 0.0001), and performance of a 3-column osteotomy (3-CO; OR 2.39, p = 0.0351). While associated with longer operative times (ratio 1.13, p < 0.0001) and greater estimated blood loss (ratio 1.31, p = 0.0018), UT fusions resulted in greater sagittal vertical axis improvement (-59.5 vs -41.0 mm, p = 0.0035) and lower PJK rates (OR 0.49, p = 0.0457). No significant differences in postoperative HRQOL measures, reoperation, or overall complication rates were detected between groups (all p > 0.1).
CONCLUSIONS: Greater deformity and need for 3-CO increased the likelihood of UT fusion. Despite longer operative times and greater blood loss, UT fusions resulted in better sagittal correction and lower 2-year PJK rates following surgery for ASD. While continued surveillance is necessary, this information may inform patient counseling and surgical decision-making.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2019 |
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| Enthalten in: |
Journal of neurosurgery. Spine - (2019) vom: 20. Dez., Seite 1-7 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Daniels, Alan H [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 27.02.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.3171/2019.9.SPINE19557 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM304612952 |
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| 041 | |a eng | ||
| 100 | 1 | |a Daniels, Alan H |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Upper-thoracic versus lower-thoracic upper instrumented vertebra in adult spinal deformity patients undergoing fusion to the pelvis |b surgical decision-making and patient outcomes |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 27.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a OBJECTIVE: Optimal patient selection for upper-thoracic (UT) versus lower-thoracic (LT) fusion during adult spinal deformity (ASD) correction is challenging. Radiographic and clinical outcomes following UT versus LT fusion remain incompletely understood. The purposes of this study were: 1) to evaluate demographic, radiographic, and surgical characteristics associated with choice of UT versus LT fusion endpoint; and 2) to evaluate differences in radiographic, clinical, and health-related quality of life (HRQOL) outcomes following UT versus LT fusion for ASD | ||
| 520 | |a METHODS: Retrospective review of a prospectively collected multicenter ASD database was performed. Patients with ASD who underwent fusion from the sacrum/ilium to the LT (T9-L1) or UT (T1-6) spine were compared for demographic, radiographic, and surgical characteristics. Outcomes including proximal junctional kyphosis (PJK), reoperation, rod fracture, pseudarthrosis, overall complications, 2-year change in alignment parameters, and 2-year HRQOL metrics (Lumbar Stiffness Disability Index, Scoliosis Research Society-22r questionnaire, Oswestry Disability Index) were compared after controlling for confounding factors via multivariate analysis | ||
| 520 | |a RESULTS: Three hundred three patients (169 LT, 134 UT) were evaluated. Independent predictors of UT fusion included greater thoracic kyphosis (odds ratio [OR] 0.97 per degree, p = 0.0098), greater coronal Cobb angle (OR 1.06 per degree, p < 0.0001), and performance of a 3-column osteotomy (3-CO; OR 2.39, p = 0.0351). While associated with longer operative times (ratio 1.13, p < 0.0001) and greater estimated blood loss (ratio 1.31, p = 0.0018), UT fusions resulted in greater sagittal vertical axis improvement (-59.5 vs -41.0 mm, p = 0.0035) and lower PJK rates (OR 0.49, p = 0.0457). No significant differences in postoperative HRQOL measures, reoperation, or overall complication rates were detected between groups (all p > 0.1) | ||
| 520 | |a CONCLUSIONS: Greater deformity and need for 3-CO increased the likelihood of UT fusion. Despite longer operative times and greater blood loss, UT fusions resulted in better sagittal correction and lower 2-year PJK rates following surgery for ASD. While continued surveillance is necessary, this information may inform patient counseling and surgical decision-making | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a 3-CO = 3-column osteotomy | |
| 650 | 4 | |a ASA = American Society of Anesthesiologists | |
| 650 | 4 | |a ASD = adult spinal deformity | |
| 650 | 4 | |a CCI = Charlson Comorbidity Index | |
| 650 | 4 | |a EBL = estimated blood loss | |
| 650 | 4 | |a HRQOL = health-related quality of life | |
| 650 | 4 | |a ISSG = International Spine Study Group | |
| 650 | 4 | |a LL = lumbar lordosis | |
| 650 | 4 | |a LSDI = Lumbar Stiffness Disability Index | |
| 650 | 4 | |a LT = lower thoracic | |
| 650 | 4 | |a ODI = Oswestry Disability Index | |
| 650 | 4 | |a OR = odds ratio | |
| 650 | 4 | |a PI = pelvic incidence | |
| 650 | 4 | |a PJA = proximal junction angle | |
| 650 | 4 | |a PJF = proximal junctional failure | |
| 650 | 4 | |a PJK = proximal junctional kyphosis | |
| 650 | 4 | |a PT = pelvic tilt | |
| 650 | 4 | |a SRS-22r = Scoliosis Research Society 22-r questionnaire | |
| 650 | 4 | |a SVA = sagittal vertical axis | |
| 650 | 4 | |a TK = thoracic kyphosis | |
| 650 | 4 | |a UIV = upper instrumented vertebra | |
| 650 | 4 | |a UT = upper thoracic | |
| 650 | 4 | |a adult spinal deformity | |
| 650 | 4 | |a complications | |
| 650 | 4 | |a lower thoracic | |
| 650 | 4 | |a outcomes | |
| 650 | 4 | |a proximal junctional kyphosis | |
| 650 | 4 | |a scoliosis | |
| 650 | 4 | |a upper instrumented vertebra | |
| 650 | 4 | |a upper thoracic | |
| 700 | 1 | |a Reid, Daniel B C |e verfasserin |4 aut | |
| 700 | 1 | |a Durand, Wesley M |e verfasserin |4 aut | |
| 700 | 1 | |a Hamilton, D Kojo |e verfasserin |4 aut | |
| 700 | 1 | |a Passias, Peter G |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Han Jo |e verfasserin |4 aut | |
| 700 | 1 | |a Protopsaltis, Themistocles S |e verfasserin |4 aut | |
| 700 | 1 | |a Lafage, Virginie |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Justin S |e verfasserin |4 aut | |
| 700 | 1 | |a Shaffrey, Christopher I |e verfasserin |4 aut | |
| 700 | 1 | |a Gupta, Munish |e verfasserin |4 aut | |
| 700 | 1 | |a Klineberg, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Schwab, Frank |e verfasserin |4 aut | |
| 700 | 1 | |a Burton, Douglas |e verfasserin |4 aut | |
| 700 | 1 | |a Bess, Shay |e verfasserin |4 aut | |
| 700 | 1 | |a Ames, Christopher P |e verfasserin |4 aut | |
| 700 | 1 | |a Hart, Robert A |e verfasserin |4 aut | |
| 700 | 0 | |a International Spine Study Group |e verfasserin |4 aut | |
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