TY - JOUR
T1 - Extension of spine fusion to the sacrum following long fusions for deformity correction
AU - O'Neill, Kevin R.
AU - Bridwell, Keith H.
AU - Lenke, Lawrence G.
AU - Chuntarapas, Tapanut
AU - Dorward, Ian
AU - Neuman, Brian
AU - Ahmad, Azeem
AU - Baldus, Christine
PY - 2014/5/20
Y1 - 2014/5/20
N2 - STUDY DESIGN.: Retrospective review of prospective database. OBJECTIVE.: To investigate the long-term results after extension of previous long spine fusions to the sacrum. SUMMARY OF BACKGROUND DATA.: Long spine fusions not involving the sacrum may be complicated by distal degeneration and require subsequent extension to the sacrum. The clinical and radiographical outcomes after such revision remain unknown. METHODS.: Patients who had extension of a long fusion (≤5 levels with a thoracic level at the cranial end) to the sacrum between 2002 and 2007 at a single institution were analyzed. Oswestry Disability Index and Scoliosis Research Society scores and/or radiographical parameters were assessed at baseline, 6 weeks and 1 year, 2, 3, and/or 5 years postoperatively (PO) and complications were recorded. RESULTS.: There were 74 patients with an average age of 49 years (range, 19-76 yr) and average clinical follow-up of 4.5 years (range, 3 mo-10 yr, 82% >2 yr PO). All had degeneration distal to prior fusions and 72% (n = 53) had fixed sagittal imbalance. Sagittal alignment improved at all PO time points from baseline (mean, 78 mm), but worsened between 1 year (mean, 21 mm) and 5 years PO (mean, 44 mm, P = 0.01). Major surgical complications occurred in 30% (n = 22) and there were 17 major reoperations in 15 patients (20%). Significant improvements (P < 0.05) in Oswestry Disability Index and all Scoliosis Research Society domain scores were found at each PO time point with no deterioration from 1 to 5 years PO. Mean outcome scores at 5 years PO were similar in groups with major surgical complications versus without and with major reoperation versus without. CONCLUSION.: Extension of long fusions to the sacrum resulted in significant and sustained improvements in Oswestry Disability Index and Scoliosis Research Society scores and alignment during 5 years PO compared with baseline. Major surgical complications occurred in 30% and reoperations were performed in 20%, but outcome scores after treatment were similar to those without complications or reoperations.
AB - STUDY DESIGN.: Retrospective review of prospective database. OBJECTIVE.: To investigate the long-term results after extension of previous long spine fusions to the sacrum. SUMMARY OF BACKGROUND DATA.: Long spine fusions not involving the sacrum may be complicated by distal degeneration and require subsequent extension to the sacrum. The clinical and radiographical outcomes after such revision remain unknown. METHODS.: Patients who had extension of a long fusion (≤5 levels with a thoracic level at the cranial end) to the sacrum between 2002 and 2007 at a single institution were analyzed. Oswestry Disability Index and Scoliosis Research Society scores and/or radiographical parameters were assessed at baseline, 6 weeks and 1 year, 2, 3, and/or 5 years postoperatively (PO) and complications were recorded. RESULTS.: There were 74 patients with an average age of 49 years (range, 19-76 yr) and average clinical follow-up of 4.5 years (range, 3 mo-10 yr, 82% >2 yr PO). All had degeneration distal to prior fusions and 72% (n = 53) had fixed sagittal imbalance. Sagittal alignment improved at all PO time points from baseline (mean, 78 mm), but worsened between 1 year (mean, 21 mm) and 5 years PO (mean, 44 mm, P = 0.01). Major surgical complications occurred in 30% (n = 22) and there were 17 major reoperations in 15 patients (20%). Significant improvements (P < 0.05) in Oswestry Disability Index and all Scoliosis Research Society domain scores were found at each PO time point with no deterioration from 1 to 5 years PO. Mean outcome scores at 5 years PO were similar in groups with major surgical complications versus without and with major reoperation versus without. CONCLUSION.: Extension of long fusions to the sacrum resulted in significant and sustained improvements in Oswestry Disability Index and Scoliosis Research Society scores and alignment during 5 years PO compared with baseline. Major surgical complications occurred in 30% and reoperations were performed in 20%, but outcome scores after treatment were similar to those without complications or reoperations.
KW - adjacent segment degeneration
KW - adjacent segment disease
KW - adult deformity
KW - patient outcomes
KW - patient-reported outcomes
KW - posterior spinal fusion
KW - radiographical outcomes
KW - sagittal imbalance
KW - surgical complications
UR - http://www.scopus.com/inward/record.url?scp=84901441623&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000000327
DO - 10.1097/BRS.0000000000000327
M3 - Article
C2 - 24718063
AN - SCOPUS:84901441623
SN - 0362-2436
VL - 39
SP - 953
EP - 962
JO - Spine
JF - Spine
IS - 12
ER -