TY - JOUR
T1 - Impact of Prior Cervical Fusion on Patients Undergoing Thoracolumbar Deformity Correction
AU - The ISSG
AU - Singh, Manjot
AU - Balmaceno-Criss, Mariah
AU - Daher, Mohammad
AU - Lafage, Renaud
AU - Eastlack, Robert K.
AU - Gupta, Munish C.
AU - Mundis, Gregory M.
AU - Gum, Jeffrey L.
AU - Hamilton, Kojo D.
AU - Hostin, Richard
AU - Passias, Peter G.
AU - Protopsaltis, Themistocles S.
AU - Kebaish, Khaled M.
AU - Lenke, Lawrence G.
AU - Ames, Christopher P.
AU - Burton, Douglas C.
AU - Lewis, Stephen M.
AU - Klineberg, Eric O.
AU - Kim, Han Jo
AU - Schwab, Frank J.
AU - Shaffrey, Christopher I.
AU - Smith, Justin S.
AU - Line, Breton G.
AU - Bess, Shay
AU - Lafage, Virginie
AU - Diebo, Bassel G.
AU - Daniels, Alan H.
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2025/1/1
Y1 - 2025/1/1
N2 - Study Design. Retrospective analysis of prospectively collected data. Objective. Evaluate the impact of prior cervical constructs on upper instrumented vertebrae (UIV) selection and postoperative outcomes among patients undergoing thoracolumbar deformity correction. Background. Surgical planning for adult spinal deformity (ASD) patients involves consideration of spinal alignment and existing fusion constructs. Methods. ASD patients with (ANTERIOR or POSTERIOR) and without (NONE) prior cervical fusion who underwent thoracolumbar fusion were included. Demographics, radiographic alignment, patient-reported outcome measures (PROMs), and complications were compared. Univariate and multivariate analyses were performed on POSTERIOR patients to identify parameters predictive of UIV choice and to evaluate postoperative outcomes impacted by UIV selection. Results. Among 542 patients, with 446 NONE, 72 ANTERIOR, and 24 POSTERIOR patients, mean age was 64.4 years and 432 (80%) were female. Cervical fusion patients had worse preoperative cervical and lumbosacral deformity, and PROMs (P<0.05). In the POSTERIOR cohort, preoperative LIV was frequently below the cervicothoracic junction (54%) and uncommonly (13%) connected to the thoracolumbar UIV. Multivariate analyses revealed that higher preoperative cervical SVA (coeff=-0.22, 95% CI=-0.43 to -0.01, P=0.038) and C2SPi (coeff=-0.72, 95% CI=-1.36 to -0.07, P=0.031), and lower preoperative thoracic kyphosis (coeff=0.14, 95% CI=0.01-0.28, P=0.040) and thoracolumbar lordosis (coeff=0.22, 95% CI=0.10-0.33, P=0.001) were predictive of cranial UIV. Two-year postoperatively, cervical patients continued to have worse cervical deformity and PROMs (P<0.05) but had comparable postoperative complications. Choice of thoracolumbar UIV below or above T6, as well as the number of unfused levels between constructs, did not affect patient outcomes. Conclusions. Among patients who underwent thoracolumbar deformity correction, prior cervical fusion was associated with more severe spinopelvic deformity and PROMs preoperatively. The choice of thoracolumbar UIV was strongly predicted by their baseline cervical and thoracolumbar alignment. Despite their poor preoperative condition, these patients still experienced significant improvements in their thoracolumbar alignment and PROMs after surgery, irrespective of UIV selection.
AB - Study Design. Retrospective analysis of prospectively collected data. Objective. Evaluate the impact of prior cervical constructs on upper instrumented vertebrae (UIV) selection and postoperative outcomes among patients undergoing thoracolumbar deformity correction. Background. Surgical planning for adult spinal deformity (ASD) patients involves consideration of spinal alignment and existing fusion constructs. Methods. ASD patients with (ANTERIOR or POSTERIOR) and without (NONE) prior cervical fusion who underwent thoracolumbar fusion were included. Demographics, radiographic alignment, patient-reported outcome measures (PROMs), and complications were compared. Univariate and multivariate analyses were performed on POSTERIOR patients to identify parameters predictive of UIV choice and to evaluate postoperative outcomes impacted by UIV selection. Results. Among 542 patients, with 446 NONE, 72 ANTERIOR, and 24 POSTERIOR patients, mean age was 64.4 years and 432 (80%) were female. Cervical fusion patients had worse preoperative cervical and lumbosacral deformity, and PROMs (P<0.05). In the POSTERIOR cohort, preoperative LIV was frequently below the cervicothoracic junction (54%) and uncommonly (13%) connected to the thoracolumbar UIV. Multivariate analyses revealed that higher preoperative cervical SVA (coeff=-0.22, 95% CI=-0.43 to -0.01, P=0.038) and C2SPi (coeff=-0.72, 95% CI=-1.36 to -0.07, P=0.031), and lower preoperative thoracic kyphosis (coeff=0.14, 95% CI=0.01-0.28, P=0.040) and thoracolumbar lordosis (coeff=0.22, 95% CI=0.10-0.33, P=0.001) were predictive of cranial UIV. Two-year postoperatively, cervical patients continued to have worse cervical deformity and PROMs (P<0.05) but had comparable postoperative complications. Choice of thoracolumbar UIV below or above T6, as well as the number of unfused levels between constructs, did not affect patient outcomes. Conclusions. Among patients who underwent thoracolumbar deformity correction, prior cervical fusion was associated with more severe spinopelvic deformity and PROMs preoperatively. The choice of thoracolumbar UIV was strongly predicted by their baseline cervical and thoracolumbar alignment. Despite their poor preoperative condition, these patients still experienced significant improvements in their thoracolumbar alignment and PROMs after surgery, irrespective of UIV selection.
KW - Adult spinal deformity
KW - cervical fusion
KW - complications
KW - radiographic outcomes
KW - thoracolumbar fusion
KW - uppermost instrumented vertebrae
UR - http://www.scopus.com/inward/record.url?scp=85202162393&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000005119
DO - 10.1097/BRS.0000000000005119
M3 - Article
C2 - 39146201
AN - SCOPUS:85202162393
SN - 0362-2436
VL - 50
SP - 26
EP - 33
JO - Spine
JF - Spine
IS - 1
ER -