TY - JOUR
T1 - Lowest Instrumented Vertebra Selection to S1 or Ilium Versus L4 or L5 in Adult Spinal Deformity
T2 - Factors for Consideration in 349 Patients With a Mean 46-Month Follow-Up
AU - Yao, Yu Cheng
AU - Kim, Han Jo
AU - Bannwarth, Mathieu
AU - Smith, Justin
AU - Bess, Shay
AU - Klineberg, Eric
AU - Ames, Christopher P.
AU - Shaffrey, Christopher I.
AU - Burton, Douglas
AU - Gupta, Munish
AU - Mundis, Gregory M.
AU - Hostin, Richard
AU - Schwab, Frank
AU - Lafage, Virginie
N1 - Publisher Copyright:
© The Author(s) 2021.
PY - 2023/5
Y1 - 2023/5
N2 - Study Design: Retrospective cohort study. Objective: To compare the outcomes of patients with adult spinal deformity (ASD) following spinal fusion with the lowest instrumented vertebra (LIV) at L4/L5 versus S1/ilium. Methods: A multicenter ASD database was evaluated. Patients were categorized into 2 groups based on LIV levels—groups L (fusion to L4/L5) and S (fusion to S1/ilium). Both groups were propensity matched by age and preoperative radiographic alignments. Patient demographics, operative details, radiographic parameters, revision rates, and health-related quality of life (HRQOL) scores were compared. Results: Overall, 349 patients had complete data, with a mean follow-up of 46 months. Patients in group S (n = 311) were older and had larger sagittal and coronal plane deformities than those in group L (n = 38). After matching, 28 patients were allocated to each group with similar demographic, radiographic, and clinical parameters. Sagittal alignment restoration at postoperative week 6 was significantly better in group S than in group L, but it was similar in both groups at the 2-year follow-up. Fusion to S1/ilium involved a longer operating time, higher PJK rates, and greater PJK angles than that to L4/L5. There were no significant differences in the complication and revision rates between the groups. Both groups showed significant improvements in HRQOL scores. Conclusions: Fusion to S1/ilium had better sagittal alignment restoration at postoperative week 6 and involved higher PJK rates and greater PJK angles than that to L4/L5. The clinical outcomes and rates of revision surgery and complications were similar between the groups.
AB - Study Design: Retrospective cohort study. Objective: To compare the outcomes of patients with adult spinal deformity (ASD) following spinal fusion with the lowest instrumented vertebra (LIV) at L4/L5 versus S1/ilium. Methods: A multicenter ASD database was evaluated. Patients were categorized into 2 groups based on LIV levels—groups L (fusion to L4/L5) and S (fusion to S1/ilium). Both groups were propensity matched by age and preoperative radiographic alignments. Patient demographics, operative details, radiographic parameters, revision rates, and health-related quality of life (HRQOL) scores were compared. Results: Overall, 349 patients had complete data, with a mean follow-up of 46 months. Patients in group S (n = 311) were older and had larger sagittal and coronal plane deformities than those in group L (n = 38). After matching, 28 patients were allocated to each group with similar demographic, radiographic, and clinical parameters. Sagittal alignment restoration at postoperative week 6 was significantly better in group S than in group L, but it was similar in both groups at the 2-year follow-up. Fusion to S1/ilium involved a longer operating time, higher PJK rates, and greater PJK angles than that to L4/L5. There were no significant differences in the complication and revision rates between the groups. Both groups showed significant improvements in HRQOL scores. Conclusions: Fusion to S1/ilium had better sagittal alignment restoration at postoperative week 6 and involved higher PJK rates and greater PJK angles than that to L4/L5. The clinical outcomes and rates of revision surgery and complications were similar between the groups.
KW - adult spinal deformity
KW - complication
KW - fusion rate
KW - health-related quality of life scores
KW - lowest instrumented level
KW - propensity matched
KW - proximal junctional kyphosis
UR - http://www.scopus.com/inward/record.url?scp=85105876373&partnerID=8YFLogxK
U2 - 10.1177/21925682211009178
DO - 10.1177/21925682211009178
M3 - Article
C2 - 33906457
AN - SCOPUS:85105876373
SN - 2192-5682
VL - 13
SP - 932
EP - 939
JO - Global Spine Journal
JF - Global Spine Journal
IS - 4
ER -