Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper instrumented vertebra

Justin K. Scheer, Virginie Lafage, Justin S. Smith, Vedat Deviren, Richard Hostin, Ian M. McCarthy, Gregory M. Mundis, Douglas C. Burton, Eric Klineberg, Munish Gupta, Khaled Kebaish, Christopher I. Shaffrey, Shay Bess, Frank Schwab, Christopher P. Ames

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

Purpose: The goal of this study was to characterize the spino-pelvic realignment and the maintenance of that realignment by the upper-most instrumented vertebra (UIV) for adult deformity spinal (ASD) patients treated with lumbar pedicle subtraction osteotomy (PSO).

Methods: ASD patients were divided by UIV, classified as upper thoracic (UT: T1–T6) or Thoracolumbar (TL: T9–L1). Complications were recorded and radiographic parameters included thoracic kyphosis (TK, T2–T12), lumbar lordosis (LL, L1–S1), sagittal vertical axis (SVA), pelvic tilt, and the mismatch between pelvic incidence and LL. Patients were also classified by the Scoliosis Research Society (SRS)-Schwab modifier grades. Changes in radiographic parameters and SRS-Schwab grades were evaluated between the two groups. Additional analyses were performed on patients with pre-operative SVA ≥ 15 cm.

Results: 165 patients were included (UT: 81 and TL: 84); 124 women, 41 men, with average age 59.9 ± 11.1 years (range 25–81). UT had a lower percentage of patients above the radiographic thresholds for disability than TL. UT had a significantly higher percentage of patients that improved in SRS-Schwab global alignment grade than the TL group at 2 years. Within the patients with pre-operative SVA ≥ 15 cm, TL developed significantly increased SVA and had a significantly higher percentage of patients above the SVA threshold at 3 months, and 1 and 2 years than UT.

Conclusions: Patients undergoing a single-level PSO for ASD who have fixation extending to the UT region (T1–T6) are more likely to maintain sagittal spino-pelvic alignment, lower overall revision rates and revision rate for proximal junctional kyphosis than those with fixation terminating in the TL region (T9–L1).

Original languageEnglish
Pages (from-to)121-130
Number of pages10
JournalEuropean Spine Journal
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Keywords

  • Adult spinal deformity
  • Maintenance of correction
  • PSO
  • SRS-Schwab classification
  • Upper instrumented vertebra

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    Scheer, J. K., Lafage, V., Smith, J. S., Deviren, V., Hostin, R., McCarthy, I. M., Mundis, G. M., Burton, D. C., Klineberg, E., Gupta, M., Kebaish, K., Shaffrey, C. I., Bess, S., Schwab, F., & Ames, C. P. (2014). Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper instrumented vertebra. European Spine Journal, 24(1), 121-130. https://doi.org/10.1007/s00586-014-3391-y