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01-01-2015 | Original Article

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

Authors: 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, International Spine Study Group (ISSG)

Published in: European Spine Journal | Special Issue 1/2015

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).

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Title: Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper instrumented vertebra
Authors: 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
International Spine Study Group (ISSG)
Publication date: 01-01-2015
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue Special Issue 1/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3391-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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