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

Publication ,  Journal Article
Scheer, JK; Lafage, V; Smith, JS; Deviren, V; Hostin, R; McCarthy, IM; Mundis, GM; Burton, DC; Klineberg, E; Gupta, M; Kebaish, K; Bess, S ...
Published in: Eur Spine J
January 2015

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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Published In

Eur Spine J

DOI

EISSN

1432-0932

Publication Date

January 2015

Volume

24 Suppl 1

Start / End Page

S121 / S130

Location

Germany

Related Subject Headings

  • Thoracic Vertebrae
  • Spinal Fusion
  • Spinal Curvatures
  • Retrospective Studies
  • Reoperation
  • Radiography
  • Osteotomy
  • Orthopedics
  • Middle Aged
  • Male
 

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Scheer, J. K., Lafage, V., Smith, J. S., Deviren, V., Hostin, R., McCarthy, I. M., … International Spine Study Group (ISSG), . (2015). Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper instrumented vertebra. Eur Spine J, 24 Suppl 1, S121–S130. https://doi.org/10.1007/s00586-014-3391-y
Scheer, Justin K., Virginie Lafage, Justin S. Smith, Vedat Deviren, Richard Hostin, Ian M. McCarthy, Gregory M. Mundis, et al. “Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper instrumented vertebra.Eur Spine J 24 Suppl 1 (January 2015): S121–30. https://doi.org/10.1007/s00586-014-3391-y.
Scheer JK, Lafage V, Smith JS, Deviren V, Hostin R, McCarthy IM, Mundis GM, Burton DC, Klineberg E, Gupta M, Kebaish K, Shaffrey CI, Bess S, Schwab F, Ames CP, International Spine Study Group (ISSG). Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper instrumented vertebra. Eur Spine J. 2015 Jan;24 Suppl 1:S121–S130.
Journal cover image

Published In

Eur Spine J

DOI

EISSN

1432-0932

Publication Date

January 2015

Volume

24 Suppl 1

Start / End Page

S121 / S130

Location

Germany

Related Subject Headings

  • Thoracic Vertebrae
  • Spinal Fusion
  • Spinal Curvatures
  • Retrospective Studies
  • Reoperation
  • Radiography
  • Osteotomy
  • Orthopedics
  • Middle Aged
  • Male