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Does a Long Fusion "T3-Sacrum" Portend a Worse Outcome than a Short Fusion "T10-Sacrum" in Primary Surgery for Adult Scoliosis?
MedLine Citation:
PMID:  21971131     Owner:  NLM     Status:  Publisher    
ABSTRACT: Study Design: Retrospective clinicoradiographic analysis.Objective: To compare the upper thoracic (UT) and lower thoracic (LT) spine as the upper-instrumented vertebra (UIV) in primary fusions to the sacrum for adult scoliosis.Summary of Background Data: The optimal level at which a fusion to the sacrum is terminated proximally for adult scoliosis remains controversial. We hypothesized that: (1) UT would have a increased pseudarthrosis, more perioperative complications, and worse outcomes; (2) LT would have more proximal junctional kyphosis (PJK).Methods: Patients who underwent primary surgery for adult scoliosis between 2002 and 2006 were studied. UT and LT were matched cohorts. Minimum follow-up for all patients was 2 years. Scoliosis Research Society (SRS) scores and Oswestry Disability Index (ODI) were the clinical outcome measures.Results: Fifty-eight patients (UT = 20, LT = 38) with a mean age of 55.7 years were followed for an average of 3.0±1.1 years. The UT group had greater preoperative thoracic kyphosis and coronal Cobb values (p<0.05). Diagnoses were: idiopathic scoliosis (75.9%) and degenerative scoliosis (24.1%). The UT cohort had a greater number of levels fused (15.8 vs. 8.6) and higher blood loss (1350-mL vs. 811-mL). Operative time, rhBMP-2/level and caudal interbody grafting (80.0%-UT vs. 89.5%-LT) were similar. The UT group witnessed an increased number of perioperative complications (30.0% vs. 15.8%), more pseudarthrosis (20.0% vs. 5.3%) and a higher prevalence of revision surgery (20.0% vs. 10.5%). The LT group had more PJK (18.4% vs. 10.0%). SRS/ODI were improved in both cohorts in all domains (p<0.001), except function (p = 0.07) and mental health (p = 0.27), which were not significantly improved in the UT group.Conclusions. With long fusions to the sacrum, one should anticipate more perioperative complications, a higher pseudarthrosis rate and perhaps more revision surgery than short fusions. Short fusions may result in a more PJK, only rarely requiring revision surgery.
Brian A O'Shaughnessy; Keith H Bridwell; Lawrence G Lenke; Woojin Cho; Christine Baldus; Michael S Chang; Joshua D Auerbach; Charles H Crawford
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-30
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-10-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri USA.
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