In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Upper Thoracic versus Lower Thoracic Upper Instrumented Vertebrae Endpoints have Similar Outcomes and Complications in Adult Scoliosis at 2 year follow up

    Final Number:
    1052

    Authors:
    Han Jo Kim MD; Oheneba Boachie-Adjei MD; Justin K. Scheer; Richard A. Hostin MD; Khaled Kebaish MD; Justin S. Smith MD PhD; Gregory Mundis MD; Frank Schwab MD, PhD; Virginie Lafage PhD; Robert Hart MD; Shay Bess MD; Vedat Deviren MD; Christopher I. Shaffrey MD, FACS; Christopher P. Ames MD; International Spine Study Group

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Optimal upper-most instrumented vertebrae (UIV) for long fusions to the sacrum/pelvis are controversial. The purpose of this study was to compare the upper thoracic (UT) and lower thoracic (LT) UIV in long fusions to the sacrum/pelvis for adult scoliosis.

    Methods: Patients from a prospective database were selected based on fusions to the sacrum/pelvis with UIV of T1-6 (UT Group) and those with a UIV of T9-L1 (LT Group). Demographic and operative data and radiographic and clinical outcomes were compared.

    Results: 198 patients (UT=91, LT=107) with mean age of 61.6 were followed for an average of 2.5 yrs. Demographics were similar between groups except for more women in the UT group (86% vs 65%) and a slightly higher BMI in the LT group (28.7 vs. 26.9). Pre-operatively, the UT group demonstrated significant greater lumbar scoliosis (53.6 vs. 33.2, p<0.01), thoracic scoliosis (41.6 vs 31.7, p=0.01) and thoracolumbar kyphosis (17.9 vs. 8.9, p=<0.01). The UT group demonstrated a greater length of stay (LOS) (9.1 vs 7.4, p<0.01) and longer operative times (430 vs 371 min, p<0.01). EBL was similar (1947cc vs 1887cc, p=0.08). Rates of complications were similar between groups (57% vs 39%, p=0.20), as were those that required revision surgery (15% vs 22%, p=0.19). The UT group had a higher percentage of patients with =2 complications (55% vs 43%, p =0.38) but not statistically significant. Although the LT group had a higher PJK angle (19.2 vs 16.5, p=0.37), the UT group had a higher number of cases requiring revision for PJK (3 vs 2, p=0.45). SRS and ODI outcomes were similar between groups.

    Conclusions: Despite UT terminations having larger coronal and sagittal plane deformities, longer operative times and LOS, UT and LT UIVs have similar complication rates and similar radiographic and clinical outcomes at two year follow up.

    Patient Care: Improve our understanding of surgical treatment strategies for adults with spinal deformity.

    Learning Objectives: By the conclusion of this session, participants should be able to: (1) Appreciate potential factors that may contribute to the decision of whether to stop a long fusion to the sacrum/pelvis in the lower versus upper thoracic spine in adult deformity patients; (2) Appreciate that despite UT terminations having larger coronal and sagittal plane deformities, longer operative times and length of stay, patients with upper and lower thoracic upper-most instrumented vertebrae have similar complication rates and similar radiographic and clinical outcomes at two year follow up.

    References:

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy