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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

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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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Conflict of interest

None of the authors have a conflict of interest with this manuscript.

Financial information

Funding for the International Spine Study Group Foundation, through which this study was conducted, is funded through research grants from DePuy Spine and individual donations.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA

    Justin K. Scheer

  2. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, 10003, USA

    Virginie Lafage & Frank Schwab

  3. Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, 22908, USA

    Justin S. Smith & Christopher I. Shaffrey

  4. Department of Orthopeadic Surgery, University of California, San Francisco, San Francisco, CA, 94110, USA

    Vedat Deviren

  5. Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, 75246, USA

    Richard Hostin & Ian M. McCarthy

  6. San Diego Center for Spinal Disorders, La Jolla, CA, 92037, USA

    Gregory M. Mundis

  7. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, 66160, USA

    Douglas C. Burton

  8. Department of Orthopaedic Surgery, University of California, Davis, CA, 95816, USA

    Eric Klineberg & Munish Gupta

  9. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, 21287, USA

    Khaled Kebaish

  10. Rocky Mountain Hospital for Children, Denver, CO, 80218, USA

    Shay Bess

  11. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, 94110, USA

    Christopher P. Ames

Authors
  1. Justin K. Scheer
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  2. Virginie Lafage
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  3. Justin S. Smith
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  5. Richard Hostin
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  7. Gregory M. Mundis
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  8. Douglas C. Burton
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  9. Eric Klineberg
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  10. Munish Gupta
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  11. Khaled Kebaish
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  12. Christopher I. Shaffrey
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  13. Shay Bess
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  14. Frank Schwab
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  15. Christopher P. Ames
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International Spine Study Group (ISSG)

Corresponding author

Correspondence to Justin K. Scheer.

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Scheer, J.K., Lafage, V., Smith, J.S. 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), 121–130 (2015). https://doi.org/10.1007/s00586-014-3391-y

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  • DOI: https://doi.org/10.1007/s00586-014-3391-y

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