Does a long-fusion "t3-Sacrum" portend a worse outcome than a short-fusion "t10-Sacrum" in primary surgery for adult scoliosis?

Brian A. O'Shaughnessy, Keith H. Bridwell, Lawrence G. Lenke, Woojin Cho, Christine Baldus, Michael S. Chang, Joshua D. Auerbach, Charles H. Crawford

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

STUDY DESIGN.: Retrospective clinicoradiographic analysis. OBJECTIVE.: To compare the upper thoracic (UT) and lower thoracic (LT) spines as the upper instrumented vertebra 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 spine would have an increased pseudarthrosis, more perioperative complications, and worse outcomes and (2) LT spine would have more proximal junctional kyphosis. METHODS.: Patients who underwent primary surgery for adult scoliosis between 2002 and 2006 were studied. UT and LT groups were matched cohorts. Minimum follow-up for all patients was 2 years. Scoliosis Research Society scores and Oswestry Disability Index 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, recombinant human bone morphogenetic protein-2 per level, and caudal interbody grafting (80.0% UT vs. 89.5% LT) were similar. The UT group experienced 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 proximal junctional kyphosis (18.4% vs. 10.0%). Scoliosis Research Society scores and Oswestry Disability Index 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. CONCLUSION.: 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 proximal junctional kyphosis, only rarely requiring revision surgery.

Original languageEnglish (US)
Pages (from-to)884-890
Number of pages7
JournalSpine
Volume37
Issue number10
DOIs
StatePublished - May 1 2012
Externally publishedYes

Fingerprint

Sacrum
Scoliosis
Thorax
Kyphosis
Pseudarthrosis
Spine
Reoperation
Operative Time

Keywords

  • adult scoliosis
  • bone morphogenetic protein
  • degenerative scoliosis
  • fusion
  • idiopathic scoliosis
  • iliac screws
  • sacrum

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

O'Shaughnessy, B. A., Bridwell, K. H., Lenke, L. G., Cho, W., Baldus, C., Chang, M. S., ... Crawford, C. H. (2012). Does a long-fusion "t3-Sacrum" portend a worse outcome than a short-fusion "t10-Sacrum" in primary surgery for adult scoliosis? Spine, 37(10), 884-890. https://doi.org/10.1097/BRS.0b013e3182376414

Does a long-fusion "t3-Sacrum" portend a worse outcome than a short-fusion "t10-Sacrum" in primary surgery for adult scoliosis? / O'Shaughnessy, Brian A.; Bridwell, Keith H.; Lenke, Lawrence G.; Cho, Woojin; Baldus, Christine; Chang, Michael S.; Auerbach, Joshua D.; Crawford, Charles H.

In: Spine, Vol. 37, No. 10, 01.05.2012, p. 884-890.

Research output: Contribution to journalArticle

O'Shaughnessy, BA, Bridwell, KH, Lenke, LG, Cho, W, Baldus, C, Chang, MS, Auerbach, JD & Crawford, CH 2012, 'Does a long-fusion "t3-Sacrum" portend a worse outcome than a short-fusion "t10-Sacrum" in primary surgery for adult scoliosis?', Spine, vol. 37, no. 10, pp. 884-890. https://doi.org/10.1097/BRS.0b013e3182376414
O'Shaughnessy, Brian A. ; Bridwell, Keith H. ; Lenke, Lawrence G. ; Cho, Woojin ; Baldus, Christine ; Chang, Michael S. ; Auerbach, Joshua D. ; Crawford, Charles H. / Does a long-fusion "t3-Sacrum" portend a worse outcome than a short-fusion "t10-Sacrum" in primary surgery for adult scoliosis?. In: Spine. 2012 ; Vol. 37, No. 10. pp. 884-890.
@article{78fb7955ce90473e9caffc8cb68bc56c,
title = "Does a long-fusion {"}t3-Sacrum{"} portend a worse outcome than a short-fusion {"}t10-Sacrum{"} in primary surgery for adult scoliosis?",
abstract = "STUDY DESIGN.: Retrospective clinicoradiographic analysis. OBJECTIVE.: To compare the upper thoracic (UT) and lower thoracic (LT) spines as the upper instrumented vertebra 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 spine would have an increased pseudarthrosis, more perioperative complications, and worse outcomes and (2) LT spine would have more proximal junctional kyphosis. METHODS.: Patients who underwent primary surgery for adult scoliosis between 2002 and 2006 were studied. UT and LT groups were matched cohorts. Minimum follow-up for all patients was 2 years. Scoliosis Research Society scores and Oswestry Disability Index 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, recombinant human bone morphogenetic protein-2 per level, and caudal interbody grafting (80.0{\%} UT vs. 89.5{\%} LT) were similar. The UT group experienced 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 proximal junctional kyphosis (18.4{\%} vs. 10.0{\%}). Scoliosis Research Society scores and Oswestry Disability Index 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. CONCLUSION.: 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 proximal junctional kyphosis, only rarely requiring revision surgery.",
keywords = "adult scoliosis, bone morphogenetic protein, degenerative scoliosis, fusion, idiopathic scoliosis, iliac screws, sacrum",
author = "O'Shaughnessy, {Brian A.} and Bridwell, {Keith H.} and Lenke, {Lawrence G.} and Woojin Cho and Christine Baldus and Chang, {Michael S.} and Auerbach, {Joshua D.} and Crawford, {Charles H.}",
year = "2012",
month = "5",
day = "1",
doi = "10.1097/BRS.0b013e3182376414",
language = "English (US)",
volume = "37",
pages = "884--890",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Does a long-fusion "t3-Sacrum" portend a worse outcome than a short-fusion "t10-Sacrum" in primary surgery for adult scoliosis?

AU - O'Shaughnessy, Brian A.

AU - Bridwell, Keith H.

AU - Lenke, Lawrence G.

AU - Cho, Woojin

AU - Baldus, Christine

AU - Chang, Michael S.

AU - Auerbach, Joshua D.

AU - Crawford, Charles H.

PY - 2012/5/1

Y1 - 2012/5/1

N2 - STUDY DESIGN.: Retrospective clinicoradiographic analysis. OBJECTIVE.: To compare the upper thoracic (UT) and lower thoracic (LT) spines as the upper instrumented vertebra 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 spine would have an increased pseudarthrosis, more perioperative complications, and worse outcomes and (2) LT spine would have more proximal junctional kyphosis. METHODS.: Patients who underwent primary surgery for adult scoliosis between 2002 and 2006 were studied. UT and LT groups were matched cohorts. Minimum follow-up for all patients was 2 years. Scoliosis Research Society scores and Oswestry Disability Index 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, recombinant human bone morphogenetic protein-2 per level, and caudal interbody grafting (80.0% UT vs. 89.5% LT) were similar. The UT group experienced 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 proximal junctional kyphosis (18.4% vs. 10.0%). Scoliosis Research Society scores and Oswestry Disability Index 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. CONCLUSION.: 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 proximal junctional kyphosis, only rarely requiring revision surgery.

AB - STUDY DESIGN.: Retrospective clinicoradiographic analysis. OBJECTIVE.: To compare the upper thoracic (UT) and lower thoracic (LT) spines as the upper instrumented vertebra 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 spine would have an increased pseudarthrosis, more perioperative complications, and worse outcomes and (2) LT spine would have more proximal junctional kyphosis. METHODS.: Patients who underwent primary surgery for adult scoliosis between 2002 and 2006 were studied. UT and LT groups were matched cohorts. Minimum follow-up for all patients was 2 years. Scoliosis Research Society scores and Oswestry Disability Index 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, recombinant human bone morphogenetic protein-2 per level, and caudal interbody grafting (80.0% UT vs. 89.5% LT) were similar. The UT group experienced 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 proximal junctional kyphosis (18.4% vs. 10.0%). Scoliosis Research Society scores and Oswestry Disability Index 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. CONCLUSION.: 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 proximal junctional kyphosis, only rarely requiring revision surgery.

KW - adult scoliosis

KW - bone morphogenetic protein

KW - degenerative scoliosis

KW - fusion

KW - idiopathic scoliosis

KW - iliac screws

KW - sacrum

UR - http://www.scopus.com/inward/record.url?scp=84860833911&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860833911&partnerID=8YFLogxK

U2 - 10.1097/BRS.0b013e3182376414

DO - 10.1097/BRS.0b013e3182376414

M3 - Article

C2 - 21971131

AN - SCOPUS:84860833911

VL - 37

SP - 884

EP - 890

JO - Spine

JF - Spine

SN - 0362-2436

IS - 10

ER -