Does a Long Fusion “T3-Sacrum” Portend a Worse Outcome than a Short Fusion “T10-Sacrum” in Primary Surgery for Adult Scoliosis?

By London Spine

Does a Long Fusion “T3-Sacrum” Portend a Worse Outcome than a Short Fusion “T10-Sacrum” in Primary Surgery for Adult Scoliosis?

Spine (Phila Pa 1976). 2011 Sep 30;

Authors: O’Shaughnessy BA, Bridwell KH, Lenke LG, Cho W, Baldus C, Chang MS, Auerbach JD, Crawford CH

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.

PMID: 21971131 [PubMed – as supplied by publisher]