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Extension of Spine Fusion to the Sacrum Following Long Fusions for Deformity Correction

O'Neill, Kevin R. MD, MS; Bridwell, Keith H. MD; Lenke, Lawrence G. MD; Chuntarapas, Tapanut MD; Dorward, Ian MD; Neuman, Brian MD; Ahmad, Azeem BS; Baldus, Christine RN, MHS

doi: 10.1097/BRS.0000000000000327

Study Design. Retrospective review of prospective database.

Objective. To investigate the long-term results after extension of previous long spine fusions to the sacrum.

Summary of Background Data. Long spine fusions not involving the sacrum may be complicated by distal degeneration and require subsequent extension to the sacrum. The clinical and radiographical outcomes after such revision remain unknown.

Methods. Patients who had extension of a long fusion (≥5 levels with a thoracic level at the cranial end) to the sacrum between 2002 and 2007 at a single institution were analyzed. Oswestry Disability Index and Scoliosis Research Society scores and/or radiographical parameters were assessed at baseline, 6 weeks and 1 year, 2, 3, and/or 5 years postoperatively (PO) and complications were recorded.

Results. There were 74 patients with an average age of 49 years (range, 19–76 yr) and average clinical follow-up of 4.5 years (range, 3 mo–10 yr, 82% >2 yr PO). All had degeneration distal to prior fusions and 72% (n = 53) had fixed sagittal imbalance. Sagittal alignment improved at all PO time points from baseline (mean, 78 mm), but worsened between 1 year (mean, 21 mm) and 5 years PO (mean, 44 mm, P = 0.01). Major surgical complications occurred in 30% (n = 22) and there were 17 major reoperations in 15 patients (20%). Significant improvements (P < 0.05) in Oswestry Disability Index and all Scoliosis Research Society domain scores were found at each PO time point with no deterioration from 1 to 5 years PO. Mean outcome scores at 5 years PO were similar in groups with major surgical complications versus without and with major reoperation versus without.

Conclusion. Extension of long fusions to the sacrum resulted in significant and sustained improvements in Oswestry Disability Index and Scoliosis Research Society scores and alignment during 5 years PO compared with baseline. Major surgical complications occurred in 30% and reoperations were performed in 20%, but outcome scores after treatment were similar to those without complications or reoperations.

Level of Evidence: 4

An analysis of 74 patients who underwent extension of a previous long fusion to the sacrum was performed. Patients had significant and sustained improvements in Oswestry Disability Index and Scoliosis Research Society scores and sagittal alignment. After appropriate treatment, major surgical complications and/or reoperations did not impact final patient outcomes.

From the Washington University, Department of Orthopaedics, St. Louis, MO.

Address correspondence and reprint requests to Keith H. Bridwell, MD, Washington University Orthopaedics, 425 S. Euclid Ave, Suite 5505, Campus Box 8233, St. Louis, MO 63110; E-mail:

Acknowledgment date: September 13, 2013. First revision date: December 22, 2013. Second revision date: March 4, 2014. Acceptance date: March 5, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, grants/grants pending, payment for lectures, patents, royalties, travel/accommodations/meeting expenses, and fellowship grant.

© 2014 by Lippincott Williams & Wilkins