Retrospective review—multicenter database.
The purpose of this study was to compare the upper thoracic (UT) and lower thoracic (LT) upper instrumented vertebrae (UIV) in long fusions to the sacrum for adult scoliosis.
Summary of Background Data.
The optimal UIV for stopping long fusions to the sacrum/pelvis are controversial. Although a UT endpoint may lead to greater operative times, blood loss, and higher rates of pseudarthrosis, the risk for the development of proximal junctional kyphosis and need for revision surgery is likely lower.
Retrospective analysis of a prospective database of patients with adult spinal deformity, Patients were selected on the basis of fusions to the sacrum/pelvis with UIV of T1–T6 (UT group) and those with a UIV of T9–L1 (LT group). Demographic data, operative details, and radiographical outcomes with Scoliosis Research Society scores, and Oswestry Disability Index outcomes were collected, as well as complication data were compared. The Fisher exact T tests were used for statistical analysis.
A total of 198 patients (UT = 91, LT = 107) with a mean age of 61.6 were followed for an average of 2.5 years. Demographic variables were similar between the groups except for larger numbers of females in the UT group and a slightly higher body mass index in the LT group. Preoperatively, the UT group demonstrated significantly more lumbar scoliosis, thoracic scoliosis, and thoracolumbar kyphosis. The UT group demonstrated a larger number of fused segments length of stay and longer operative times. There was slightly larger volume of blood loss in the UT group.
The total number of complications and number of revision surgical procedures were similar between the groups. The UT group had a higher percentage of patients with 2 or more complications. Both groups had similar proximal junctional kyphosis angles and number of cases requiring revision for proximal junctional kyphosis. Scoliosis Research Society and Oswestry Disability Index outcomes were similar between the groups.
The UT and LT groups had similar outcomes. The UT group may have a higher rate of total complications, but major complications requiring return to the operative room were similar. The length of stay and operative times were higher in the UT group but may have been necessarily evidenced by the significantly higher coronal deformity and greater thoracolumbar kyphosis in the UT group.
Level of Evidence: 4