Introduction: Few studies have reported the results and complication rates for extension of previous long scoliosis fusions terminating at L3, L4, or L5 to the sacro‐pelvis. The purpose of this study was to evaluate the efficacy and complications of different surgical approaches to optimize spinal alignment correction in patients requiring revision spinal surgery with extension of fusion to the sacro‐pelvis.
Methods: Retrospective, consecutive (1995–2006), multicenter, chart, HRQL, and radiographic review of adult deformity pts previously fused distally to L3, L4, or L5 receiving revision surgery to extend the fusion to the sacro‐pelvis. Pts were divided into APSF (n=30) and PSF (n=14; 10 of 14 had either a PLIF or TLIF) approach groups. Pts were evaluated for pedicle subtraction osteotomy (PSO; n=13) or no PSO (n=31). Radiographic evaluation included coronal and sagittal spino‐pelvic measures. Perioperative complications were noted.
Results: 44 pts of 54 eligible pts, mean age 49.0 yrs (21–73 yrs), had 2 yr radiographic data. Mean follow‐up was 41.9 months (23–135 months). 41 of 54 pts had 2 yr SRS 22 scores. No statistically significant preoperative differences existed between the APSF and PSF groups, except the APSF group had a larger TL curve (p=0.011). Only pts receiving PSO had significant sagittal vertical axis (SVA) correction postoperatively (p=0.002). Although not statistically significant, more complications occurred in APSF compared to PSF (14 vs 1; p=0.092; Table 1). Table 1 indicates that there was no difference in: 1) total complications PSO vs no PSO, 2) total pseudarthroses PSF vs APSF, and 3) post‐op HRQL outcomes between pts with or without complications.
Conclusion: Posterior approach with osteotomy achieved equivalent sagittal spinal alignment and post‐op HRQL scores without an increase in pseudoarthrosis rates compared to APSF in pts undergoing revision surgery with extension of fusion to the sacro‐pelvis. PSO achieved a statistically significant improvement in SVA correction without increasing complications. Post‐op HRQL outcomes were equivalent to the published literature of primary surgery to the pelvis.