Selecting caudal fusion levels: 2 year functional and stiffness outcomes with matched pairs analysis in multilevel fusion to L5 versus S1.

dc.contributor.author

Daniels, Alan H

dc.contributor.author

Koller, Heiko

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Hiratzka, Shannon L

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Mayer, Michael

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Meier, Oliver

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Contag, Alec Gabriel

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Eltorai, Adam EM

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Hiratzka, Jayme

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Kojo Hamilton, D

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Shaffrey, Christopher I

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Smith, Justin S

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Bess, Shay

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Klineberg, Eric O

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Ames, Christopher P

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Lafage, Virginie

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Line, Breton

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Schwab, Frank J

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Hart, Robert A

dc.contributor.author

Group, International Spine Study

dc.date.accessioned

2023-07-09T21:26:26Z

dc.date.available

2023-07-09T21:26:26Z

dc.date.issued

2017-06

dc.date.updated

2023-07-09T21:26:25Z

dc.description.abstract

Purpose

Controversy persists as to whether to end multilevel thoracolumbar fusions caudally at L5 or S1. Some argue that stopping at L5 may preserve greater function, but there are few data comparing functional limitations due to lumbar stiffness in patients with fusion to L5 versus S1. The aim of this study was to evaluate whether patients undergoing multilevel thoracolumbar fusions with an L5 caudal endpoint have a better lumbosacral function than patients with an S1 caudal endpoint.

Methods

Patients undergoing successful thoracolumbar fusion of 5 or more levels to L5 or S1, with solid fusion at 2 year follow-up, were examined from a single European center in addition to a multi-center North American database of 237 patients. In total, 40 patients with a distal stopping point of L5 were matched with a subset of 40 patients with a distal endpoint of S1 ± pelvic fixation. The L5 and S1 groups were matched for the final Oswestry Disability Index (ODI), Sagittal Vertical Axis (SVA C7-S1), number of fusion levels, and age. Impacts of lumbar stiffness on function as measured by the Lumbar Stiffness Disability Index (LSDI) were compared using the conditional logistic regression.

Results

After matching, there was no significant difference between the S1 and L5 groups for the final ODI (29.22 ± 21.6 for S1 versus 29.21 ± 21.7 for L5; p = 0.98), SVA (29.5 ± 40.3 mm for S1 versus 33.7 ± 37.1 mm for L5; p = 0.97), mean age (61.6 ± 11.0 years for S1 versus 58.3 ± 12.6 years for L5; p = 0.23), and number of fusion levels (9.7 ± 3.3 levels for S1 versus 9.0 ± 3 levels for L5; p = 0.34). The final 2-year postoperative LSDI scores were not significantly different between the S1 group (28.08 ± 21.47) and L5 group (29.21 ± 21.66) (hazard ratio 0.99, 95 % CI 0.97-1.03, p = 0.81).

Conclusion

The analysis of patients with multilevel thoracolumbar fusions demonstrated that after minimum 2 year follow-up, self-reported functional impacts of lumbar stiffness were not significantly different between the patients with distal endpoints of L5 versus S1. The choice of distal fusion level of L5 does not appear to retain sufficient spinal flexibility to substantially affect postoperative function.

Level of evidence

Level III.
dc.identifier

10.1007/s00586-016-4790-z

dc.identifier.issn

0940-6719

dc.identifier.issn

1432-0932

dc.identifier.uri

https://hdl.handle.net/10161/28384

dc.language

eng

dc.publisher

Springer Science and Business Media LLC

dc.relation.ispartof

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

dc.relation.isversionof

10.1007/s00586-016-4790-z

dc.subject

Lumbar Vertebrae

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Sacrum

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Thoracic Vertebrae

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Humans

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Disability Evaluation

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Spinal Fusion

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Matched-Pair Analysis

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Follow-Up Studies

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Adult

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Aged

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Middle Aged

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Patient Outcome Assessment

dc.title

Selecting caudal fusion levels: 2 year functional and stiffness outcomes with matched pairs analysis in multilevel fusion to L5 versus S1.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

1645

pubs.end-page

1651

pubs.issue

6

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

26

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