Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper instrumented vertebra.

dc.contributor.author

Scheer, Justin K

dc.contributor.author

Lafage, Virginie

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Smith, Justin S

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Deviren, Vedat

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Hostin, Richard

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McCarthy, Ian M

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Mundis, Gregory M

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Burton, Douglas C

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Klineberg, Eric

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Gupta, Munish

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Kebaish, Khaled

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Shaffrey, Christopher I

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Bess, Shay

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Schwab, Frank

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Ames, Christopher P

dc.contributor.author

International Spine Study Group (ISSG)

dc.date.accessioned

2023-08-29T22:30:32Z

dc.date.available

2023-08-29T22:30:32Z

dc.date.issued

2015-01

dc.date.updated

2023-08-29T22:30:31Z

dc.description.abstract

Purpose

The goal of this study was to characterize the spino-pelvic realignment and the maintenance of that realignment by the upper-most instrumented vertebra (UIV) for adult deformity spinal (ASD) patients treated with lumbar pedicle subtraction osteotomy (PSO).

Methods

ASD patients were divided by UIV, classified as upper thoracic (UT: T1-T6) or Thoracolumbar (TL: T9-L1). Complications were recorded and radiographic parameters included thoracic kyphosis (TK, T2-T12), lumbar lordosis (LL, L1-S1), sagittal vertical axis (SVA), pelvic tilt, and the mismatch between pelvic incidence and LL. Patients were also classified by the Scoliosis Research Society (SRS)-Schwab modifier grades. Changes in radiographic parameters and SRS-Schwab grades were evaluated between the two groups. Additional analyses were performed on patients with pre-operative SVA ≥ 15 cm.

Results

165 patients were included (UT: 81 and TL: 84); 124 women, 41 men, with average age 59.9 ± 11.1 years (range 25-81). UT had a lower percentage of patients above the radiographic thresholds for disability than TL. UT had a significantly higher percentage of patients that improved in SRS-Schwab global alignment grade than the TL group at 2 years. Within the patients with pre-operative SVA ≥ 15 cm, TL developed significantly increased SVA and had a significantly higher percentage of patients above the SVA threshold at 3 months, and 1 and 2 years than UT.

Conclusions

Patients undergoing a single-level PSO for ASD who have fixation extending to the UT region (T1-T6) are more likely to maintain sagittal spino-pelvic alignment, lower overall revision rates and revision rate for proximal junctional kyphosis than those with fixation terminating in the TL region (T9-L1).
dc.identifier.issn

0940-6719

dc.identifier.issn

1432-0932

dc.identifier.uri

https://hdl.handle.net/10161/28794

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/s00586-014-3391-y

dc.subject

International Spine Study Group (ISSG)

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Lumbar Vertebrae

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Thoracic Vertebrae

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Humans

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Spinal Curvatures

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Radiography

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Spinal Fusion

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Osteotomy

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Reoperation

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Retrospective Studies

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Follow-Up Studies

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Adult

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Aged

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Aged, 80 and over

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Middle Aged

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Female

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Male

dc.title

Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper instrumented vertebra.

dc.type

Journal article

duke.contributor.orcid

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

pubs.begin-page

S121

pubs.end-page

S130

pubs.issue

1

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

24 Suppl 1

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