Journal ArticleDOI
Is the T9, T11, or L1 the more reliable proximal level after adult lumbar or lumbosacral instrumented fusion to L5 or S1?
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Three different proximal fusion levels did not demonstrate significant radiographic and clinical outcomes or revision prevalence after surgery, and the more distal proximal Fusion level at a neutral and stable vertebra may be satisfactory.Abstract:
Study design A retrospective comparison study. Objective To compare the postoperative proximal junctional change and revision prevalence as influenced by 3 different proximal levels after adult lumbar deformity instrumented fusion from the distal thoracic/upper lumbar spine (T9-L2) to L5 or S1. Summary of background data Few comparative studies on postoperative sagittal plane change and revision prevalence as influenced by 3 different proximal levels after adult lumbar deformity instrumented fusion from the distal thoracic/upper lumbar spine (T9-L2) to L5 or S1 have been published. Many surgeons have hypothesized that stopping proximally in the upper lumbar spine (L1 or L2) or the thoracolumbar junction (T11 or T12) would lead to a high percentage of rapid proximal degeneration, kyphosis, and decompensation because of the concentration of stress on these relatively mobile segments. Therein, many surgeons have felt it is unsafe to stop at these regions of the spine and it is better to always stop proximally at T9 or T10. Methods A clinical and radiographic assessment in addition to revision prevalence of 125 adult lumbar deformity patients (average age 57.1 year) who underwent long (average 7.1 vertebrae) segmental posterior spinal instrumented fusion from the distal thoracic/upper lumbar spine (T9-L2) to L5 or S1 with a minimum 2-year follow-up (2-19.8 year follow-up) were compared as influenced by T9-T10 (group 1, n = 37), T11-T12 (group 2, n = 49), and L1-L2 (group 3, n = 39) proximal fusion levels. The revision prevalence and sagittal Cobb angle change at the proximal junction after surgery were compared. Results Three groups demonstrated nonsignificant differences in the prevalence of proximal junctional kyphosis (group 1 51% vs. group 2 55% vs. group 3 36%, P = 0.20) and revision (group 1 24% vs. group 2 24% vs. group 3 26%, P = 0.99) at the ultimate follow-up. Subsequent proximal junctional angle and sagittal vertical axis changes between the ultimate follow-up and preoperative (P = 0.10 and 0.46 respectively) were not significantly different. The SRS total and all subscale outcomes scores among the 3 groups did not demonstrate significant differences (P > 0.50). Conclusion Three different proximal fusion levels did not demonstrate significant radiographic and clinical outcomes or revision prevalence after surgery. Therefore the more distal proximal fusion level at a neutral and stable vertebra may be satisfactory.read more
Citations
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Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up
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Patrick T O'Leary,Keith H. Bridwell,Lawrence G. Lenke,Christopher R. Good,Mark A. Pichelmann,Jacob M. Buchowski,Yongjung J. Kim,Jennifer Flynn +7 more
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Proximal junctional kyphosis following adult spinal deformity surgery
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References
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Journal ArticleDOI
Accelerated degeneration of the segment adjacent to a lumbar fusion.
TL;DR: This study presents 18 patients in whom new symptoms developed from the segment adjacent to a fusion after an average symptom-free interval of 8.5 years (1-38 years).
Journal ArticleDOI
An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers
TL;DR: The majority of asymptomatic individuals are able to maintain their sagittal alignment despite advancing age, and increasing age correlated to a more forward sagittal vertical axis with loss of distal lumbar lordosis but without an increase in thoracic or thoracolumbar kyphosis.
Journal ArticleDOI
Proximal Junctional Kyphosis in Adult Spinal Deformity Following Long Instrumented Posterior Spinal Fusion : Incidence, Outcomes, and Risk Factor Analysis
R. Chris Glattes,Keith H. Bridwell,Lawrence G. Lenke,Yongjung J. Kim,Anthony Rinella,Charles C. Edwards +5 more
TL;DR: Investigation in adults undergoing long posterior spinal fusion found incidence of proximal junctional kyphosis was high, but SRS-24 scores were not significantly affected in patients with PJK, and the sagittal C7 plumb was not significantly more positive in PJK patients.
Journal ArticleDOI
Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis : a multicenter study of 244 patients
Thomas R. Haher,John M. Gorup,Tae M. Shin,Peter Homel,Andrew A. Merola,Dennis P. Grogan,Linda I. Pugh,Thomas G. Lowe,Michael Murray +8 more
TL;DR: In this paper, an outcome questionnaire was constructed to evaluate patient satisfaction and performance and to discriminate among patients with adolescent idiopathic scoliosis, and the reliability of the questionnaire was confirmed with a Cronbach's alpha coefficient greater than 0.6 for each domain.
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Intradiscal pressure measurements above an instrumented fusion. A cadaveric study.
TL;DR: In general, the addition of instrumentation significantly affected the intradiscal pressure in the levels above a simulated fusion, with a greater increase seen at the L4-L5 level than the L3-L4 level.