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).
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:ASDpatients 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).
Authors: Frank Schwab; Benjamin Ungar; Benjamin Blondel; Jacob Buchowski; Jeffrey Coe; Donald Deinlein; Christopher DeWald; Hossein Mehdian; Christopher Shaffrey; Clifford Tribus; Virginie Lafage Journal: Spine (Phila Pa 1976) Date: 2012-05-20 Impact factor: 3.468
Authors: Daniel B Murrey; Craig D Brigham; Gary M Kiebzak; Frederick Finger; Samuel J Chewning Journal: Spine (Phila Pa 1976) Date: 2002-11-01 Impact factor: 3.468
Authors: Steven D Glassman; Keith Bridwell; John R Dimar; William Horton; Sigurd Berven; Frank Schwab Journal: Spine (Phila Pa 1976) Date: 2005-09-15 Impact factor: 3.468
Authors: Yongjung J Kim; Keith H Bridwell; Lawrence G Lenke; Gene Cheh; Christine Baldus Journal: Spine (Phila Pa 1976) Date: 2007-09-15 Impact factor: 3.468
Authors: Justin S Smith; Christopher I Shaffrey; Kai-Ming G Fu; Justin K Scheer; Shay Bess; Virginie Lafage; Frank Schwab; Christopher P Ames Journal: Neurosurg Clin N Am Date: 2013-02-21 Impact factor: 2.509
Authors: Themistocles Protopsaltis; Nicolas Bronsard; Alex Soroceanu; Jensen K Henry; Renaud Lafage; Justin Smith; Eric Klineberg; Gregory Mundis; Han Jo Kim; Richard Hostin; Robert Hart; Christopher Shaffrey; Shay Bess; Christopher Ames Journal: Eur Spine J Date: 2016-07-20 Impact factor: 3.134
Authors: Gregory W Poorman; Peter L Zhou; Dennis Vasquez-Montes; Samantha Horn; Cole Bortz; Frank Segreto; Joshua Auerbach; John Y Moon; Jared C Tishelman; Michael C Gerling; Bassel G Diebo; Rafael De La Garza-Ramos; Justin C Paul; Peter G Passias Journal: J Spine Surg Date: 2018-06
Authors: Sohrab Virk; Uwe Platz; Shay Bess; Douglas Burton; Peter Passias; Munish Gupta; Themistocles Protopsaltis; Han Jo Kim; Justin S Smith; Robert Eastlack; Khaled Kebaish; Gregory M Mundis; Pierce Nunley; Christopher Shaffrey; Jeffrey Gum; Virginie Lafage; Frank Schwab Journal: J Spine Surg Date: 2021-03