Sohrab Virk1, Uwe Platz2, Shay Bess3, Douglas Burton4, Peter Passias5, Munish Gupta6, Themistocles Protopsaltis5, Han Jo Kim1, Justin S Smith7, Robert Eastlack8, Khaled Kebaish9, Gregory M Mundis8, Pierce Nunley10, Christopher Shaffrey11, Jeffrey Gum12, Virginie Lafage1, Frank Schwab1. 1. Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA. 2. Department of spine surgery, Schön Kllink Neustadt, Neustadt, Germany. 3. Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO, USA. 4. Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, USA. 5. Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA. 6. Department of Orthopaedic Surgery, Washington University, St Louis, MO, USA. 7. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA. 8. Scripps Clinic Medical Group Division of Orthopaedic Surgery, La Jolla, CA, USA. 9. Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 10. Spine Institute of Louisiana, Shreveport, LA, USA. 11. Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. 12. Norton Leatherman Spine Center, Louisville, KY, USA.
Abstract
BACKGROUND: The decision upper-most instrumented vertebrae (UIV) in a multi-level fusion procedure can dramatically influence outcomes of corrective spine surgery. We aimed to create an algorithm for selection of UIV based on surgeon selection/reasoning of sample cases. METHODS: The clinical/imaging data for 11 adult spinal deformity (ASD) patients were presented to 14 spine deformity surgeons who selected the UIV and provided reasons for avoidance of adjacent levels. The UIV chosen was grouped into either upper thoracic (UT, T1-T6), lower thoracic (LT, T7-T12), lumbar or cervical. Disagreement between surgeons was defined as ≥3 not agreeing. We performed a descriptive analysis of responses and created an algorithm for choosing UIV then applied this to a large database of ASD patients. RESULTS: Surgeons agreed in 8/11 cases on regional choice of UIV. T10 was the most common UIV in the LT region (58%) and T3 was the most common UIV in the UT region (44%). The most common determinant of UIV in the UT region was proximal thoracic kyphosis and presence of coronal deformity. The most common determinant of UIV in the LT region was small proximal thoracic kyphosis. Within the ASD database (236 patients), when the algorithm called for UT fusion, patients fused to TL region were more likely to develop proximal junctional kyphosis (PJK) at 1 year post-operatively (76.9% vs. 38.9%, P=0.025). CONCLUSIONS: Our algorithm for selection of UIV emphasizes the role of proximal and regional thoracic kyphosis. Failure to follow this consensus for UT fusion was associated with twice the rate of PJK. 2021 Journal of Spine Surgery. All rights reserved.
BACKGROUND: The decision upper-most instrumented vertebrae (UIV) in a multi-level fusion procedure can dramatically influence outcomes of corrective spine surgery. We aimed to create an algorithm for selection of UIV based on surgeon selection/reasoning of sample cases. METHODS: The clinical/imaging data for 11 adult spinal deformity (ASD) patients were presented to 14 spine deformity surgeons who selected the UIV and provided reasons for avoidance of adjacent levels. The UIV chosen was grouped into either upper thoracic (UT, T1-T6), lower thoracic (LT, T7-T12), lumbar or cervical. Disagreement between surgeons was defined as ≥3 not agreeing. We performed a descriptive analysis of responses and created an algorithm for choosing UIV then applied this to a large database of ASD patients. RESULTS: Surgeons agreed in 8/11 cases on regional choice of UIV. T10 was the most common UIV in the LT region (58%) and T3 was the most common UIV in the UT region (44%). The most common determinant of UIV in the UT region was proximal thoracic kyphosis and presence of coronal deformity. The most common determinant of UIV in the LT region was small proximal thoracic kyphosis. Within the ASD database (236 patients), when the algorithm called for UT fusion, patients fused to TL region were more likely to develop proximal junctional kyphosis (PJK) at 1 year post-operatively (76.9% vs. 38.9%, P=0.025). CONCLUSIONS: Our algorithm for selection of UIV emphasizes the role of proximal and regional thoracic kyphosis. Failure to follow this consensus for UT fusion was associated with twice the rate of PJK. 2021 Journal of Spine Surgery. All rights reserved.
Entities:
Keywords:
Upper instrumented vertebra; adult spinal deformity (ASD); long fusion; proximal junctional kyphosis; spinal instrumentation; surgery
Authors: Frank J Schwab; Nicola Hawkinson; Virginie Lafage; Justin S Smith; Robert Hart; Gregory Mundis; Douglas C Burton; Breton Line; Behrooz Akbarnia; Oheneba Boachie-Adjei; Richard Hostin; Christopher I Shaffrey; Vincent Arlet; Kirkham Wood; Munish Gupta; Shay Bess; Praveen V Mummaneni Journal: Eur Spine J Date: 2012-05-17 Impact factor: 3.134
Authors: Alex Soroceanu; Douglas C Burton; Jonathan Haim Oren; Justin S Smith; Richard Hostin; Christopher I Shaffrey; Behrooz A Akbarnia; Christopher P Ames; Thomas J Errico; Shay Bess; Munish C Gupta; Vedat Deviren; Frank J Schwab; Virginie Lafage Journal: Spine (Phila Pa 1976) Date: 2016-11-15 Impact factor: 3.468
Authors: Takahito Fujimori; Shinichi Inoue; Hai Le; William W Schairer; Sigurd H Berven; Bobby K Tay; Vedat Deviren; Shane Burch; Motoki Iwasaki; Serena S Hu Journal: Neurosurg Focus Date: 2014-05 Impact factor: 4.047
Authors: Justin K Scheer; Joseph A Osorio; Justin S Smith; Frank Schwab; Virginie Lafage; Robert A Hart; Shay Bess; Breton Line; Bassel G Diebo; Themistocles S Protopsaltis; Amit Jain; Tamir Ailon; Douglas C Burton; Christopher I Shaffrey; Eric Klineberg; Christopher P Ames Journal: Spine (Phila Pa 1976) Date: 2016-11-15 Impact factor: 3.468