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Revisions and Junctional Failures of Short versus Long Fusions for Adult Spinal Deformity
132S
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
http://dx.doi.org/10.1016/j.spinee.2014.08.322
http://dx.doi.org/10.1016/j.spinee.2014.08.323
P69. Revisions and Junctional Failures of Short versus Long Fusions for Adult Spinal Deformity International Spine Study Group1, Shian Liu, BS2, Emmanuelle Ferrero, MD3, Christopher P. Ames, MD4, Khaled M. Kebaish, MD5, Ibrahim Obeid6, Richard A. Hostin, MD7, Eric O. Klineberg, MD8, Oheneba Boachie-Adjei, MD9, Justin S. Smith, MD, PhD10, Gregory M. Mundis, Jr., MD11, Stephen P. Maier, II, BA2, Themistocles S. Protopsaltis, MD2, Frank J. Schwab, MD2, Virginie Lafage, PhD2; 1 Brighton, CO, US; 2New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, US; 3New York, NY, US; 4 University of California San Francisco, San Francisco, CA, US; 5 Baltimore, MD, US; 6France; 7Southwest Scoliosis Institute, Plano, TX, US; 8University of California Davis School of Medicine, Sacramento, CA, US; 9Hospital for Special Surgery, New York, NY, US; 10University of Virginia Health System, Charlottesville, VA, US; 11San Diego Center for Spinal Disorders, La Jolla, CA, US
P70. Three-Column Osteotomies in Elderly Patients: Is It Worth It? International Spine Study Group1, Vincent Challier, MD2, Shian Liu, BS3, Christopher P. Ames, MD4, Khaled M. Kebaish, MD5, Ibrahim Obeid6, Richard A. Hostin, MD7, Eric O. Klineberg, MD8, Oheneba Boachie-Adjei, MD9, Justin S. Smith, MD, PhD10, Behrooz A. Akbarnia, MD11, Kristina Bianco, BA12, Themistocles S. Protopsaltis, MD3, Frank J. Schwab, MD3, Virginie Lafage, PhD3; 1Brighton, CO, US; 2Spine Research Institute, New York, NY, US; 3New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, US; 4University of California San Francisco, San Francisco, CA, US; 5Baltimore, MD, US; 6 France; 7Southwest Scoliosis Institute, Plano, TX, US; 8University of California Davis School of Medicine, Sacramento, CA, US; 9Hospital for Special Surgery, New York, NY, US; 10University of Virginia Health System, Charlottesville, VA, US; 11San Diego Center for Spinal Disorders, La Jolla, CA, US; 12Spine Research Center, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, US
BACKGROUND CONTEXT: There has been much concern about the risk of proximal junctional kyphosis (PJK) after spinal fusion, especially with shorter fusions. The only study evaluating rates of PJK in proximal versus distal thoracic fusions, found no significant difference. PURPOSE: To investigate the rates of PJK and revisions in long fusions (LF) versus shorter fusions (SF). STUDY DESIGN/SETTING: Retrospective analysis of a multicenter database of patients who had undergone three-column osteotomy (3CO). PATIENT SAMPLE: 167 patients who underwent a lumbar 3CO and fusion to the pelvis with minimum 1-year follow-up. OUTCOME MEASURES: Baseline and postoperative radiographic parameters, complications and revisions. Radiographic parameters included sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), PJK, and lumbar lordosis (LL). METHODS: Retrospective analysis of a multicenter database of 167 patients who underwent a lumbar three-column osteotomy (3CO) and fusion to the pelvis with minimum 1-year follow-up. LF group was defined as upper instrumented vertebrae at T2-T4 (n574) and SF group was defined as UIV T10-L3 (n593). Cohorts were analyzed for differences in baseline and postoperative radiographic parameters, complications and revisions. RESULTS: At baseline, the two groups were similar in age (61þ9 years) and BMI (28þ6), but LF patients had a significantly greater PT (LF 36⁰, SF 30⁰, p 0.002), max kyphosis (LF -50⁰, SF -43⁰, p 0.021), and SVA (LF 164mm, SF 137mm, p 0.023). Following surgery, LF patients had significantly larger LL at 6 weeks (LF 56⁰, SF 51⁰, p 0.024), TK at 6 months (LF -56⁰, SF -48⁰, p 0.007), maximum kyphosis (LF -59⁰, SF -50⁰, p 0.003) and PJK at 1 year (LF -13⁰, SF -17⁰, p 0.008); there were no significant differences in 1-year SVA. Furthermore, no significant differences existed between group in number of total revisions, revision rate at 1 year, and number of complications. However, the SF patients had a significantly larger rate in revisions at 3 months (LF 1.4% vs SF 11.8%, p 0.010), with no difference in etiology. In total, there were 8 revisions for PJK (of 47 revisions in total); 75% of the revisions for PJK (n56) were SF patients who all had a baseline SVAO10cm. CONCLUSIONS: At baseline, the LF group had significantly more global sagittal malalignment and TK; however, postoperatively, sagittal alignment was not significantly different at any time point. There were also no significant differences in total number of revisions, except at 3 months for the SF group. PJK was higher at 1 year for the SF group, without a significant difference in revisions for PJK. These results suggest that while SF leads to radiographic PJK, it does not necessarily lead to an increase in surgical intervention, and certain patients with a high SVA can undergo SF with satisfactory sagittal outcomes.
BACKGROUND CONTEXT: As the elderly population grows, there has been a concomitant increase in their functional expectations. Degenerative spine deformity requires surgical techniques of correction such as various types of 3-column osteotomies (3CO), many of which carry risks of complications and revisions. Despite these risks, 3COs have shown potential benefit across commonly studied age groups. However, it remains unclear if these benefits apply to the elderly population. We propose to evaluate sagittal alignment and its evolution after 3CO in a population over 70 years old. PURPOSE: To compare baseline and two-year follow-up sagittal alignment and its evolution, complication and revision rate after 3CO in a population over 70 years old and in a control group of younger patients matched by global and spinopelvic alignment. STUDY DESIGN/SETTING: Multicenter, retrospective review from 11 sites across the United States. PATIENT SAMPLE: 54 patients over the age of 70 with sagittal spine deformity (SSD) patients who underwent 3CO. OUTCOME MEASURES: Operating room (OR) time (mn), OR blood loss (ml), pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), complications, revisions. METHODS: Radiographic retrospective review of 54 patients over 70 year who underwent 3CO for SSD and were consecutively enrolled from 11 sites across the United States. All patients had full-spine radiographs analyzed at baseline (BL) and postoperatively (2 years). Operative reports and complications were also collected. A comparison was performed with a control group of younger patients (CG, n551) matched by global and spinopelvic alignment. RESULTS: Radiographic analysis at baseline revealed severe SSD according to SRS-Schwab classification across the EC and CG groups without significant differences in sagittal plane spinopelvic parameters (EC PT 33⁰, CG PT 32⁰; EC PI-LL 34⁰, CG PI-LL 34⁰; EC SVA 150mm, CG 153mm). At 2 years, significant improvement was observed in the elderly cohort (EC) (SVA BL 150mm to SVA 2y 57mm, p50.001; PT BL 33⁰, PT 2y 25⁰, p 0.001; PI-LL BL 34⁰, PI-LL 2y 7⁰, p 0.001). Compared with the CG, there was a significant difference in changes in PI-LL (EC: -27 vs CG: -22 p50.03). There was no significant difference in OR time (EC 403 min, CG 466 min, p 0.087), postoperative complications (EC 25%, CG 18%, p50.569) or total rate of revisions between groups (EC 45%, CG 28%, p50.066). The EC group had significantly more intraoperative complications (EC: 34% vs CG: 9% p50.019) such as increased rate of bleeding over 4L (77% of intraoperative complication in the EC), revision for proximal junction kyphosis (PJK) (EC: 8% vs CG: 1% p50.038) and infection (EC: 5% vs CG: 3% p50.03).
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
http://dx.doi.org/10.1016/j.spinee.2014.08.322
http://dx.doi.org/10.1016/j.spinee.2014.08.323
P69. Revisions and Junctional Failures of Short versus Long Fusions for Adult Spinal Deformity International Spine Study Group1, Shian Liu, BS2, Emmanuelle Ferrero, MD3, Christopher P. Ames, MD4, Khaled M. Kebaish, MD5, Ibrahim Obeid6, Richard A. Hostin, MD7, Eric O. Klineberg, MD8, Oheneba Boachie-Adjei, MD9, Justin S. Smith, MD, PhD10, Gregory M. Mundis, Jr., MD11, Stephen P. Maier, II, BA2, Themistocles S. Protopsaltis, MD2, Frank J. Schwab, MD2, Virginie Lafage, PhD2; 1 Brighton, CO, US; 2New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, US; 3New York, NY, US; 4 University of California San Francisco, San Francisco, CA, US; 5 Baltimore, MD, US; 6France; 7Southwest Scoliosis Institute, Plano, TX, US; 8University of California Davis School of Medicine, Sacramento, CA, US; 9Hospital for Special Surgery, New York, NY, US; 10University of Virginia Health System, Charlottesville, VA, US; 11San Diego Center for Spinal Disorders, La Jolla, CA, US
P70. Three-Column Osteotomies in Elderly Patients: Is It Worth It? International Spine Study Group1, Vincent Challier, MD2, Shian Liu, BS3, Christopher P. Ames, MD4, Khaled M. Kebaish, MD5, Ibrahim Obeid6, Richard A. Hostin, MD7, Eric O. Klineberg, MD8, Oheneba Boachie-Adjei, MD9, Justin S. Smith, MD, PhD10, Behrooz A. Akbarnia, MD11, Kristina Bianco, BA12, Themistocles S. Protopsaltis, MD3, Frank J. Schwab, MD3, Virginie Lafage, PhD3; 1Brighton, CO, US; 2Spine Research Institute, New York, NY, US; 3New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, US; 4University of California San Francisco, San Francisco, CA, US; 5Baltimore, MD, US; 6 France; 7Southwest Scoliosis Institute, Plano, TX, US; 8University of California Davis School of Medicine, Sacramento, CA, US; 9Hospital for Special Surgery, New York, NY, US; 10University of Virginia Health System, Charlottesville, VA, US; 11San Diego Center for Spinal Disorders, La Jolla, CA, US; 12Spine Research Center, New York University Langone Medical Center Hospital for Joint Diseases, New York, NY, US
BACKGROUND CONTEXT: There has been much concern about the risk of proximal junctional kyphosis (PJK) after spinal fusion, especially with shorter fusions. The only study evaluating rates of PJK in proximal versus distal thoracic fusions, found no significant difference. PURPOSE: To investigate the rates of PJK and revisions in long fusions (LF) versus shorter fusions (SF). STUDY DESIGN/SETTING: Retrospective analysis of a multicenter database of patients who had undergone three-column osteotomy (3CO). PATIENT SAMPLE: 167 patients who underwent a lumbar 3CO and fusion to the pelvis with minimum 1-year follow-up. OUTCOME MEASURES: Baseline and postoperative radiographic parameters, complications and revisions. Radiographic parameters included sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), PJK, and lumbar lordosis (LL). METHODS: Retrospective analysis of a multicenter database of 167 patients who underwent a lumbar three-column osteotomy (3CO) and fusion to the pelvis with minimum 1-year follow-up. LF group was defined as upper instrumented vertebrae at T2-T4 (n574) and SF group was defined as UIV T10-L3 (n593). Cohorts were analyzed for differences in baseline and postoperative radiographic parameters, complications and revisions. RESULTS: At baseline, the two groups were similar in age (61þ9 years) and BMI (28þ6), but LF patients had a significantly greater PT (LF 36⁰, SF 30⁰, p 0.002), max kyphosis (LF -50⁰, SF -43⁰, p 0.021), and SVA (LF 164mm, SF 137mm, p 0.023). Following surgery, LF patients had significantly larger LL at 6 weeks (LF 56⁰, SF 51⁰, p 0.024), TK at 6 months (LF -56⁰, SF -48⁰, p 0.007), maximum kyphosis (LF -59⁰, SF -50⁰, p 0.003) and PJK at 1 year (LF -13⁰, SF -17⁰, p 0.008); there were no significant differences in 1-year SVA. Furthermore, no significant differences existed between group in number of total revisions, revision rate at 1 year, and number of complications. However, the SF patients had a significantly larger rate in revisions at 3 months (LF 1.4% vs SF 11.8%, p 0.010), with no difference in etiology. In total, there were 8 revisions for PJK (of 47 revisions in total); 75% of the revisions for PJK (n56) were SF patients who all had a baseline SVAO10cm. CONCLUSIONS: At baseline, the LF group had significantly more global sagittal malalignment and TK; however, postoperatively, sagittal alignment was not significantly different at any time point. There were also no significant differences in total number of revisions, except at 3 months for the SF group. PJK was higher at 1 year for the SF group, without a significant difference in revisions for PJK. These results suggest that while SF leads to radiographic PJK, it does not necessarily lead to an increase in surgical intervention, and certain patients with a high SVA can undergo SF with satisfactory sagittal outcomes.
BACKGROUND CONTEXT: As the elderly population grows, there has been a concomitant increase in their functional expectations. Degenerative spine deformity requires surgical techniques of correction such as various types of 3-column osteotomies (3CO), many of which carry risks of complications and revisions. Despite these risks, 3COs have shown potential benefit across commonly studied age groups. However, it remains unclear if these benefits apply to the elderly population. We propose to evaluate sagittal alignment and its evolution after 3CO in a population over 70 years old. PURPOSE: To compare baseline and two-year follow-up sagittal alignment and its evolution, complication and revision rate after 3CO in a population over 70 years old and in a control group of younger patients matched by global and spinopelvic alignment. STUDY DESIGN/SETTING: Multicenter, retrospective review from 11 sites across the United States. PATIENT SAMPLE: 54 patients over the age of 70 with sagittal spine deformity (SSD) patients who underwent 3CO. OUTCOME MEASURES: Operating room (OR) time (mn), OR blood loss (ml), pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), complications, revisions. METHODS: Radiographic retrospective review of 54 patients over 70 year who underwent 3CO for SSD and were consecutively enrolled from 11 sites across the United States. All patients had full-spine radiographs analyzed at baseline (BL) and postoperatively (2 years). Operative reports and complications were also collected. A comparison was performed with a control group of younger patients (CG, n551) matched by global and spinopelvic alignment. RESULTS: Radiographic analysis at baseline revealed severe SSD according to SRS-Schwab classification across the EC and CG groups without significant differences in sagittal plane spinopelvic parameters (EC PT 33⁰, CG PT 32⁰; EC PI-LL 34⁰, CG PI-LL 34⁰; EC SVA 150mm, CG 153mm). At 2 years, significant improvement was observed in the elderly cohort (EC) (SVA BL 150mm to SVA 2y 57mm, p50.001; PT BL 33⁰, PT 2y 25⁰, p 0.001; PI-LL BL 34⁰, PI-LL 2y 7⁰, p 0.001). Compared with the CG, there was a significant difference in changes in PI-LL (EC: -27 vs CG: -22 p50.03). There was no significant difference in OR time (EC 403 min, CG 466 min, p 0.087), postoperative complications (EC 25%, CG 18%, p50.569) or total rate of revisions between groups (EC 45%, CG 28%, p50.066). The EC group had significantly more intraoperative complications (EC: 34% vs CG: 9% p50.019) such as increased rate of bleeding over 4L (77% of intraoperative complication in the EC), revision for proximal junction kyphosis (PJK) (EC: 8% vs CG: 1% p50.038) and infection (EC: 5% vs CG: 3% p50.03).
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.