Spinal deformity in elderly patients: comparison of two distal termination sites of lumbar curve fusion

Zaborovskii, Nikita; Пташников, Д. А.; Mikhaylov, D. A.; Smekalenkov, Oleg; Masevnin, Sergei; Lapaeva, Olga; Mooraby, Zabioulah

doi:10.1007/s00590-016-1858-8

Cited by 5 publications

(28 citation statements)

References 25 publications

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“…There were no significant differences on age, gender, diagnosis, and follow-up between the two groups. Because the preoperative scoliosis angles, lordosis angles, SVA, ODI, and VAS scores were significantly different in some studies [14,16,17,29], the change values from pre-operation to the last follow-up were used for analysis to eliminate the influence of different preoperative values.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…We used the change values from pre-operation to the last follow-up for analysis. The data of main scoliosis angles were extracted from four articles [14,16,17,29] (Fig. 2).…”

Section: Final Correction Of Scoliosismentioning

confidence: 99%

“…The SVA was calculated as the distance from the C7 plumb line to the posterior endplate corner of S1. Data on the preoperative and final SVA were available from five studies [14,[16][17][18]29] (Fig. 4).…”

Section: Final Correction Of Svamentioning

confidence: 99%

“…There was no significant difference between L group and S group in analysis (MD 0.94; 95% CI − 1.19 to 3.07, P = 0.39) with moderate heterogeneity (P = 0.18, I 2 = 41%). Data on the preoperative and final VAS scores were available from two studies [17,29] (Fig. 11).…”

Section: Final Improvement Of Odi and Vas Scoresmentioning

confidence: 99%

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Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis

et al. 2019

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Purpose Choosing an optimal distal fusion level for adult spinal deformity (ASD) is still controversial. To compare the radiographic and clinical outcomes of distal fusion to L5 versus the sacrum in ASD, we conducted a meta-analysis. Methods Relevant studies on long fusion terminating at L5 or the sacrum in ASD were retrieved from the PubMed, Embase, Cochrane, and Google Scholar databases. Then, studies were manually selected for inclusion based on predefined criteria. The meta-analysis was performed by RevMan 5.3. Results Eleven retrospective studies with 1211 patients were included in meta-analysis. No significant difference was found in overall complication rate (95% CI 0.60 to 1.30) and revision rate (95% CI 0.59 to 1.99) between fusion to L5 group (L group) and fusion to the sacrum group (S group). Significant lower rate of pseudarthrosis and implant-related complications (95% CI 0.29 to 0.64) as well as proximal adjacent segment disease (95% CI 0.35 to 0.92) was found in L group. Patients in S group obtained a better correction of lumbar lordosis (95% CI − 7.85 to − 0.38) and less loss of sagittal balance (95% CI − 1.80 to − 0.50). Conclusion Our meta-analysis suggested that long fusion terminating at L5 or the sacrum was similar in scoliosis correction, overall complication rate, revision rate, and improvement in pain and disability. However, fusion to L5 had advantages in lower rate of pseudarthrosis, implant-related complications, and proximal adjacent segment disease, while fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance, and absence of distal adjacent segment disease. Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.Key points 1. The meta-analysis suggested that fusion to L5 was similar to fusion to the sacrum in the correction of scoliosis, overall complication rate, revision rate and improvements of pain and disability.2. Fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance and absence of distal adjacent segment disease. Fusion toL5 had advantages in lower rate of pseudarthrosis and implantrelated complications and proximal adjacent segment disease. Jia F, Wang G, Liu X, Li T, Sun J (2019) Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis. Eur Spine J; scoliosis lordosis SVA overall complicaƟons revisions pseudarthrosis and implant-related complicaƟons Jia F, Wang G, Liu X, Li T, Sun J (2019) Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis. Eur Spine J;Take Home Messages 1. There were no significant differences between two groups in overall complication rate and revision rate, which was counter-intuitive. The improvements of pain and disability were also similar in both groups.2. Fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance and absence of distal adjacent segment di...

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Section: Study Characteristicsmentioning

confidence: 99%

“…We used the change values from pre-operation to the last follow-up for analysis. The data of main scoliosis angles were extracted from four articles [14,16,17,29] (Fig. 2).…”

Section: Final Correction Of Scoliosismentioning

confidence: 99%

Section: Final Correction Of Svamentioning

confidence: 99%

Section: Final Improvement Of Odi and Vas Scoresmentioning

confidence: 99%

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Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis

et al. 2019

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“…(8,31). The L5-S1 disc space, as the most mobile part of the spine, is important for good quality of life in patients with high ambulatory capacity.…”

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confidence: 99%

The effect of distal fusion level on functional and radiographic parameters following long posterior instrumentation and fusion

Olguner

Çeliktaş²,

Arslan³

et al. 2020

Turkish Neurosurgery

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AIM:To investigate the effect of distal fusion level on radiographic parameters and functional outcome in patients with degenerative spine disease who undergo long posterior fusion with instrumentation. MATERIAL and METHODS:This study included 78 adult patients aged>60 years who underwent long posterior fusion (>6 levels) for spinal deformity with a minimum 2-year follow-up. The patients were divided into two groups based on distal fusion level (L5 group and iliac group). Spinopelvic parameters, including lumbar lordosis (LL) and sagittal vertical axis (SVA), were evaluated. Functional outcome was evaluated with the pain visual analog scale (VAS) and the Oswestry Disability Index (ODI) questionnaire. Correlations between clinical and radiographic parameters were calculated statistically. RESULTS:In the L5 group, the mean SVA and LL significantly improved after surgery (p=0.025 and 0.008, respectively). Similarly, the SVA and LL also improved significantly in the iliac group (p=0.002 and 0.001, respectively). In both groups, lumbar VAS, leg VAS and ODI scores significantly improved (p<0.001). The change in ODI score was significantly greater in the iliac group than the L5 group (p=0.013). CONCLUSION:Although patients did not achieve the desired optimal spinal saggital balance, both L5 and iliac groups showed significant improvement in VAS and ODI scores. The iliac group showed slightly better improvement in ODI score.

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A Systematic Review of Risk Factors Associated With Distal Junctional Failure in Adult Spinal Deformity Surgery

McDonnell

Ahern

Wagner

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Background: The surgical management of adult spinal deformity (ASD) is a major surgical undertaking associated with considerable perioperative risk and a substantial complication profile. Although the natural history and risk factors associated with proximal junctional kyphosis (PJK) and proximal junctional failure are widely reported, distal junctional failure (DJF) is less well understood.Study Design: A systematic review was carried out.Objectives: The primary objective is to identify the risk factors associated with DJF. The secondary objective is to delineate the incidence rate and causative factors associated with DJF.Methods: A systematic review of articles in Medline/PubMed and The Cochrane Library databases was performed according to preferred reporting items for systematic reviews and metaanalyses guidelines. Data was collated to determine the prevalence of DJF and overall revision rates, and identify potential risk factors for development of DJF.Results: Twelve studies were included for systematic review. There were 81/2261 (3.6%) cases of DJF. Overall, DJF represented 27.3% of all revision surgeries. Anterior-posterior surgery had a reduced incidence of postoperative DJF [5.0% vs. 8.7%; P = 0.08; relative risk (RR) = 1.73], as did patients below 60 years of age at the time of surgery (2.9% vs. 3.9%; P = 0.09; RR = 1.34). There was a higher incidence of DJF among those patients who received interbody fusion (9.9% vs. 5.1%; P = 0.06; RR = 1.93) compared with those who did not. However, none of these findings reached statistical significance. There were significantly more rates of DJF for fusions ending on L5 compared with constructs fused to the sacrum (11.7% vs. 3.6%; P = 0.02; RR = 3.28).Conclusions: Cohorts 60 years and above of age at the time of surgery and patients managed with posterior-only fusion or interbody fusion have increased incidences of DJF. Fusion to L5 instead of the sacrum significantly influences DJF rates. However, the quality of available evidence is low and further highquality studies are required to more robustly analyze the clinical, radiographic, and surgical risk factors associated with the development of DJF after ASD surgery.

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Spinal deformity in elderly patients: comparison of two distal termination sites of lumbar curve fusion

Abstract: The research showed that fusion of lumbar curve extending to the pelvis provided good sagittal balance, global spinal alignments, and likely HRQOL parameters after 3-year follow-up. But, eventually, we obtained higher number of complications.

Cited by 5 publications

References 25 publications

Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis

Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis

The effect of distal fusion level on functional and radiographic parameters following long posterior instrumentation and fusion

A Systematic Review of Risk Factors Associated With Distal Junctional Failure in Adult Spinal Deformity Surgery

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