Re‐operation After Long‐Segment Fusions for Adult Spinal Deformity: The Impact of Extending the Construct Below the Lumbar Spine. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Witiw, Christopher D; Fessler, Richard G; Nguyen, Stacie; Mummaneni, Praveen; Anand, Neel; Blaskiewicz, Donald; Uribe, Juan; Wang, Michael Y; Kanter, Adam S; Okonkwo, David; Park, Paul; Deviren, Vedat; Akbarnia, Behrooz A; Eastlack, Robert K; Shaffrey, Christopher; Mundis, Gregory M
• Is Part Of: Neurosurgery. Volume 82:Issue 2(2018)
• Publication Date: 2018-02
• Subjects: Distal junctional failure -- Adjacent segment degeneration -- Adult spinal deformity -- Reoperation -- Spine; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyx163
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : BACKGROUND : Deciding where to end a long‐segment fusion for adult spinal deformity (ASD) may be a challenge, particularly in the absence of an abnormality at L5/S1. Some suggest prophylactic extension of the construct to the sacrum and/or ilium (S/I) to protect against distal junctional failure, while others support terminating in the lower lumbar spine to preserve motion. OBJECTIVE : To compare the risk of re‐operation after long‐segment fusions for ASD that ends at L4 or L5 (L4/5) vs S/I. METHODS : A multicenter database of patients treated for ASD by circumferential minimally invasive surgery or hybrid surgical technique was screened for individuals with long fusions (≥4 vertebral levels) ending at L4 or below and with at least 2 yr of follow‐up. Multivariate regression modeling was used to compare surgical morbidity between the L4/5 and S/I groups, and Cox proportional hazard modeling was used to compare risk of re‐operation. RESULTS : There were 45 subjects with fusion to L4/5 and 71 to S/I. Over a 32‐mo median follow‐up, 41 re‐operations were performed; 6 were for distal junctional failure. In those with normal or mild degeneration at L5/S1, fusion to S/I afforded no significant change in re‐operative risk (hazard ratio = 1.18 [95% confidence interval: 0.53‐2.62], P = .682). In those undergoing circumferential minimally invasive surgery correction, fusion to S/I was associated with significantly greater blood loss (499.6 cc, P < .001) and surgical time (97.5 min, P = .04). CONCLUSION : In the setting of a normal or mildly degenerated L5/S1 disc space, fusion to the sacrum/ilium did not significantly change the risk of requiring a re‐operation after a long‐segment fusion for ASD.