Abstract
Background
Factors related to postoperative mechanical failure after long fusion with lower instrumented
vertebra (LIV) at L5 have not been well investigated. Elucidating such factors may
allow us to perform alternatives to spinopelvic fusion for adult spinal deformity
(ASD) cases. We investigated the incidence and risk factors of LIV failure in patients
with ASD who underwent surgical treatment of long corrective fusion until the L5 vertebrae.
Methods
Between 2009 and 2018, 52 patients who underwent corrective fusions to L5 were followed-up
for at least one-year. We evaluated the associated patient factors for LIV failure
which include loosening of the pedicle screw of LIV, fracture of LIV, distal junctional
kyphosis (DJK).
Results
The mean age of the participants was 71.2 ± 7.59 (range, 44–84). LIV failure occurred
in 20 patients (38.5%), and 6 patients (11.5%) underwent secondary surgery for caudal
segments. The mean pelvic incidence (PI) was 52.5 ± 9.8 in the failure group versus
45.3 ± 11.4 in non-failure group (P = 0.02) and pelvic tilt (PT) was 39.1 ± 9.0 versus 32.4 ± 13.0. There were no significant
differences in sex, age, body mass index, number of levels fused, and other radiographic
data. Logistic regression analysis that included T1 pelvic angle, PT, PI - postoperative
LL and PI also identified PI as the only significant determinant of LIV failure (OR = 1.07,
P = 0.034). Receiver operating characteristic analysis demonstrated that a PI over
50.0° was associated with LIV failure (sensitivity 63%, specificity 70%, AUC 0.694).
Conclusion
LIV failure was frequently observed after long corrective fusion for patients with
ASD. High PI was found to be a significant risk factor for the LIV failure.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Orthopaedic ScienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: surgical considerations and treatment options in patients with poor bone quality.Spine. 2006 Sep 1; 31: S144-S151
- Adult spinal deformity surgery: complications and outcomes in patients over age 60.Spine. 2007 Sep 15; 32: 2238-2244
- Activity of daily living after long level fusion in adult spinal deformity: compared with over 60-year-old degenerative spine patients without adult spinal deformity.Spine. 2018 Dec 1; 43: 1638-1647
- Long adult deformity fusions to L5 and the sacrum. A matched cohort analysis.Spine. 2004 Sep 15; 29: 1996-2005
- Thoracolumbar deformity arthrodesis to L5 in adults: the fate of the L5-S1 disc.Spine. 2003 Sep 15; 28: 2122-2131
- Thoracolumbar deformity arthrodesis stopping at L5: fate of the L5-S1 disc, minimum 5-year follow-up.Spine. 2007 Nov 15; 32: 2771-2776
- A Japanese nationwide multicenter survey on perioperative complications of corrective fusion for elderly patients with adult spinal deformity.J Orthop Sci. 2017 Mar; 22: 237-242
- Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study.Spine. 2012 May 20; 37: 1077-1082
- Lumbar degenerative scoliosis (LDS). Thieme, Stuttgart1999: 167-170
- Dorsal-ventral-dorsal three ways correction & fusion for lumbar degenerative kyphosis. Spine & Spinal Cord, 2007: 2287-2294 ([in Japanese)])
- The comprehensive anatomical spinal osteotomy classification.Neurosurgery. 2014 Jan; 74 (; discussion 20): 112-120
- The effect of Paraspinal muscle degeneration on distal pedicle screw loosening following corrective surgery for degenerative lumbar scoliosis.Spine. 2020 May 1; 45: 590-598
- Distal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention.Spine. 2006 Feb 1; 31: 299-302
- Magnetic resonance classification of lumbar intervertebral disc degeneration.Spine. 2001 Sep 1; 26: 1873-1878
- European spine study G. Global alignment and proportion (GAP) Score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery.J Bone Joint Surg Am. 2017 Oct 4; 99: 1661-1672
- Activities of daily living and patient satisfaction after long fusion for adult spinal deformity: a retrospective study.Eur Spine J. 2019 Jul; 28: 1670-1677
- Postoperative disability after long corrective fusion to the pelvis in elderly patients with spinal deformity.Spine. 2018 Jul 15; 43: E804-E812
- Selecting caudal fusion levels: 2 year functional and stiffness outcomes with matched pairs analysis in multilevel fusion to L5 versus S1.Eur Spine J. 2017 Jun; 26: 1645-1651
- Sacroiliac joint pain after multiple-segment lumbar fusion: a long-term observational study-Non-fused sacrum vs. fused sacrum.Spine Surg Relat Res. 2017; 1: 90-95
- Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis.Spine. 2007 Sep 15; 32: 2232-2237
- Can we stop the long fusion at L5 for selected adult spinal deformity patients with less severe disability and less complex deformity?.Clin Neurol Neurosurg. 2020 Jul; 194: 105917
- Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up.Spine. 2008 Sep 15; 33: 2179-2184
- Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis.Spine. 2011 Jan 1; 36: E60-E68
- Minimum 5-year analysis of L5-S1 fusion using sacropelvic fixation (bilateral S1 and iliac screws) for spinal deformity.Spine. 2006 Feb 1; 31: 303-308
- Radiographic predictors for mechanical failure after adult spinal deformity surgery: a retrospective cohort study in 138 patients.Spine. 2017 Jul 15; 42: E855-E863
- Gravity line analysis in adult volunteers: age-related correlation with spinal parameters, pelvic parameters, and foot position.Spine. 2006 Dec 1; 31: E959-E967
- Sagittal morphology and equilibrium of pelvis and spine.Eur Spine J. 2002 Feb; 11: 80-87
Article info
Publication history
Published online: December 16, 2021
Accepted:
November 21,
2021
Received in revised form:
October 12,
2021
Received:
June 15,
2021
Identification
Copyright
© 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
