TITLE: Outcomes and Complications of Extension of Previous Long Fusion to the Sacropelvis: Does Surgical Approach Make a Difference?
AUTHORS (LAST NAME, FIRST NAME): Burton, Douglas C.1; Boachie-Adjei, Oheneba2;
Shaffrey, Christopher I.3; Schwab, Frank J.4; Hostin, Richard 5; Shelokov, Alexis P.5; Bess,
Shay6; Akbarnia, Behrooz A.7; Study Group, International Spine 8
INSTITUTIONS (ALL): 1. University of Kansas Medical Center, Kansas City, KS, USA.
2. Hospital for Special Surgery, New York, NY, USA.
3. Neurosurgery, University of Virginia, Charlottesville, VA, USA.
4. NYU Hospital for Joint Diseases, New York, NY, USA.
5. Baylor Scoliosis Center, Plano, TX, USA.
6. Rocky Mountain Hospital for Children, Denver, CO, USA.
7. San Diego Center for Spinal Disorders, La Jolla, CA, USA.
8. ISSG, San Diego, CA, USA.
ABSTRACT BODY:
Summary (80 words max): Multicenter, retrospective review of outcomes following
extension of previous long scoliosis fusions to the sacro-pelvis demonstrated that posterior
only procedures (PSF) had similar sagittal correction and fewer complications at 2 year
follow-up than combined anterior-posterior procedures (APSF).
Introduction: Few studies have reported the results and complication rates for extension of
previous long scoliosis fusions terminating at L3, L4, or L5 to the sacro-pelvis. The purpose of
this study was to evaluate the efficacy and complications of different surgical approaches to
optimize spinal alignment correction in patients requiring revision spinal surgery with
extension of fusion to the sacro-pelvis.
Methods: Retrospective, consecutive (1995-2006), multicenter, chart, HRQL, and
radiographic review of adult deformity pts previously fused distally to L3, L4, or L5 receiving
revision surgery to extend the fusion to the sacro-pelvis. Pts were divided into APSF (n=30)
and PSF (n=14; 10 of 14 had either a PLIF or TLIF) approach groups. Pts were evaluated for
pedicle subtraction osteotomy (PSO; n=13) or no PSO (n=31). Radiographic evaluation
included coronal and sagittal spino-pelvic measures. Perioperative complications were noted.
Results: 44 pts of 54 eligible pts, mean age 49.0 yrs (21-73 yrs), had 2 yr radiographic
data. Mean follow-up was 41.9 months (23-135 months). 41 of 54 pts had 2 yr SRS 22
scores. No statistically significant preoperative differences existed between the APSF and PSF
groups, except the APSF group had a larger TL curve (p=0.011). Only pts receiving PSO had
significant sagittal vertical axis (SVA) correction postoperatively (p=0.002). Although not
statistically significant, more complications occurred in APSF compared to PSF (14 vs 1;
p=0.092; Table 1). Table 1 indicates that there was no difference in: 1) total complications
PSO vs no PSO, 2) total pseudarthroses PSF vs APSF, and 3) post-op HRQL outcomes
between pts with or without complications.
Conclusion: Posterior approach with osteotomy achieved equivalent sagittal spinal alignment
and post-op HRQL scores without an increase in pseudoarthrosis rates compared to APSF in
pts undergoing revision surgery with extension of fusion to the sacro-pelvis. PSO achieved a
statistically significant improvement in SVA correction without increasing complications. Postop HRQL outcomes were equivalent to the published literature of primary surgery to the
pelvis.