Upper Instrumented Vertebral Fractures in Long Lumbar Fusions: What Are the Associated Risk Factors?
A retrospective comparative study. To investigate the risk factors associated with upper instrumented vertebral (UIV) fractures in adult lumbar deformity. Long segment lumbar fusions may lead to junctional failures. The purpose of this study was to determine factors associated with junctional failur...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2012-07, Vol.37 (16), p.1407-1414 |
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| creator | LEWIS, Stephen J ABBAS, Harith CHUA, Sooyong BACON, Sarah BRONSTEIN, Yigal GOLDSTEIN, Sergey MAGANA, Sofia SULLIVAN, Kelly DOLD, Andrew P BODROGI, Andrew |
| description | A retrospective comparative study.
To investigate the risk factors associated with upper instrumented vertebral (UIV) fractures in adult lumbar deformity.
Long segment lumbar fusions may lead to junctional failures. The purpose of this study was to determine factors associated with junctional failures.
Twenty-seven consecutive patients from 2001 to 2008 with minimum 4 levels fused, lower instrumented vertebra (LIV) of L5 or S1, upper instrumented vertebra of T10 or distal, and no previous surgery proximal to the instrumentation were retrospectively reviewed. We describe the UIV angle, the sagittal angle of the upper instrumented vertebra with the horizontal. Patients were divided into 3 groups: group 1, 7 patients with UIV fractures; group 2, 6 patients with other proximal failures; and group 3, 14 patients with no proximal complications.
The mean number of levels fused was 5.7 (4-7), 5.2 (4-8), and 6.2 (4-8); mean age was 64.1, 61.8, and 64.1, and mean body mass index was 33.5, 30.0, and 31.6 for groups 1, 2, and 3, respectively (P > 0.05). Osteotomies were performed in 5 of 7 in group 1, 1 of 6 in group 2, and 5 of 14 in group 3. Mean follow-up was 26.3 months. The average intraoperative UIV angle (UIV0) and immediate postoperative UIV angle (UIV1) were 18.6°/15.4° for group 1, 5.7°/5.3° for group 2, and 10.3°/7.1° for group 3 (P < 0.05). Surgical revision rates were higher in group 1 (71%) compared with groups 2 (50%) and 3 (43%). Eight of 11 (73%) patients with upper instrumented vertebra of L1 or L2 had either UIV fracture or other proximal failure compared with 5 of 16 (31%) in patients with upper instrumented vertebra of T10, T11, or T12.
Our series of long lumbar fusions had a high long-term complication and revision rate. A high UIV angle on intraoperative lateral radiograph was strongly associated with UIV fractures. UIVs of L1 or L2 had a higher rate of adjacent segment or UIV failure. |
| doi_str_mv | 10.1097/BRS.0b013e31824fffb9 |
| format | Article |
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To investigate the risk factors associated with upper instrumented vertebral (UIV) fractures in adult lumbar deformity.
Long segment lumbar fusions may lead to junctional failures. The purpose of this study was to determine factors associated with junctional failures.
Twenty-seven consecutive patients from 2001 to 2008 with minimum 4 levels fused, lower instrumented vertebra (LIV) of L5 or S1, upper instrumented vertebra of T10 or distal, and no previous surgery proximal to the instrumentation were retrospectively reviewed. We describe the UIV angle, the sagittal angle of the upper instrumented vertebra with the horizontal. Patients were divided into 3 groups: group 1, 7 patients with UIV fractures; group 2, 6 patients with other proximal failures; and group 3, 14 patients with no proximal complications.
The mean number of levels fused was 5.7 (4-7), 5.2 (4-8), and 6.2 (4-8); mean age was 64.1, 61.8, and 64.1, and mean body mass index was 33.5, 30.0, and 31.6 for groups 1, 2, and 3, respectively (P > 0.05). Osteotomies were performed in 5 of 7 in group 1, 1 of 6 in group 2, and 5 of 14 in group 3. Mean follow-up was 26.3 months. The average intraoperative UIV angle (UIV0) and immediate postoperative UIV angle (UIV1) were 18.6°/15.4° for group 1, 5.7°/5.3° for group 2, and 10.3°/7.1° for group 3 (P < 0.05). Surgical revision rates were higher in group 1 (71%) compared with groups 2 (50%) and 3 (43%). Eight of 11 (73%) patients with upper instrumented vertebra of L1 or L2 had either UIV fracture or other proximal failure compared with 5 of 16 (31%) in patients with upper instrumented vertebra of T10, T11, or T12.
Our series of long lumbar fusions had a high long-term complication and revision rate. A high UIV angle on intraoperative lateral radiograph was strongly associated with UIV fractures. UIVs of L1 or L2 had a higher rate of adjacent segment or UIV failure.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0b013e31824fffb9</identifier><identifier>PMID: 22366970</identifier><identifier>CODEN: SPINDD</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cerebrospinal fluid. Meninges. Spinal cord ; Female ; Humans ; Linear Models ; Lumbar Vertebrae - diagnostic imaging ; Lumbar Vertebrae - injuries ; Lumbar Vertebrae - surgery ; Male ; Medical sciences ; Middle Aged ; Nervous system (semeiology, syndromes) ; Neurology ; Ontario ; Orthopedic surgery ; Osteotomy - adverse effects ; Radiography ; Reoperation ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Spinal Fractures - diagnostic imaging ; Spinal Fractures - etiology ; Spinal Fractures - surgery ; Spinal Fusion - adverse effects ; Spinal Fusion - instrumentation ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Thoracic Vertebrae - diagnostic imaging ; Thoracic Vertebrae - surgery ; Time Factors ; Treatment Failure ; Young Adult</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2012-07, Vol.37 (16), p.1407-1414</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c286t-65798e54fbcdbdb85acaaba68f5234ba1a4662bb45bc2ac44c6424870693a5133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26181390$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22366970$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>LEWIS, Stephen J</creatorcontrib><creatorcontrib>ABBAS, Harith</creatorcontrib><creatorcontrib>CHUA, Sooyong</creatorcontrib><creatorcontrib>BACON, Sarah</creatorcontrib><creatorcontrib>BRONSTEIN, Yigal</creatorcontrib><creatorcontrib>GOLDSTEIN, Sergey</creatorcontrib><creatorcontrib>MAGANA, Sofia</creatorcontrib><creatorcontrib>SULLIVAN, Kelly</creatorcontrib><creatorcontrib>DOLD, Andrew P</creatorcontrib><creatorcontrib>BODROGI, Andrew</creatorcontrib><title>Upper Instrumented Vertebral Fractures in Long Lumbar Fusions: What Are the Associated Risk Factors?</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>A retrospective comparative study.
To investigate the risk factors associated with upper instrumented vertebral (UIV) fractures in adult lumbar deformity.
Long segment lumbar fusions may lead to junctional failures. The purpose of this study was to determine factors associated with junctional failures.
Twenty-seven consecutive patients from 2001 to 2008 with minimum 4 levels fused, lower instrumented vertebra (LIV) of L5 or S1, upper instrumented vertebra of T10 or distal, and no previous surgery proximal to the instrumentation were retrospectively reviewed. We describe the UIV angle, the sagittal angle of the upper instrumented vertebra with the horizontal. Patients were divided into 3 groups: group 1, 7 patients with UIV fractures; group 2, 6 patients with other proximal failures; and group 3, 14 patients with no proximal complications.
The mean number of levels fused was 5.7 (4-7), 5.2 (4-8), and 6.2 (4-8); mean age was 64.1, 61.8, and 64.1, and mean body mass index was 33.5, 30.0, and 31.6 for groups 1, 2, and 3, respectively (P > 0.05). Osteotomies were performed in 5 of 7 in group 1, 1 of 6 in group 2, and 5 of 14 in group 3. Mean follow-up was 26.3 months. The average intraoperative UIV angle (UIV0) and immediate postoperative UIV angle (UIV1) were 18.6°/15.4° for group 1, 5.7°/5.3° for group 2, and 10.3°/7.1° for group 3 (P < 0.05). Surgical revision rates were higher in group 1 (71%) compared with groups 2 (50%) and 3 (43%). Eight of 11 (73%) patients with upper instrumented vertebra of L1 or L2 had either UIV fracture or other proximal failure compared with 5 of 16 (31%) in patients with upper instrumented vertebra of T10, T11, or T12.
Our series of long lumbar fusions had a high long-term complication and revision rate. A high UIV angle on intraoperative lateral radiograph was strongly associated with UIV fractures. UIVs of L1 or L2 had a higher rate of adjacent segment or UIV failure.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>Female</subject><subject>Humans</subject><subject>Linear Models</subject><subject>Lumbar Vertebrae - diagnostic imaging</subject><subject>Lumbar Vertebrae - injuries</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Ontario</subject><subject>Orthopedic surgery</subject><subject>Osteotomy - adverse effects</subject><subject>Radiography</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Spinal Fractures - diagnostic imaging</subject><subject>Spinal Fractures - etiology</subject><subject>Spinal Fractures - surgery</subject><subject>Spinal Fusion - adverse effects</subject><subject>Spinal Fusion - instrumentation</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Thoracic Vertebrae - diagnostic imaging</subject><subject>Thoracic Vertebrae - surgery</subject><subject>Time Factors</subject><subject>Treatment Failure</subject><subject>Young Adult</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE1Lw0AQhhdRbK3-A5G9CF5S9yubxIvUYlUoCNXqMcxuNjaaj7qTHPz3prQqeJrL874z8xByytmYsyS6vFk8jZlhXDrJY6HyPDfJHhnyUMQB52GyT4ZMahEIJfWAHCG-M8a05MkhGQghtU4iNiTZcr12nj7U2PqucnXrMvrifOuMh5LOPNi28w5pUdN5U7_ReVcZ8HTWYdHUeEVfV9DSiXe0XTk6QWxsAZuORYEfdNanG4_Xx-QghxLdyW6OyHJ2-zy9D-aPdw_TyTywItZtoMMoiV2ocmMzk5k4BAtgQMd5KKQywEFpLYxRobECrFJWK6HiiOlEQsilHJGLbe_aN5-dwzatCrSuLKF2TYcpZ6J_m0kZ9ajaotY3iN7l6doXFfivHko3ftPeb_rfbx87223oTOWy39CP0B443wGAFsrcQ20L_OM0j7nsT_gGdhWFNw</recordid><startdate>20120715</startdate><enddate>20120715</enddate><creator>LEWIS, Stephen J</creator><creator>ABBAS, Harith</creator><creator>CHUA, Sooyong</creator><creator>BACON, Sarah</creator><creator>BRONSTEIN, Yigal</creator><creator>GOLDSTEIN, Sergey</creator><creator>MAGANA, Sofia</creator><creator>SULLIVAN, Kelly</creator><creator>DOLD, Andrew P</creator><creator>BODROGI, Andrew</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120715</creationdate><title>Upper Instrumented Vertebral Fractures in Long Lumbar Fusions: What Are the Associated Risk Factors?</title><author>LEWIS, Stephen J ; ABBAS, Harith ; CHUA, Sooyong ; BACON, Sarah ; BRONSTEIN, Yigal ; GOLDSTEIN, Sergey ; MAGANA, Sofia ; SULLIVAN, Kelly ; DOLD, Andrew P ; BODROGI, Andrew</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c286t-65798e54fbcdbdb85acaaba68f5234ba1a4662bb45bc2ac44c6424870693a5133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>Female</topic><topic>Humans</topic><topic>Linear Models</topic><topic>Lumbar Vertebrae - diagnostic imaging</topic><topic>Lumbar Vertebrae - injuries</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Ontario</topic><topic>Orthopedic surgery</topic><topic>Osteotomy - adverse effects</topic><topic>Radiography</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Spinal Fractures - diagnostic imaging</topic><topic>Spinal Fractures - etiology</topic><topic>Spinal Fractures - surgery</topic><topic>Spinal Fusion - adverse effects</topic><topic>Spinal Fusion - instrumentation</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Thoracic Vertebrae - diagnostic imaging</topic><topic>Thoracic Vertebrae - surgery</topic><topic>Time Factors</topic><topic>Treatment Failure</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>LEWIS, Stephen J</creatorcontrib><creatorcontrib>ABBAS, Harith</creatorcontrib><creatorcontrib>CHUA, Sooyong</creatorcontrib><creatorcontrib>BACON, Sarah</creatorcontrib><creatorcontrib>BRONSTEIN, Yigal</creatorcontrib><creatorcontrib>GOLDSTEIN, Sergey</creatorcontrib><creatorcontrib>MAGANA, Sofia</creatorcontrib><creatorcontrib>SULLIVAN, Kelly</creatorcontrib><creatorcontrib>DOLD, Andrew P</creatorcontrib><creatorcontrib>BODROGI, Andrew</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>LEWIS, Stephen J</au><au>ABBAS, Harith</au><au>CHUA, Sooyong</au><au>BACON, Sarah</au><au>BRONSTEIN, Yigal</au><au>GOLDSTEIN, Sergey</au><au>MAGANA, Sofia</au><au>SULLIVAN, Kelly</au><au>DOLD, Andrew P</au><au>BODROGI, Andrew</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Upper Instrumented Vertebral Fractures in Long Lumbar Fusions: What Are the Associated Risk Factors?</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2012-07-15</date><risdate>2012</risdate><volume>37</volume><issue>16</issue><spage>1407</spage><epage>1414</epage><pages>1407-1414</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><coden>SPINDD</coden><abstract>A retrospective comparative study.
To investigate the risk factors associated with upper instrumented vertebral (UIV) fractures in adult lumbar deformity.
Long segment lumbar fusions may lead to junctional failures. The purpose of this study was to determine factors associated with junctional failures.
Twenty-seven consecutive patients from 2001 to 2008 with minimum 4 levels fused, lower instrumented vertebra (LIV) of L5 or S1, upper instrumented vertebra of T10 or distal, and no previous surgery proximal to the instrumentation were retrospectively reviewed. We describe the UIV angle, the sagittal angle of the upper instrumented vertebra with the horizontal. Patients were divided into 3 groups: group 1, 7 patients with UIV fractures; group 2, 6 patients with other proximal failures; and group 3, 14 patients with no proximal complications.
The mean number of levels fused was 5.7 (4-7), 5.2 (4-8), and 6.2 (4-8); mean age was 64.1, 61.8, and 64.1, and mean body mass index was 33.5, 30.0, and 31.6 for groups 1, 2, and 3, respectively (P > 0.05). Osteotomies were performed in 5 of 7 in group 1, 1 of 6 in group 2, and 5 of 14 in group 3. Mean follow-up was 26.3 months. The average intraoperative UIV angle (UIV0) and immediate postoperative UIV angle (UIV1) were 18.6°/15.4° for group 1, 5.7°/5.3° for group 2, and 10.3°/7.1° for group 3 (P < 0.05). Surgical revision rates were higher in group 1 (71%) compared with groups 2 (50%) and 3 (43%). Eight of 11 (73%) patients with upper instrumented vertebra of L1 or L2 had either UIV fracture or other proximal failure compared with 5 of 16 (31%) in patients with upper instrumented vertebra of T10, T11, or T12.
Our series of long lumbar fusions had a high long-term complication and revision rate. A high UIV angle on intraoperative lateral radiograph was strongly associated with UIV fractures. UIVs of L1 or L2 had a higher rate of adjacent segment or UIV failure.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>22366970</pmid><doi>10.1097/BRS.0b013e31824fffb9</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Cerebrospinal fluid. Meninges. Spinal cord Female Humans Linear Models Lumbar Vertebrae - diagnostic imaging Lumbar Vertebrae - injuries Lumbar Vertebrae - surgery Male Medical sciences Middle Aged Nervous system (semeiology, syndromes) Neurology Ontario Orthopedic surgery Osteotomy - adverse effects Radiography Reoperation Retrospective Studies Risk Assessment Risk Factors Spinal Fractures - diagnostic imaging Spinal Fractures - etiology Spinal Fractures - surgery Spinal Fusion - adverse effects Spinal Fusion - instrumentation Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Thoracic Vertebrae - diagnostic imaging Thoracic Vertebrae - surgery Time Factors Treatment Failure Young Adult |
| title | Upper Instrumented Vertebral Fractures in Long Lumbar Fusions: What Are the Associated Risk Factors? |
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