A guide to selecting upper thoracic versus lower thoracic uppermost instrumented vertebra in adult spinal deformity correction
Purpose Operative treatment of adult spinal deformity (ASD) has been shown to improve patient health-related quality of life (HRQOL). Selection of the uppermost instrumented vertebra (UIV) in either the upper thoracic (UT) or lower thoracic (LT) spine is a pivotal decision with effects on operative...
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| Veröffentlicht in: | European spine journal 2024-07, Vol.33 (7), p.2742-2750 |
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| container_title | European spine journal |
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| creator | Kumar, Rohit Prem Adida, Samuel Lavadi, Raj Swaroop Mitha, Rida Legarreta, Andrew D. Hudson, Joseph S. Shah, Manan Diebo, Bassel Fields, Daryl P. Buell, Thomas J. Hamilton, D. Kojo Daniels, Alan H. Agarwal, Nitin |
| description | Purpose
Operative treatment of adult spinal deformity (ASD) has been shown to improve patient health-related quality of life (HRQOL). Selection of the uppermost instrumented vertebra (UIV) in either the upper thoracic (UT) or lower thoracic (LT) spine is a pivotal decision with effects on operative and postoperative outcomes. This review overviews the multifaceted decision-making process for UIV selection in ASD correction.
Methods
PubMed was queried for articles using the keywords “uppermost instrumented vertebra”, “upper thoracic”, “lower thoracic”, and “adult spinal deformity”.
Results
Optimization of UIV selection may lead to superior deformity correction, better patient-reported outcomes, and lower risk of proximal junctional kyphosis (PJK) and failure (PJF). Patient alignment characteristics, including preoperative thoracic kyphosis, coronal deformity, and the magnitude of sagittal correction influence surgical decision-making when selecting a UIV, while comorbidities such as poor body mass index, osteoporosis, and neuromuscular pathology should also be taken in to account. Additionally, surgeon experience and resources available to the hospital may also play a role in this decision. Currently, it is incompletely understood whether postoperative HRQOLs, functional and radiographic outcomes, and complications after surgery differ between selection of the UIV in either the UT or LT spine.
Conclusion
The correct selection of the UIV in surgical planning is a challenging task, which requires attention to preoperative alignment, patient comorbidities, clinical characteristics, available resources, and surgeon-specific factors such as experience. |
| doi_str_mv | 10.1007/s00586-024-08206-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2974007717</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2974007717</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-a343821e9c93aee66a30f35d221de939900a1d2813ad34104a5ffebd39df13ed3</originalsourceid><addsrcrecordid>eNp9kTtvFTEQRi0URC6BP5ACWaKhWRg_9uEyisJDikQDteW7nr1stLveeOxEafjt-OYmBFGkGmnmzDeyD2OnAj4KgPYTAdRdU4HUFXQSmsq8YBuhlazAKHnENmA0VE0rzDF7TXQFIGoDzSt2rLpaSqj1hv0-47s8euQpcMIJ-zQuO57XFSNPv0J0_djzG4yUiU_h9t_uPTQHSnxcKMU845LQ7-GE2-hKlzufp8RpHRc3cY9DiPOY7ngfYtxfCssb9nJwE-Hbh3rCfn6--HH-tbr8_uXb-dll1SvZpMoprTop0PRGOcSmcQoGVXsphUejjAFwwstOKOeVFqBdPQy49cr4QSj06oR9OOSuMVxnpGTnkXqcJrdgyGSlaXX50la0BX3_H3oVciwPIKug02Dq2nSFkgeqj4Eo4mDXOM4u3lkBdm_HHuzYYsfe27GmLL17iM7bGf3flUcdBVAHgMpo2WF8uv1M7B92Ypz9</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3084095598</pqid></control><display><type>article</type><title>A guide to selecting upper thoracic versus lower thoracic uppermost instrumented vertebra in adult spinal deformity correction</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Kumar, Rohit Prem ; Adida, Samuel ; Lavadi, Raj Swaroop ; Mitha, Rida ; Legarreta, Andrew D. ; Hudson, Joseph S. ; Shah, Manan ; Diebo, Bassel ; Fields, Daryl P. ; Buell, Thomas J. ; Hamilton, D. Kojo ; Daniels, Alan H. ; Agarwal, Nitin</creator><creatorcontrib>Kumar, Rohit Prem ; Adida, Samuel ; Lavadi, Raj Swaroop ; Mitha, Rida ; Legarreta, Andrew D. ; Hudson, Joseph S. ; Shah, Manan ; Diebo, Bassel ; Fields, Daryl P. ; Buell, Thomas J. ; Hamilton, D. Kojo ; Daniels, Alan H. ; Agarwal, Nitin</creatorcontrib><description>Purpose
Operative treatment of adult spinal deformity (ASD) has been shown to improve patient health-related quality of life (HRQOL). Selection of the uppermost instrumented vertebra (UIV) in either the upper thoracic (UT) or lower thoracic (LT) spine is a pivotal decision with effects on operative and postoperative outcomes. This review overviews the multifaceted decision-making process for UIV selection in ASD correction.
Methods
PubMed was queried for articles using the keywords “uppermost instrumented vertebra”, “upper thoracic”, “lower thoracic”, and “adult spinal deformity”.
Results
Optimization of UIV selection may lead to superior deformity correction, better patient-reported outcomes, and lower risk of proximal junctional kyphosis (PJK) and failure (PJF). Patient alignment characteristics, including preoperative thoracic kyphosis, coronal deformity, and the magnitude of sagittal correction influence surgical decision-making when selecting a UIV, while comorbidities such as poor body mass index, osteoporosis, and neuromuscular pathology should also be taken in to account. Additionally, surgeon experience and resources available to the hospital may also play a role in this decision. Currently, it is incompletely understood whether postoperative HRQOLs, functional and radiographic outcomes, and complications after surgery differ between selection of the UIV in either the UT or LT spine.
Conclusion
The correct selection of the UIV in surgical planning is a challenging task, which requires attention to preoperative alignment, patient comorbidities, clinical characteristics, available resources, and surgeon-specific factors such as experience.</description><identifier>ISSN: 0940-6719</identifier><identifier>ISSN: 1432-0932</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-024-08206-9</identifier><identifier>PMID: 38522054</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Attention task ; Body mass index ; Bone surgery ; Comorbidity ; Decision making ; Humans ; Kyphosis ; Kyphosis - surgery ; Medicine ; Medicine & Public Health ; Mental task performance ; Neurosurgery ; Osteoporosis ; Patients ; Quality of life ; Review Article ; Spinal Curvatures - diagnostic imaging ; Spinal Curvatures - surgery ; Spinal Fusion - instrumentation ; Spinal Fusion - methods ; Surgeons ; Surgical Orthopedics ; Thoracic Vertebrae - diagnostic imaging ; Thoracic Vertebrae - surgery ; Vertebrae</subject><ispartof>European spine journal, 2024-07, Vol.33 (7), p.2742-2750</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-a343821e9c93aee66a30f35d221de939900a1d2813ad34104a5ffebd39df13ed3</cites><orcidid>0009-0003-4657-2864</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00586-024-08206-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00586-024-08206-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38522054$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kumar, Rohit Prem</creatorcontrib><creatorcontrib>Adida, Samuel</creatorcontrib><creatorcontrib>Lavadi, Raj Swaroop</creatorcontrib><creatorcontrib>Mitha, Rida</creatorcontrib><creatorcontrib>Legarreta, Andrew D.</creatorcontrib><creatorcontrib>Hudson, Joseph S.</creatorcontrib><creatorcontrib>Shah, Manan</creatorcontrib><creatorcontrib>Diebo, Bassel</creatorcontrib><creatorcontrib>Fields, Daryl P.</creatorcontrib><creatorcontrib>Buell, Thomas J.</creatorcontrib><creatorcontrib>Hamilton, D. Kojo</creatorcontrib><creatorcontrib>Daniels, Alan H.</creatorcontrib><creatorcontrib>Agarwal, Nitin</creatorcontrib><title>A guide to selecting upper thoracic versus lower thoracic uppermost instrumented vertebra in adult spinal deformity correction</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose
Operative treatment of adult spinal deformity (ASD) has been shown to improve patient health-related quality of life (HRQOL). Selection of the uppermost instrumented vertebra (UIV) in either the upper thoracic (UT) or lower thoracic (LT) spine is a pivotal decision with effects on operative and postoperative outcomes. This review overviews the multifaceted decision-making process for UIV selection in ASD correction.
Methods
PubMed was queried for articles using the keywords “uppermost instrumented vertebra”, “upper thoracic”, “lower thoracic”, and “adult spinal deformity”.
Results
Optimization of UIV selection may lead to superior deformity correction, better patient-reported outcomes, and lower risk of proximal junctional kyphosis (PJK) and failure (PJF). Patient alignment characteristics, including preoperative thoracic kyphosis, coronal deformity, and the magnitude of sagittal correction influence surgical decision-making when selecting a UIV, while comorbidities such as poor body mass index, osteoporosis, and neuromuscular pathology should also be taken in to account. Additionally, surgeon experience and resources available to the hospital may also play a role in this decision. Currently, it is incompletely understood whether postoperative HRQOLs, functional and radiographic outcomes, and complications after surgery differ between selection of the UIV in either the UT or LT spine.
Conclusion
The correct selection of the UIV in surgical planning is a challenging task, which requires attention to preoperative alignment, patient comorbidities, clinical characteristics, available resources, and surgeon-specific factors such as experience.</description><subject>Adult</subject><subject>Attention task</subject><subject>Body mass index</subject><subject>Bone surgery</subject><subject>Comorbidity</subject><subject>Decision making</subject><subject>Humans</subject><subject>Kyphosis</subject><subject>Kyphosis - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mental task performance</subject><subject>Neurosurgery</subject><subject>Osteoporosis</subject><subject>Patients</subject><subject>Quality of life</subject><subject>Review Article</subject><subject>Spinal Curvatures - diagnostic imaging</subject><subject>Spinal Curvatures - surgery</subject><subject>Spinal Fusion - instrumentation</subject><subject>Spinal Fusion - methods</subject><subject>Surgeons</subject><subject>Surgical Orthopedics</subject><subject>Thoracic Vertebrae - diagnostic imaging</subject><subject>Thoracic Vertebrae - surgery</subject><subject>Vertebrae</subject><issn>0940-6719</issn><issn>1432-0932</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kTtvFTEQRi0URC6BP5ACWaKhWRg_9uEyisJDikQDteW7nr1stLveeOxEafjt-OYmBFGkGmnmzDeyD2OnAj4KgPYTAdRdU4HUFXQSmsq8YBuhlazAKHnENmA0VE0rzDF7TXQFIGoDzSt2rLpaSqj1hv0-47s8euQpcMIJ-zQuO57XFSNPv0J0_djzG4yUiU_h9t_uPTQHSnxcKMU845LQ7-GE2-hKlzufp8RpHRc3cY9DiPOY7ngfYtxfCssb9nJwE-Hbh3rCfn6--HH-tbr8_uXb-dll1SvZpMoprTop0PRGOcSmcQoGVXsphUejjAFwwstOKOeVFqBdPQy49cr4QSj06oR9OOSuMVxnpGTnkXqcJrdgyGSlaXX50la0BX3_H3oVciwPIKug02Dq2nSFkgeqj4Eo4mDXOM4u3lkBdm_HHuzYYsfe27GmLL17iM7bGf3flUcdBVAHgMpo2WF8uv1M7B92Ypz9</recordid><startdate>20240701</startdate><enddate>20240701</enddate><creator>Kumar, Rohit Prem</creator><creator>Adida, Samuel</creator><creator>Lavadi, Raj Swaroop</creator><creator>Mitha, Rida</creator><creator>Legarreta, Andrew D.</creator><creator>Hudson, Joseph S.</creator><creator>Shah, Manan</creator><creator>Diebo, Bassel</creator><creator>Fields, Daryl P.</creator><creator>Buell, Thomas J.</creator><creator>Hamilton, D. Kojo</creator><creator>Daniels, Alan H.</creator><creator>Agarwal, Nitin</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><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>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0009-0003-4657-2864</orcidid></search><sort><creationdate>20240701</creationdate><title>A guide to selecting upper thoracic versus lower thoracic uppermost instrumented vertebra in adult spinal deformity correction</title><author>Kumar, Rohit Prem ; Adida, Samuel ; Lavadi, Raj Swaroop ; Mitha, Rida ; Legarreta, Andrew D. ; Hudson, Joseph S. ; Shah, Manan ; Diebo, Bassel ; Fields, Daryl P. ; Buell, Thomas J. ; Hamilton, D. Kojo ; Daniels, Alan H. ; Agarwal, Nitin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-a343821e9c93aee66a30f35d221de939900a1d2813ad34104a5ffebd39df13ed3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Attention task</topic><topic>Body mass index</topic><topic>Bone surgery</topic><topic>Comorbidity</topic><topic>Decision making</topic><topic>Humans</topic><topic>Kyphosis</topic><topic>Kyphosis - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mental task performance</topic><topic>Neurosurgery</topic><topic>Osteoporosis</topic><topic>Patients</topic><topic>Quality of life</topic><topic>Review Article</topic><topic>Spinal Curvatures - diagnostic imaging</topic><topic>Spinal Curvatures - surgery</topic><topic>Spinal Fusion - instrumentation</topic><topic>Spinal Fusion - methods</topic><topic>Surgeons</topic><topic>Surgical Orthopedics</topic><topic>Thoracic Vertebrae - diagnostic imaging</topic><topic>Thoracic Vertebrae - surgery</topic><topic>Vertebrae</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kumar, Rohit Prem</creatorcontrib><creatorcontrib>Adida, Samuel</creatorcontrib><creatorcontrib>Lavadi, Raj Swaroop</creatorcontrib><creatorcontrib>Mitha, Rida</creatorcontrib><creatorcontrib>Legarreta, Andrew D.</creatorcontrib><creatorcontrib>Hudson, Joseph S.</creatorcontrib><creatorcontrib>Shah, Manan</creatorcontrib><creatorcontrib>Diebo, Bassel</creatorcontrib><creatorcontrib>Fields, Daryl P.</creatorcontrib><creatorcontrib>Buell, Thomas J.</creatorcontrib><creatorcontrib>Hamilton, D. Kojo</creatorcontrib><creatorcontrib>Daniels, Alan H.</creatorcontrib><creatorcontrib>Agarwal, Nitin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kumar, Rohit Prem</au><au>Adida, Samuel</au><au>Lavadi, Raj Swaroop</au><au>Mitha, Rida</au><au>Legarreta, Andrew D.</au><au>Hudson, Joseph S.</au><au>Shah, Manan</au><au>Diebo, Bassel</au><au>Fields, Daryl P.</au><au>Buell, Thomas J.</au><au>Hamilton, D. Kojo</au><au>Daniels, Alan H.</au><au>Agarwal, Nitin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A guide to selecting upper thoracic versus lower thoracic uppermost instrumented vertebra in adult spinal deformity correction</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2024-07-01</date><risdate>2024</risdate><volume>33</volume><issue>7</issue><spage>2742</spage><epage>2750</epage><pages>2742-2750</pages><issn>0940-6719</issn><issn>1432-0932</issn><eissn>1432-0932</eissn><abstract>Purpose
Operative treatment of adult spinal deformity (ASD) has been shown to improve patient health-related quality of life (HRQOL). Selection of the uppermost instrumented vertebra (UIV) in either the upper thoracic (UT) or lower thoracic (LT) spine is a pivotal decision with effects on operative and postoperative outcomes. This review overviews the multifaceted decision-making process for UIV selection in ASD correction.
Methods
PubMed was queried for articles using the keywords “uppermost instrumented vertebra”, “upper thoracic”, “lower thoracic”, and “adult spinal deformity”.
Results
Optimization of UIV selection may lead to superior deformity correction, better patient-reported outcomes, and lower risk of proximal junctional kyphosis (PJK) and failure (PJF). Patient alignment characteristics, including preoperative thoracic kyphosis, coronal deformity, and the magnitude of sagittal correction influence surgical decision-making when selecting a UIV, while comorbidities such as poor body mass index, osteoporosis, and neuromuscular pathology should also be taken in to account. Additionally, surgeon experience and resources available to the hospital may also play a role in this decision. Currently, it is incompletely understood whether postoperative HRQOLs, functional and radiographic outcomes, and complications after surgery differ between selection of the UIV in either the UT or LT spine.
Conclusion
The correct selection of the UIV in surgical planning is a challenging task, which requires attention to preoperative alignment, patient comorbidities, clinical characteristics, available resources, and surgeon-specific factors such as experience.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38522054</pmid><doi>10.1007/s00586-024-08206-9</doi><tpages>9</tpages><orcidid>https://orcid.org/0009-0003-4657-2864</orcidid></addata></record> |
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| ispartof | European spine journal, 2024-07, Vol.33 (7), p.2742-2750 |
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| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Attention task Body mass index Bone surgery Comorbidity Decision making Humans Kyphosis Kyphosis - surgery Medicine Medicine & Public Health Mental task performance Neurosurgery Osteoporosis Patients Quality of life Review Article Spinal Curvatures - diagnostic imaging Spinal Curvatures - surgery Spinal Fusion - instrumentation Spinal Fusion - methods Surgeons Surgical Orthopedics Thoracic Vertebrae - diagnostic imaging Thoracic Vertebrae - surgery Vertebrae |
| title | A guide to selecting upper thoracic versus lower thoracic uppermost instrumented vertebra in adult spinal deformity correction |
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