Factors affecting the postoperative progression of thoracic kyphosis in surgically treated adult patients with lumbar degenerative scoliosis

Keio Spine Research Group

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

STUDY DESIGN: A retrospective case series of patients treated surgically for degenerative lumbar scoliosis (DLS).

OBJECTIVE: To determine incidence and risk factors of progressive global thoracic kyphosis (pGTK) after surgery for DLS.

SUMMARY OF BACKGROUND DATA: Sagittal balance affects the surgical treatment of spinal deformity in adults. Little is known about the loss of sagittal balance due to pGTK, or about the risk factors for pGTK, after surgery for DLS.

METHODS: We reviewed records from a multicenter database of adults with DLS, treated with posterior spinal fusion. Inclusion required an age of 50 years or more at the time of surgery, an upper instrumented vertebra at T9 and below, more than 5 fused segments, and at least 2 years of follow-up. We included 73 patients with a mean age of 68.3 years (range, 51-77 yr) and a mean follow-up period of 3.6 years (range, 2-11 yr). Independent risk factors for pGTK were identified by logistic regression analysis.

RESULTS: Significant pGTK, defined as an increase in thoracic kyphosis of more than 10° from before surgery to the time of final follow-up, was observed in 41% of the patients. Loss of the sagittal vertical axis was larger in patients with pGTK than without (4.7 vs. 1.5 cm; P = 0.02). Risk analysis showed larger lumbar lordosis correction in patients with pGTK. Multivariate logistic regression analysis identified an age greater than 75 (odds ratio, 5.53; P = 0.02, 95% confidence interval [1.4-22.4]) and sacropelvic fusion (odds ratio = 2.66, P = 0.02, 95% confidence interval [1.5-11.1]) as independent risk factors for pGTK.

CONCLUSION: The pGTK incidence after surgery for DLS was 41%. Age, sacropelvic fusion, and a larger sagittal correction were identified as pGTK risk factors. Long-term follow-up will provide more data on the clinical impact of pGTK in elderly patients.3.

Original languageEnglish
Pages (from-to)E521-E528
JournalSpine
Volume39
Issue number8
DOIs
Publication statusPublished - 2014 Apr 15

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Kyphosis
Scoliosis
Thorax
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals
Lordosis
Spinal Fusion
Incidence
Spine

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Factors affecting the postoperative progression of thoracic kyphosis in surgically treated adult patients with lumbar degenerative scoliosis. / Keio Spine Research Group.

In: Spine, Vol. 39, No. 8, 15.04.2014, p. E521-E528.

Research output: Contribution to journalArticle

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title = "Factors affecting the postoperative progression of thoracic kyphosis in surgically treated adult patients with lumbar degenerative scoliosis",
abstract = "STUDY DESIGN: A retrospective case series of patients treated surgically for degenerative lumbar scoliosis (DLS).OBJECTIVE: To determine incidence and risk factors of progressive global thoracic kyphosis (pGTK) after surgery for DLS.SUMMARY OF BACKGROUND DATA: Sagittal balance affects the surgical treatment of spinal deformity in adults. Little is known about the loss of sagittal balance due to pGTK, or about the risk factors for pGTK, after surgery for DLS.METHODS: We reviewed records from a multicenter database of adults with DLS, treated with posterior spinal fusion. Inclusion required an age of 50 years or more at the time of surgery, an upper instrumented vertebra at T9 and below, more than 5 fused segments, and at least 2 years of follow-up. We included 73 patients with a mean age of 68.3 years (range, 51-77 yr) and a mean follow-up period of 3.6 years (range, 2-11 yr). Independent risk factors for pGTK were identified by logistic regression analysis.RESULTS: Significant pGTK, defined as an increase in thoracic kyphosis of more than 10° from before surgery to the time of final follow-up, was observed in 41{\%} of the patients. Loss of the sagittal vertical axis was larger in patients with pGTK than without (4.7 vs. 1.5 cm; P = 0.02). Risk analysis showed larger lumbar lordosis correction in patients with pGTK. Multivariate logistic regression analysis identified an age greater than 75 (odds ratio, 5.53; P = 0.02, 95{\%} confidence interval [1.4-22.4]) and sacropelvic fusion (odds ratio = 2.66, P = 0.02, 95{\%} confidence interval [1.5-11.1]) as independent risk factors for pGTK.CONCLUSION: The pGTK incidence after surgery for DLS was 41{\%}. Age, sacropelvic fusion, and a larger sagittal correction were identified as pGTK risk factors. Long-term follow-up will provide more data on the clinical impact of pGTK in elderly patients.3.",
author = "{Keio Spine Research Group} and Mitsuru Yagi and Naobumi Hosogane and Eijiro Okada and Koota Watanabe and Masafumi Machida and Masaki Tezuka and Morio Matsumoto and Takashi Asazuma",
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T1 - Factors affecting the postoperative progression of thoracic kyphosis in surgically treated adult patients with lumbar degenerative scoliosis

AU - Keio Spine Research Group

AU - Yagi, Mitsuru

AU - Hosogane, Naobumi

AU - Okada, Eijiro

AU - Watanabe, Koota

AU - Machida, Masafumi

AU - Tezuka, Masaki

AU - Matsumoto, Morio

AU - Asazuma, Takashi

PY - 2014/4/15

Y1 - 2014/4/15

N2 - STUDY DESIGN: A retrospective case series of patients treated surgically for degenerative lumbar scoliosis (DLS).OBJECTIVE: To determine incidence and risk factors of progressive global thoracic kyphosis (pGTK) after surgery for DLS.SUMMARY OF BACKGROUND DATA: Sagittal balance affects the surgical treatment of spinal deformity in adults. Little is known about the loss of sagittal balance due to pGTK, or about the risk factors for pGTK, after surgery for DLS.METHODS: We reviewed records from a multicenter database of adults with DLS, treated with posterior spinal fusion. Inclusion required an age of 50 years or more at the time of surgery, an upper instrumented vertebra at T9 and below, more than 5 fused segments, and at least 2 years of follow-up. We included 73 patients with a mean age of 68.3 years (range, 51-77 yr) and a mean follow-up period of 3.6 years (range, 2-11 yr). Independent risk factors for pGTK were identified by logistic regression analysis.RESULTS: Significant pGTK, defined as an increase in thoracic kyphosis of more than 10° from before surgery to the time of final follow-up, was observed in 41% of the patients. Loss of the sagittal vertical axis was larger in patients with pGTK than without (4.7 vs. 1.5 cm; P = 0.02). Risk analysis showed larger lumbar lordosis correction in patients with pGTK. Multivariate logistic regression analysis identified an age greater than 75 (odds ratio, 5.53; P = 0.02, 95% confidence interval [1.4-22.4]) and sacropelvic fusion (odds ratio = 2.66, P = 0.02, 95% confidence interval [1.5-11.1]) as independent risk factors for pGTK.CONCLUSION: The pGTK incidence after surgery for DLS was 41%. Age, sacropelvic fusion, and a larger sagittal correction were identified as pGTK risk factors. Long-term follow-up will provide more data on the clinical impact of pGTK in elderly patients.3.

AB - STUDY DESIGN: A retrospective case series of patients treated surgically for degenerative lumbar scoliosis (DLS).OBJECTIVE: To determine incidence and risk factors of progressive global thoracic kyphosis (pGTK) after surgery for DLS.SUMMARY OF BACKGROUND DATA: Sagittal balance affects the surgical treatment of spinal deformity in adults. Little is known about the loss of sagittal balance due to pGTK, or about the risk factors for pGTK, after surgery for DLS.METHODS: We reviewed records from a multicenter database of adults with DLS, treated with posterior spinal fusion. Inclusion required an age of 50 years or more at the time of surgery, an upper instrumented vertebra at T9 and below, more than 5 fused segments, and at least 2 years of follow-up. We included 73 patients with a mean age of 68.3 years (range, 51-77 yr) and a mean follow-up period of 3.6 years (range, 2-11 yr). Independent risk factors for pGTK were identified by logistic regression analysis.RESULTS: Significant pGTK, defined as an increase in thoracic kyphosis of more than 10° from before surgery to the time of final follow-up, was observed in 41% of the patients. Loss of the sagittal vertical axis was larger in patients with pGTK than without (4.7 vs. 1.5 cm; P = 0.02). Risk analysis showed larger lumbar lordosis correction in patients with pGTK. Multivariate logistic regression analysis identified an age greater than 75 (odds ratio, 5.53; P = 0.02, 95% confidence interval [1.4-22.4]) and sacropelvic fusion (odds ratio = 2.66, P = 0.02, 95% confidence interval [1.5-11.1]) as independent risk factors for pGTK.CONCLUSION: The pGTK incidence after surgery for DLS was 41%. Age, sacropelvic fusion, and a larger sagittal correction were identified as pGTK risk factors. Long-term follow-up will provide more data on the clinical impact of pGTK in elderly patients.3.

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DO - 10.1097/BRS.0000000000000226

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