Upper Thoracic Versus lower Thoracic as Site of Upper-instrumented Vertebrae for Long Fusion Surgery in Adult Spinal Deformity: A Meta-analysis of Proximal Junctional Kyphosis.

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Upper Thoracic Versus lower Thoracic as Site of Upper-instrumented Vertebrae for Long Fusion Surgery in Adult Spinal Deformity: A Meta-analysis of Proximal Junctional Kyphosis.

World Neurosurg. 2017 Mar 15;:

Authors: Luo M, Wang P, Wang W, Shen M, Xu G, Xia L

Abstract
OBJECTIVE: A meta-analysis was performed to compare incidence rates of radiographic and surgical proximal junctional kyphosis (PJK) between upper thoracic (UT) versus lower thoracic (LT) as site of upper-instrumented vertebrae (UIV) endpoints for long fusion surgery in adult spinal deformity (ASD).
METHODS: The MEDLINE, Embase, and the Cochrane Library databases were searched for English-language articles that addressed the UT versus LT fixation strategies. The division of the UT and LT groups was based on UIV. Two reviewers independently assessed the quality of the studies using the Newcastle-Ottawa scale. Data on incidence rates of radiographic and surgical PJK were extracted from the included studies. RevMan 5.3 was used for data pooling and analysis.
RESULTS: Ten retrospective studies with 1,230 patients were included. Pooled data on radiographic PJK were available in nine studies comprising 1,032 patients, and the total radiographic PJK rate was 32.2%. Pooled data on surgical PJK were available in six studies comprising 732 patients, and the total surgical PJK rate was 6.7%. Decreased radiographic PJK (95% CI 0.49 to 0.85, P=0.002; I(2)=48%) and surgical PJK (95% CI 0.18 to 0.76, P=0.007; I(2)=22%) were found in the UT group.
CONCLUSION: For long fusion surgery in ASD, radiographic PJK is a very common complication with an incidence rate of up to 32.2%. Surgical PJK has an incidence rate of 6.7% and should be seriously considered. The pooled results indicate that choosing the UT as the site of UIV could decrease the incidence rate of radiographic PJK and surgical PJK.

PMID: 28315802 [PubMed - as supplied by publisher]

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