title: Radiographic predictors of outcome after long fusion to L5 in adult scoliosis.
abstract: Radiographic factors that correlate with outcome following long posterior fusion to L5 for adult scoliosis were investigated. Measurement of thoracic, lumbar, and fractional lumbosacral curves, L5 obliquity, lumbar and L5-S1 lordosis, coronal balance, sagittal balance, and L5-S1 disc height were performed on preoperative, postoperative, and follow-up 36-in posteroanterior/lateral radiographs. Of 16 patients, 14 were female (88%) and 2 male (12%). Average follow-up was 32 months (8-78 months). Scoliotic curves demonstrated stable corrections; however, lumbar and L5-S1 lordosis decreased and sagittal decompensation worsened. Ten patients (62%) had no evidence of transitional degeneration. Six patients (38%) had radiographic evidence of L5-S1 degeneration, and three (19%) underwent revision. Patients with good preoperative sagittal balance, preserved lumbar lordosis, good postoperative fractional curve correction, and L5-S1 disc height preservation are most likely to benefit from posterior fusion to L5, avoiding sacral fusion, for adult scoliosis.
authors.affiliation: Department of Orthopaedics and Rehabilitation, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA. khuang@psu.edu
authors.forename: Karen M
authors.initials: KM
authors.lastname: Brown
authors.forename: Steven C
authors.initials: SC
authors.lastname: Ludwig
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Gelb
mesh_terms: D000328:Adult; D000368:Aged; D015984:Causality; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects / Q000592:standards*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D008141:Lordosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome