title: Incidence of proximal adjacent failure in adult lumbar deformity correction based on proximal fusion level.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To review the results and proximal adjacent problems of long fusion (more than 4 levels) according to the level of proximal fusion (L2~T9) in adult lumbar deformity using pedicle screw fixation.
  
  
  BACKGROUND
  There are few written reports concerning proximal adjacent segmental failure according to the level of proximal fusion in adult lumbar deformity.
  
  
  METHODS
  The radiographs and clinical records of thirty-five patients (30 females, 5 males) of adult lumbar deformity with more than 2-year follow-up after surgery were analyzed. The average age was 62 years (range, 38~75). All patients were divided into three groups according to the level of proximal fusion: Group 1 (n=14) fusion up to L1 or L2; Group 2 (n=14) fusion up to T11 or T12; and Group 3 (n=7) fusion up to T9 or T10.
  
  
  RESULTS
  The preoperative coronal curve of 28+/-14 degrees was corrected to 9+/-7 degrees immediately after surgery and 11+/-7 degrees at the final follow-up. The preoperative local kyphosis of 24+/-12 degrees was corrected to -1+/-10 degrees immediately after surgery and 1+/-11 degrees at the final follow-up. The lumbar lordosis was 14+/-18 degrees before surgery; 27+/-11 degrees after surgery; and 16+/-12 degrees at the final follow- up. The parameters of coronal and sagittal balance were improved in all patients after surgery, except one patient in group 2 who showed coronal imbalance due to over-correction. Sagittal imbalance at the most recent follow-up was detected in 10 patients with significant difference between the groups; 5 (36%) in Group 1, 5 (36%) in Group 2, and none in Group 3. Proximal adjacent segmental problems that are consisted with proximal disc degeneration with kyphosis, compression fractures above the fusion and screw failure proximal to the end of the fusion were observed in 15 patients with significant difference between the groups; 7 (50%) in Group 1, 7 (50%) in Group 2, and 1 (14%) in Group 3. There was 1 superficial infection and 2 transient neurologies.
  
  
  CONCLUSIONS
  Fusion up to throacolumbar junction (L2~T11) in surgical treatment of adult lumbar deformity had more proximal adjacent problems with poorer results. Fusion higher than T10 is recommended for adult lumbar deformity.
authors.affiliation: Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea.
authors.forename: Jin-Hyok
authors.initials: JH
authors.lastname: Kim
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Kim
authors.forename: Se-Il
authors.initials: SI
authors.lastname: Suk
references.citation: Spine (Phila Pa 1976). 1994 Jan 15;19(2):123-8
references.pmid: 8153817
references.citation: J Neurosurg Spine. 2004 Jul;1(1):1-8
references.pmid: 15291013
references.citation: Spine (Phila Pa 1976). 1989 Dec;14(12):1391-7
references.pmid: 2533406
references.citation: Spine (Phila Pa 1976). 1990 Jul;15(7):650-3
references.pmid: 2218710
references.citation: Spine (Phila Pa 1976). 2003 Sep 15;28(18):2164-9; discussion 2169
references.pmid: 14501930
references.citation: J South Orthop Assoc. 1996 Fall;5(3):221-8
references.pmid: 8884710
references.citation: J Bone Joint Surg Am. 1995 Apr;77(4):513-23
references.pmid: 7713967
references.citation: Spine (Phila Pa 1976). 1983 Jul-Aug;8(5):489-500
references.pmid: 6648699
references.citation: Spine (Phila Pa 1976). 2002 Apr 1;27(7):776-86
references.pmid: 11923673
references.citation: Spine (Phila Pa 1976). 1981 May-Jun;6(3):268-73
references.pmid: 6455747
references.citation: Spine (Phila Pa 1976). 1997 Oct 15;22(20):2452-7
references.pmid: 9355229
references.citation: Spine (Phila Pa 1976). 2006 Feb 1;31(3):303-8
references.pmid: 16449903
references.citation: Spine (Phila Pa 1976). 1999 Aug 15;24(16):1712-20
references.pmid: 10472106
references.citation: Spine (Phila Pa 1976). 1986 Oct;11(8):824-9
references.pmid: 3027899
references.citation: Orthopade. 1993 Aug;22(4):232-42
references.pmid: 8414480
references.citation: Spine (Phila Pa 1976). 2001 May 1;26(9):E182-92
references.pmid: 11337635
references.citation: J Bone Joint Surg Am. 1972 Apr;54(3):492-510
references.pmid: 5055149
references.citation: Orthop Clin North Am. 1988 Apr;19(2):347-51
references.pmid: 3282202
references.citation: Clin Orthop Relat Res. 1988 Feb;227:10-23
references.pmid: 3338200
references.citation: J Bone Joint Surg Am. 1981 Feb;63(2):268-87
references.pmid: 6450768