title: Revision extension to the pelvis versus primary spinopelvic instrumentation in adult deformity: comparison of clinical outcomes and complications.
abstract: OBJECTIVE
  To evaluate the outcomes and complications of patients with adult spinal deformity treated in a primary versus revision fashion with long fusions to the sacropelvis.
  
  
  METHODS
  A retrospective review was performed of a multicenter consecutive series of patients with adult spinal deformity requiring fusion to the sacropelvis, either primarily or as revision, with minimum 2-year follow-up. Clinical (Scoliosis Research Society [SRS] 22 questionnaire) and radiographic parameters (including sagittal vertical axis [SVA], coronal Cobb angle, lumbar lordosis, and thoracic kyphosis) were compared between the groups.
  
  
  RESULTS
  There were 63 patients who met inclusion criteria; mean patient age was 51.9 years, and mean follow-up was 43 months. Patients requiring primary fusion were older (58.0 years vs. 49.5 years, P=0.01) and at baseline had a lower SVA (2.1 cm vs. 6.8 cm, P=0.01) and greater thoracolumbar Cobb angle (51.2 degrees vs. 36.5 degrees, P=0.003). At last follow-up, patients undergoing primary fusion and patients undergoing revision treatment had similar SVA (2.9 cm vs. 1.8 cm, P=0.32) and lumbar lordosis (-42.3 degrees vs. -43.4 degrees, P=0.82); patients undergoing revision treatment had more favorable SRS 22 scores (3.65 vs. 3.14, P=0.005). There was no statistical difference in complication rates between the groups (44.4% vs. 35%, P=0.68).
  
  
  CONCLUSIONS
  Patients requiring revision extension of instrumentation to the pelvis can be treated with the same expectation of radiographic and clinical success as patients treated primarily with fusion to the sacropelvis. The complication rate for the revision procedure is not insignificant and may be similar to a primary procedure that includes pelvic fixation.
authors: Department of Neurosurgery, Weill Cornell Medical College, New York, New York, USA.
authors: Kai-Ming G
authors: KM
authors: Fu
authors: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: jss7f@virginia.edu.virginia.edu.
authors: Justin S
authors: JS
authors: Smith
authors: Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors: Douglas C
authors: DC
authors: Burton
authors: Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
authors: Khaled M
authors: KM
authors: Kebaish
authors: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
authors: Christopher I
authors: CI
authors: Shaffrey
authors: Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, USA.
authors: Frank
authors: F
authors: Schwab
authors: Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York, USA.
authors: Virginie
authors: V
authors: Lafage
authors: Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
authors: Vincent
authors: V
authors: Arlet
authors: Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas, USA.
authors: Richard
authors: R
authors: Hostin
authors: Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
authors: Oheneba
authors: O
authors: Boachie
authors: San Diego Center for Spinal Disorders, La Jolla, California, USA.
authors: Behrooz
authors: B
authors: Akbarnia
authors: Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado, USA.
authors: Shay
authors: S
authors: Bess
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010388:Pelvis / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000628:therapy; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D013123:Spinal Fusion; D013131:Spine / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complications; Instrumentation; Pelvis; Revision; Spine deformity; Surgery