title: Upper thoracic versus lower thoracic upper instrumented vertebrae endpoints have similar outcomes and complications in adult scoliosis.
abstract: METHODS
  Retrospective review-multicenter database.
  
  
  OBJECTIVE
  The purpose of this study was to compare the upper thoracic (UT) and lower thoracic (LT) upper instrumented vertebrae (UIV) in long fusions to the sacrum for adult scoliosis.
  
  
  BACKGROUND
  The optimal UIV for stopping long fusions to the sacrum/pelvis are controversial. Although a UT endpoint may lead to greater operative times, blood loss, and higher rates of pseudarthrosis, the risk for the development of proximal junctional kyphosis and need for revision surgery is likely lower.
  
  
  METHODS
  Retrospective analysis of a prospective database of patients with adult spinal deformity, Patients were selected on the basis of fusions to the sacrum/pelvis with UIV of T1-T6 (UT group) and those with a UIV of T9-L1 (LT group). Demographic data, operative details, and radiographical outcomes with Scoliosis Research Society scores, and Oswestry Disability Index outcomes were collected, as well as complication data were compared. The Fisher exact T tests were used for statistical analysis.
  
  
  RESULTS
  A total of 198 patients (UT = 91, LT = 107) with a mean age of 61.6 were followed for an average of 2.5 years. Demographic variables were similar between the groups except for larger numbers of females in the UT group and a slightly higher body mass index in the LT group. Preoperatively, the UT group demonstrated significantly more lumbar scoliosis, thoracic scoliosis, and thoracolumbar kyphosis. The UT group demonstrated a larger number of fused segments length of stay and longer operative times. There was slightly larger volume of blood loss in the UT group.The total number of complications and number of revision surgical procedures were similar between the groups. The UT group had a higher percentage of patients with 2 or more complications. Both groups had similar proximal junctional kyphosis angles and number of cases requiring revision for proximal junctional kyphosis. Scoliosis Research Society and Oswestry Disability Index outcomes were similar between the groups.
  
  
  CONCLUSIONS
  The UT and LT groups had similar outcomes. The UT group may have a higher rate of total complications, but major complications requiring return to the operative room were similar. The length of stay and operative times were higher in the UT group but may have been necessarily evidenced by the significantly higher coronal deformity and greater thoracolumbar kyphosis in the UT group.
  
  
  METHODS
  4.
authors.affiliation: *Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY; †Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA; ‡Department of Orthopedic Surgery, New York University School of Medicine, New York, NY; §Rocky Mountain Hospital for Children, Presbyterian/St Luke's Medical Center, Denver, CO; ¶Department of Orthopedic Surgery, University of California Davis, Sacramento, CA; ‖Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA; **San Diego Center for Spinal Disorders, La Jolla, CA; ††Michael O'Brien, Baylor Scoliosis Center, Plano, TX; and ‡‡Department of Neurosurgery, University of California San Francisco, San Francisco, CA.
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.forename: Munish C
authors.initials: MC
authors.lastname: Gupta
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
authors.forename: Behrooz
authors.initials: B
authors.lastname: Akbarnia
authors.forename: Greg M
authors.initials: GM
authors.lastname: Mundis
authors.forename: Michael
authors.initials: M
authors.lastname: OʼBrien
authors.forename: Richard
authors.initials: R
authors.lastname: Hostin
authors.forename: Christopher
authors.initials: C
authors.lastname: Ames
mesh_terms: D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome