Stopping at the sacrum versus a non-sacral vertebra in long fusion surgery for adult spinal deformity: A meta-analysis of revision with a minimum 2-year follow-up.

Stopping at the sacrum versus a non-sacral vertebra in long fusion surgery for adult spinal deformity: A meta-analysis of revision with a minimum 2-year follow-up.

World Neurosurg. 2018 Dec 31;:

Authors: Chen S, Luo M, Wang Y, Liu H

Abstract
OBJECT: A pooled comparison was conducted on a revision to the sacrum (S) versus a non-sacral (NS) surgical strategy in adult spinal deformity (ASD).
METHODS: Strictly following the PRISMA 2009 guidelines, the MEDLINE, EMBASE, and Cochrane Library databases were used to search for studies published in English up to March 2018 that addressed the sacrum versus non-sacral surgical approach for a long fusion to treat ASD. Data on total revision, and revision reasons were extracted from the included studies were pooled analyzed.
RESULTS: Eight retrospective studies with a total of 1846 ASD patients (528 S and 1318 NS) were included. The total revision rate was 11.38% (S: 17.80% and NS: 8.80%), and implant failure, pseudarthrosis, adjacent segment degeneration, and proximal junctional kyphosis (PJK) were common reasons for revision. The pooled result indicated that the NS group had decreased incident rates of total revision (95%CI 1.20 to 2.32, P=0.002; I2=0%) and pseudarthrosis (95%CI 2.16 to 15.44, P=0.0005; I2=0%) compared to the S group. No significant differences were observed in implant failure (95%CI 0.86 to 3.90, P=0.12; I2=0%), adjacent segment degeneration (95%CI 0.08 to 1.25, P=0.10; I2=0%) and PJK (95%CI 0.54 to 6.88, P=0.35; I2=0%) between the two groups.
CONCLUSION: Revision in ASD patients is a serious problem with a total rate of 11.38%, and implant failure, pseudarthrosis, adjacent segment degeneration, and PJK are common reasons for revision. Stopping at sacrum vertebra in long fusion surgery of ASD patients seems to increase the incidence rates of total revision and pseudarthrosis.

PMID: 30605759 [PubMed - as supplied by publisher]

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