Clinical and radiographic outcomes of upper thoracic versus lower thoracic upper instrumented vertebrae for adult scoliosis: a meta-analysis.

X Kang,T Yang,L Dong,X Chen,Z Wang,G Huang

doi:10.1590/1414-431x20176651

X Kang, T Yang + Show 4 more

Open Access

https://doi.org/10.1590/1414-431x20176651

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Abstract

The aim of this study was to evaluate the clinical and radiographic outcomes of upper thoracic (UT) versus lower thoracic (LT) upper instrumented vertebrae (UIV) for adult scoliosis by meta-analysis. We conducted a literature search in three databases to retrieve related studies up to March 15, 2017. The preliminary screened studies were assessed by two reviewers according to the selection criteria. All analyses were carried out using the statistical software package R version 2.31. Odds ratios (OR) with 95% confidence intervals (CI) were used to describe the results. The I2 statistic and Q statistic test were used for heterogeneity assessment. Egger's test was performed to detect publication bias. To assess the effect of each study on the overall pooled OR or standardized mean difference (SMD), sensitive analysis was conducted. Ten trials published between 2007 and 2015 were eligible and included in our study. Meta-analysis revealed that the UT group was associated with more blood loss (SMD=0.4779, 95%CI=0.3349-0.6209, Z=6.55, P<0.0001) and longer operating time (SMD=0.5780, 95%CI=0.1971-0.958, Z=2.97, P=0.0029) than the LT group. However, there was no significant difference in Oswestry Disability Index, Scoliosis Research Society (SRS) function subscores, radiographic outcomes including sagittal vertical axis, lumbar lordosis, and thoracic kyphosis, length of hospital stay, and revision rates between the two groups. No evidence of publication bias was found between the two groups. Fusion from the lower thoracic spine (below T10) has as advantages a shorter operation time and less blood loss than upper thoracic spine (above T10) in posterior long-segment fixation for degenerative lumbar scoliosis.

Highlights

Adult spinal deformities (ASDs) are complex pathologies associated with a broad range of clinical and radiological presentation
10 articles related to the clinical and radiographic outcomes of upper thoracic versus lower thoracic upper instrumented vertebrae for adult scoliosis were included in this meta-analysis
We performed a meta-analysis to pool the results of previous studies that reported the outcomes between upper thoracic (UT) and lower thoracic (LT) as sites of upper instrumented vertebrae (UIV) in adult patients with spinal deformity

Summary

Introduction

Adult spinal deformities (ASDs) are complex pathologies associated with a broad range of clinical and radiological presentation. The prevalence of ASD has been reported as high as 60% in the general population older than 60 years [1]. Restoring and maintaining spinal balance are the key points for the successful surgical treatment of adults with spinal deformity. Conservative treatment includes physical therapy, facet blocks, nonsteroidal antiinflammatories, nerve root or epidural injections and oral narcotic medications. Conservative management is not always satisfactory in adult scoliotic patients [2]. With the growth of the aging population, surgical management is becoming more frequent and aggressive, which might result in several complications in patients

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