Stopping at Sacrum Versus Nonsacral Vertebra in Long Fusion Surgery for Adult Spinal Deformity: Meta-Analysis of Revision with Minimum 2-Year Follow-Up

Abstract

A pooled comparison was conducted on a revision to the sacrum (S) versus a nonsacral (NS) surgical strategy in adult spinal deformity (ASD). 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 S versus NS surgical approach for a long fusion to treat ASD. Data on total revisions and revision reasons were extracted from the included studies and were pooled analyzed. 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 results indicated that the NS group had decreased incident rates of total revision (95% confidence interval [CI] 1.20-2.32, P= 0.002; I2= 0%) and pseudarthrosis (95% CI 2.16-15.44, P= 0.0005; I2= 0%) compared with the S group. No significant differences wereobserved in implant failure (95% CI 0.86-3.90, P= 0.12; I2= 0%), adjacent segment degeneration (95% CI 0.08-1.25, P= 0.10; I2= 0%), and PJK (95% CI 0.54-6.88, P= 0.35; I2=0%) between the 2 groups. 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 the sacrum vertebra in long fusion surgery on ASD patients seems to increase the incidence rates of total revision and pseudarthrosis.