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| WU Aimin,CHEN Dong,ZHANG Kai.The effect of the proximal instrumented vertebrae on complications and revision rate in long fusion correction of degenerative adult lumbar scoliosis: a Meta analysis[J].Chinese Journal of Spine and Spinal Cord,2018,(11):995-1003. |
| The effect of the proximal instrumented vertebrae on complications and revision rate in long fusion correction of degenerative adult lumbar scoliosis: a Meta analysis |
| Received:May 30, 2018 Revised:September 21, 2018 |
| English Keywords:Degenerative lumbar scoliosis Long fusion Proximal instrumented vertebra Complications Meta analysis |
| Fund:中国博士后科学基金面上一等资助项目（2018M630450）；国家自然科学基金项目（81501933，81572168） |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the effect of the proximal instrumented vertebrae on complications and revision rate in long fusion correction of degenerative adult lumbar scoliosis. Methods: The databases of Pubmed, Embase, Cochrane library, VIP, Wanfang and CNKI were searched at March 15th, 2018 to identify studies that compared outcome measures of the upper and lower proximal instrumented vertebrae(UV, upper vertebrae to T10 and above region; LV, lower vertebrae to lower than T10 region) in correction of degenerative adult lumbar scoliosis with long fusion. The included criteria were: (1) the studies focusing on comparison of outcome measures of the upper and lower proximal instrumented vertebrae in long fusion correction of degenerative adult lumbar scoliosis; (2) randomised or non-randomised controlled studies; (3) age≥18 years old; (4) follow up ≥1 year. The general information, complications[peri-operative and later post-operative complications: dural tear, deep vein thrombosis, deep wound infection, superficial wound infection, neurologic complications, proximal adjacent degenerative diseases, proximal junctional kyphosis(PJK), implant failure, pseudarthrosis and total complications], blood loss and revision rate(different reasons for revision, PJK, pseudarthrosis, implant failure and infection) were extracted. Methodological index for non-randomised studies(MINORS) was used to assess the quality of included studies, and Begges test was used to assess the publication bias. The Meta analysis was performed by using STATA 12.0. Results: Ten articles (2 in Chinese and 8 in English) were enrolled in this meta analysis, with total 883 cases(UV=353 cases; LV=530 cases). The MINORS scores ranged from 16 to 20, no significant publication bias was observed by using Beggs test. The complications included perioperative complications and later post-operative complications. For perioperative complications, the blood loss of UV group was significant more than that of LV group[weight mean difference(WMD): 409.33ml (95%CI: 288.74, 529.92)], however, no significant difference was found in deep vein thrombosis, deep wound infection, superficial wound infection, neurologic complications and total perioperative complications between two groups. For later post-operative complications, the incidence of proximal adjacent degenerative disease in UV group was lower than that in LV group[relative risk(RR): 0.26 (95%CI: 0.11, 0.63)], however, no significant difference was found in PJK, implant failure, pseudarthrosis and total later post-operative complications between two groups. No significant difference was found in the total revision and revison caused by PJK, pseudarthrosis, implant failure and infection. Conclusions: Selection of the upper thoracic region as the proximal instrumented vertebrae in the correction of degenerative adult lumbar scoliosis with long fusion may reduce the rate of proximal adjacent degenerative disease, however, present no advantage in terms of blood loss, other complications and revision rate. |
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