Data from: Long fusion correction of degenerative adult spinal deformity and the selection of the upper or lower thoracic region as the site of proximal instrumentation: a systematic review and meta-analysis

Objective: The aim of this study was to compare outcomes when the upper and lower thoracic regions were used as the site of proximal instrumentation to treat adult spinal deformity.
Methods: Medline, Embase and Cochrane library searches were performed to identify studies that compared outcome measures when the upper and lower thoracic vertebrae (UTV and LTV, respectively) were used as the site of proximal instrumentation. The weighted mean difference (WMD) was calculated for continuous outcomes, and the relative risk (RR) was calculated for dichotomous outcomes.
Results: Seven articles (n=554patients) met the final inclusion criteria, and we compared the outcome measures of a long fusion extending to the upper and lower thoracic regions. The pooled analysis revealed that extending fixation into the upper thoracic region decreased the risk of proximal junctional kyphosis (PJK) revision surgery (RR: 0.36, 95% CI: 0.14 to 0.90; P<0.05).The operation time (WMD: 0.93;95% CI: 0.48, 1.39; P<0.05) and estimated blood loss (WMD: 0.59;95% CI: 0.33, 0.85; P<0.05) were significantly greater in the UTV group than in the LTV group. No significant differences were found in the Scoliosis Research Society (SRS) pain, self-image, function, mental health, subtotal, satisfaction, or total scores; the total number of complications; or the total number of revision surgeries.
Conclusion: Long posterior fixation extending into the upper thoracic region reduces the incidence of revision surgery related to PJK; however, it increased the operative level resulting in a longer operative time and greater estimated blood loss. This initial analysis indicates that extending fixation to the upper thoracic region is appropriate for patients who are likely to develop PJK following initial scoliosis correction.

研究目的：本研究旨在对比以胸段上、下部作为近端固定位点治疗成人脊柱畸形的临床结局。
研究方法：本研究通过检索Medline、Embase及Cochrane图书馆数据库，筛选对比以胸段上椎体（Upper Thoracic Vertebrae, UTV）与胸段下椎体（Lower Thoracic Vertebrae, LTV）作为近端固定位点的相关研究。对于连续性结局指标，计算加权均数差（Weighted Mean Difference, WMD）；对于二分类结局指标，计算相对危险度（Relative Risk, RR）。
研究结果：最终共有7篇文献、合计554例患者符合纳入标准，本研究对比了长节段融合延伸至胸段上、下部的临床结局。合并分析结果显示，将固定节段延伸至胸段上部可降低近端交界性后凸（Proximal Junctional Kyphosis, PJK）相关翻修手术的风险（RR=0.36，95%CI：0.14~0.90；P<0.05）。胸段上部固定组（UTV组）的手术时长（WMD=0.93，95%CI：0.48~1.39；P<0.05）与估算失血量（WMD=0.59，95%CI：0.33~0.85；P<0.05）均显著高于胸段下部固定组（LTV组）。在脊柱侧弯研究学会（Scoliosis Research Society, SRS）评估的疼痛、自我形象、功能、心理健康、分项总分、满意度及总评分，并发症总例数，以及翻修手术总例数方面，两组均无显著差异。
研究结论：延伸至胸段上部的后路长节段固定可降低与PJK相关的翻修手术发生率，但会增加手术节段，导致手术时长延长、估算失血量增加。本初步分析表明，对于初始脊柱侧弯矫正术后可能发生PJK的患者，将固定节段延伸至胸段上部是合适的治疗选择。