Table 1.
Characteristics of Studies Focusing on Outcomes After Surgery for Correction of Adult Spinal Deformity.
| Study | Type of Study | Patient population/Indications | Radiographic Outcomes | Surgical Outcomes | Clinical Outcomes | Complications | Level of Evidence | Quality of Evidence (Grade) |
|---|---|---|---|---|---|---|---|---|
| Yagi et al 2012* | Retrospective case series (n = 76) | Patients undergoing long instrumented (>5 levels) spine fusion for adult idiopathic scoliosis | PJK | IV | Very low | |||
| Park et al 2017 | Retrospective case review (n = 160) | Patients undergoing long spinal fusion to the sacrum for ASD | PJK PJF |
IV | Very low | |||
| Yagi et al al 2011* | Retrospective case series (n = 157) | Patients undergoing long instrumented (>5 levels) spine fusion for adult idiopathic scoliosis | PJK | IV | Low | |||
| Wang et al 2016* | Prospective cohort study (n = 98) | Patients undergoing instrumented segmental posterior spinal fusion (>4 levels) for degenerative lumbar scoliosis | PJK | II | Very low | |||
| Lee et al 2014* | Retrospective comparative study (n = 47) | Patients undergoing lumbar fusion for sagittal imbalance due to lumbar degenerative kyphosis | PJK | III | Very low | |||
| Kyrölä et al 2019* | Retrospective cohort study (n = 79) | Patients undergoing corrective surgery of coronal or sagittal deformity of the spine | PJF Rod breakage |
SRS-30 ODI |
Neural injury | III | Low | |
| Yagi et al 2018 | Retrospective propensity-matched cohort study (n = 113) | Patients undergoing long instrumented (>5 levels) spine fusion for adult idiopathic scoliosis | PJF SVA, PI-LL, PT |
III | Very low | |||
| Hyun et al 2016* | Retrospective database review (n = 44) | Patients undergoing multilevel (>5 levels) spinal instrumented fusion stopping at the thoracolumbar junction (from T9 to L2) for ASD | PJK | III | Low | |||
| Rodriguez-Fontan et al 2020* | Retrospective matched cohort study (n = 80) | Patients undergoing posterior instrumented fusion for correction of ASD | PJK PJF |
III | Low | |||
| Park et al 2020* | Retrospective case series (n = 63) | Patients undergoing all-pedicle-screw instrumentation and fusion for ASD with the upper instrumented level at the thoracolumbar junction | PJF | IV | Low | |||
| Kim et al 2016* | Retrospective case series (n = 49) | Patients undergoing multilevel (>4 levels) posterior fusion with instrumentation for ASD | PJK | IV | Very low | |||
| Kim et al 2020* | Retrospective case series (n = 68) | Patients undergoing long fusion surgery with pelvic fixation using bilateral iliac screws for ASD | PJK Screw loosening |
IV | Low | |||
| Bridwell et al 2013* | Retrospective case series (n = 90) | Patients undergoing primary instrumented multilevel posterior spinal fusion (≥5 levels) for adult idiopathic/degenerative scoliosis | PJK | IV | Very low | |||
| Maruo et al 2013* | Retrospective case series (n = 90) | Patients undergoing long instrumented spinal fusion (≥6 levels) to the sacrum for ASD | PJK | IV | Very low | |||
| Harris et al 2022 | Retrospective cohort study (n = 91) | Patients undergoing posterior spinal fusion (≥5 levels) for ASD | Intraoperative blood loss | III | Low | |||
| Scheer et al 2016* | Retrospective multicenter database study (n = 557) | Patients undergoing posterior spinal fusion for ASD | Overall major intra-or perioperative complications | III | Low | |||
| Raad et al 2017* | Retrospective review (n = 237) | Patients undergoing multilevel (≥5 levels) spinal fusion for ASD | Intraoperative blood loss | III | Low | |||
| Klineberg et al 2016* | Retrospective multicenter database study (n = 380) | Patients undergoing corrective surgery of coronal or sagittal deformity of the spine | Hospital length of stay | III | Low | |||
| Amin et al 2018* | Retrospective review (n = 303) | Patients undergoing multilevel (≥5 levels) spinal fusion for ASD | Nonroutine discharge | III | Low | |||
| Noh et al 2019 | Retrospective comparative study (n = 203) | Patients undergoing multilevel (≥4 levels) posterior spinal fusion for ASD | Overall mechanical complications | III | Low | |||
| Gupta et al 2000* | Retrospective comparative study (n = 399) | Patients undergoing long (≥7 levels) posterior spinal fusion for scoliosis | Revision surgery | III | Low | |||
| Puvanesarajah et al 2016* | Retrospective database review (n = 2293) | Patients undergoing long (≥8 levels) posterolateral spinal fusion for ASD | Revision surgery | III | Low | |||
| Varshneya et al 2022* | Retrospective cohort study (n = 2564) | Patients undergoing long (≥7 levels) posterior spinal fusion for adult spinal scoliosis | Index hospitalization cost Outpatient cost |
Revision surgery Readmission Neural injury Overall complications |
III | Low | ||
| Taliaferro et al 2021* | Retrospective state database review (n = 12 641) | Patients undergoing posterolateral lumbar fusion (≥3 levels) for degenerative spinal deformity | Revision surgery Readmission |
III | Very low | |||
| Yagi et al 2011* | Retrospective database review (n = 176) | Women treated surgically for scoliosis with preoperative BMD assessment of the lumbar spine and femoral neck determined by DXA | Fusion rate | Overall complications | III | Low | ||
| Ploumis et al 2015 | Retrospective case series (n = 54) | Patients undergoing multilevel (≥4 levels) fusions ending at L5 or S1 for ASD | C7PL distance from the midsacrum in the coronal plane | IV | Very low | |||
| Yuan et al 2021* | Retrospective study (n = 130) | Patients undergoing long spinal fusion (≥5 levels) for degenerative lumbar scoliosis | Screw loosening | III | Low | |||
| Banno et al 2019* | Retrospective study (n = 106) | Patients undergoing fusion surgery with bilateral iliac screws for ASD with 2 groups: Conventional two-rod or multi-rod constructs | Screw loosening | III | Low | |||
| Nakazawa et al 2018* | Retrospective case series (n = 23) | Patients undergoing surgery for ASD using S2 alar screws as anchors in the lower vertebrae | SVA, PI-LL Screw loosening |
IV | Low | |||
| O'Leary et al | Retrospective matched cohort analysis (n = 44) | Patients undergoing spinal fusion (≥4 segments) with long segmental pedicle screw constructs for ASD | Pedicle screw fracture | III | Low | |||
| Lertudomphonwanit et al 2018* | Retrospective cohort study (n = 526) | Patients undergoing long posterior fusion (≥5 levels) to the sacrum for ASD | Rod fracture | III | Low | |||
| Kim et al 2015* | Retrospective study (n = 40) | Patients undergoing surgery involving posterior column release with segmental pedicle screw insertion for lumbar degenerative kyphosis | Pseudarthrosis Cage subsidence Proximal adjacent fractures SVA, LL, TK, PT, SL, sagittal decompensation |
III | Low | |||
| Xu et al 2022* | Retrospective study (n = 78) | Patients undergoing lumbosacral instrumentation for degenerative lumbar scoliosis | Screw loosening | III | Low | |||
| Zhang et al 2021* | Retrospective study (n = 79) | Patients undergoing long fusion arthrodesis (≥4 segments) for scoliosis | Low back pain | III | Low | |||
| Yuan et al 2020 | Retrospective cohort study (n = 123) | Patients undergoing spinal fusion for adult degenerative lumbar scoliosis | Minimum clinically important difference in outcome | III | Low | |||
| Passias et al 2020 | Retrospective case series (n = 166) | Patients undergoing surgical correction of ASD with 3 year ODI follow-up | Sustained vs deteriorated functionality | IV | Very low |
* = included in meta-analysis.
PJK/PJF, proximal junctional kyphosis/failure; SVA, sagittal vertical axis; PI-LL, pelvic incidence-lumbar lordosis; LL, lumbar lordosis; TK, thoracic kyphosis; PT, pelvic tilt; C7PL, C7 plumbline; SL, sacral slope; SRS-30, scoliosis research society deformity sequence questionnaire; ODI, Oswestry Disability Index.