{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:08Z","timestamp":1787025728748,"version":"build-2736575974"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,5]]},"abstract":"\n Object<\/jats:title>\n Despite increasing numbers of patients with adult spinal deformity, it is unclear how to select the optimal upper instrumented vertebra (UIV) in long fusion surgery for these patients. The purpose of this study was to compare the use of vertebrae in the upper thoracic (UT) versus lower thoracic (LT) spine as the upper instrumented vertebra in long fusion surgery for adult spinal deformity.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients who underwent fusion from the sacrum to the thoracic spine for adult spinal deformity with sagittal imbalance at a single medical center were studied. The patients with a sagittal vertical axis (SVA) \u2265 40 mm who had radiographs and completed the 12-item Short-Form Health Survey (SF-12) preoperatively and at final follow-up (\u2265 2 years postoperatively) were included.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Eighty patients (mean age of 61.1 \u00b1 10.9 years; 69 women and 11 men) met the inclusion criteria. There were 31 patients in the UT group and 49 patients in the LT group. The mean follow-up period was 3.6 \u00b1 1.6 years. The physical component summary (PCS) score of the SF-12 significantly improved from the preoperative assessment to final follow-up in each group (UT, 34 to 41; LT, 29 to 37; p = 0.001). This improvement reached the minimum clinically important difference in both groups. There was no significant difference in PCS score improvement between the 2 groups (p = 0.8). The UT group had significantly greater preoperative lumbar lordosis (28\u00b0 vs 18\u00b0, p = 0.03) and greater thoracic kyphosis (36\u00b0 vs 18\u00b0, p = 0.001). After surgery, there was no significant difference in lumbar lordosis or thoracic kyphosis. The UT group had significantly greater postoperative cervicothoracic kyphosis (20\u00b0 vs 11\u00b0, p = 0.009). The UT group tended to maintain a smaller positive SVA (51 vs 73 mm, p = 0.08) and smaller T-1 spinopelvic inclination (\u22122.6\u00b0 vs 0.6\u00b0, p = 0.06). The LT group tended to have more proximal junctional kyphosis (PJK), although the difference did not reach statistical significance. Radiographic PJK was 32% in the UT group and 41% in the LT group (p = 0.4). Surgical PJK was 6.4% in the UT group and 10% in the LT group (p = 0.6).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Both the UT and LT groups demonstrated significant improvement in clinical and radiographic outcomes. A significant difference was not observed in improvement of clinical outcomes between the 2 groups.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.3.focus13541","type":"journal-article","created":{"date-parts":[[2014,5,1]],"date-time":"2014-05-01T06:54:41Z","timestamp":1398927281000},"page":"E9","source":"Crossref","is-referenced-by-count":60,"title":["Long fusion from sacrum to thoracic spine for adult spinal deformity with sagittal imbalance: upper versus lower thoracic spine as site of upper instrumented vertebra"],"prefix":"10.3171","volume":"36","author":[{"given":"Takahito","family":"Fujimori","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Franicsco, California;"},{"name":"Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Franicsco, California;"},{"name":"Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Franicsco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William W.","family":"Schairer","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Franicsco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigurd H.","family":"Berven","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Franicsco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bobby K.","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Franicsco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedat","family":"Deviren","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Franicsco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane","family":"Burch","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Franicsco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoki","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena S.","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of California, San Franicsco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2079","article-title":"The minimum clinically important difference in Scoliosis Research Society-22 Appearance, Activity, And Pain domains after surgical correction of adolescent idiopathic scoliosis","volume":"35","author":"Carreon","year":"2010"},{"key":"b2-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2232","article-title":"Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis","volume":"32","author":"Cho","year":"2007"},{"key":"b3-0360009","series-title":"J Neurosurg Spine","first-page":"445","article-title":"Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors. Clinical article","volume":"19","author":"Cho","year":"2013"},{"key":"b4-0360009","series-title":"Spine J","first-page":"968","article-title":"Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales","volume":"8","author":"Copay","year":"2008"},{"key":"b5-0360009","series-title":"J Spinal Disord","first-page":"1","article-title":"Treatment of adult spinal deformity with fusion to the sacrum using CD instrumentation","volume":"4","author":"Devlin","year":"1991"},{"key":"b6-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"776","article-title":"Outcome and complications of long fusions to the sacrum in adult spine deformity: Luque-Galveston, combined iliac and sacral screws, and sacral fixation","volume":"27","author":"Emami","year":"2002"},{"key":"b7-0360009","series-title":"Phys Ther","first-page":"776","article-title":"A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale","volume":"81","author":"Fritz","year":"2001"},{"key":"b8-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"E1318","article-title":"Kinematics of the thoracic spine in trunk rotation: in vivo 3-dimensional analysis","volume":"37","author":"Fujimori","year":"2012"},{"key":"b9-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2024","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"Glassman","year":"2005"},{"key":"b10-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2764","article-title":"The impact of perioperative complications on clinical outcome in adult deformity surgery","volume":"32","author":"Glassman","year":"2007"},{"key":"b11-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"1643","article-title":"Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis","volume":"30","author":"Glattes","year":"2005"},{"key":"b12-0360009","series-title":"Spine (Phila Pa 1976)","article-title":"Incidence, mode, and location of acute proximal junctional failures following surgical treatment for adult spinal deformity","author":"Hostin","year":"2013"},{"key":"b13-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2329","article-title":"Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases","volume":"31","author":"Kim","year":"2006"},{"key":"b14-0360009","series-title":"Spine J","first-page":"994","article-title":"The use of the T1 sagittal angle in predicting overall sagittal balance of the spine","volume":"10","author":"Knott","year":"2010"},{"key":"b15-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"489","article-title":"Spinal fusions to the sacrum in adults with scoliosis","volume":"8","author":"Kostuik","year":"1983"},{"key":"b16-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2771","article-title":"Thoracolumbar deformity arthrodesis stopping at L5: fate of the L5-S1 disc, minimum 5-year follow-up","volume":"32","author":"Kuhns","year":"2007"},{"key":"b17-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2205","article-title":"Long adult spinal deformity fusion to the sacrum using rh-BMP-2 versus autogenous iliac crest bone graft","volume":"34","author":"Maeda","year":"2009"},{"key":"b18-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"884","article-title":"Does a long-fusion \u201cT3-sacrum\u201d portend a worse outcome than a short-fusion \u201cT10-sacrum\u201d in primary surgery for adult scoliosis?","volume":"37","author":"O'Shaughnessy","year":"2012"},{"key":"b19-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"1828","article-title":"Sagittal plane considerations and the pelvis in the adult patient","volume":"34","author":"Schwab","year":"2009"},{"key":"b20-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"1077","article-title":"Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study","volume":"37","author":"Schwab","year":"2012"},{"key":"b21-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2243","article-title":"Predicting outcome and complications in the surgical treatment of adult scoliosis","volume":"33","author":"Schwab","year":"2008"},{"issue":"3","key":"b22-0360009","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Adult degenerative scoliosis: evaluation and management","volume":"28","author":"Silva","year":"2010"},{"issue":"3","key":"b23-0360009","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Adult scoliosis surgery outcomes: a systematic review","volume":"28","author":"Yadla","year":"2010"},{"key":"b1-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2079","article-title":"The minimum clinically important difference in Scoliosis Research Society-22 Appearance, Activity, And Pain domains after surgical correction of adolescent idiopathic scoliosis","volume":"35","author":"Carreon","year":"2010"},{"key":"b2-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2232","article-title":"Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis","volume":"32","author":"Cho","year":"2007"},{"key":"b3-0360009","series-title":"J Neurosurg Spine","first-page":"445","article-title":"Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors. Clinical article","volume":"19","author":"Cho","year":"2013"},{"key":"b4-0360009","series-title":"Spine J","first-page":"968","article-title":"Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales","volume":"8","author":"Copay","year":"2008"},{"key":"b5-0360009","series-title":"J Spinal Disord","first-page":"1","article-title":"Treatment of adult spinal deformity with fusion to the sacrum using CD instrumentation","volume":"4","author":"Devlin","year":"1991"},{"key":"b6-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"776","article-title":"Outcome and complications of long fusions to the sacrum in adult spine deformity: Luque-Galveston, combined iliac and sacral screws, and sacral fixation","volume":"27","author":"Emami","year":"2002"},{"key":"b7-0360009","series-title":"Phys Ther","first-page":"776","article-title":"A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale","volume":"81","author":"Fritz","year":"2001"},{"key":"b8-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"E1318","article-title":"Kinematics of the thoracic spine in trunk rotation: in vivo 3-dimensional analysis","volume":"37","author":"Fujimori","year":"2012"},{"key":"b9-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2024","article-title":"The impact of positive sagittal balance in adult spinal deformity","volume":"30","author":"Glassman","year":"2005"},{"key":"b10-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2764","article-title":"The impact of perioperative complications on clinical outcome in adult deformity surgery","volume":"32","author":"Glassman","year":"2007"},{"key":"b11-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"1643","article-title":"Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis","volume":"30","author":"Glattes","year":"2005"},{"key":"b12-0360009","series-title":"Spine (Phila Pa 1976)","article-title":"Incidence, mode, and location of acute proximal junctional failures following surgical treatment for adult spinal deformity","author":"Hostin","year":"2013"},{"key":"b13-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2329","article-title":"Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases","volume":"31","author":"Kim","year":"2006"},{"key":"b14-0360009","series-title":"Spine J","first-page":"994","article-title":"The use of the T1 sagittal angle in predicting overall sagittal balance of the spine","volume":"10","author":"Knott","year":"2010"},{"key":"b15-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"489","article-title":"Spinal fusions to the sacrum in adults with scoliosis","volume":"8","author":"Kostuik","year":"1983"},{"key":"b16-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2771","article-title":"Thoracolumbar deformity arthrodesis stopping at L5: fate of the L5-S1 disc, minimum 5-year follow-up","volume":"32","author":"Kuhns","year":"2007"},{"key":"b17-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2205","article-title":"Long adult spinal deformity fusion to the sacrum using rh-BMP-2 versus autogenous iliac crest bone graft","volume":"34","author":"Maeda","year":"2009"},{"key":"b18-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"884","article-title":"Does a long-fusion \u201cT3-sacrum\u201d portend a worse outcome than a short-fusion \u201cT10-sacrum\u201d in primary surgery for adult scoliosis?","volume":"37","author":"O'Shaughnessy","year":"2012"},{"key":"b19-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"1828","article-title":"Sagittal plane considerations and the pelvis in the adult patient","volume":"34","author":"Schwab","year":"2009"},{"key":"b20-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"1077","article-title":"Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study","volume":"37","author":"Schwab","year":"2012"},{"key":"b21-0360009","series-title":"Spine (Phila Pa 1976)","first-page":"2243","article-title":"Predicting outcome and complications in the surgical treatment of adult scoliosis","volume":"33","author":"Schwab","year":"2008"},{"issue":"3","key":"b22-0360009","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Adult degenerative scoliosis: evaluation and management","volume":"28","author":"Silva","year":"2010"},{"issue":"3","key":"b23-0360009","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Adult scoliosis surgery outcomes: a systematic review","volume":"28","author":"Yadla","year":"2010"}],"container-title":["Neurosurgical 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