{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T19:57:21Z","timestamp":1772827041614,"version":"3.50.1"},"reference-count":66,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The goal of this study was to compare the impact of using a lower thoracic (LT) versus upper lumbar (UL) level as the upper instrumented vertebra (UIV) on clinical and radiographic outcomes following minimally invasive surgery for adult spinal deformity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A multicenter retrospective study design was used. Inclusion criteria were age \u2265 18 years, and one of the following: coronal Cobb angle &gt; 20\u00b0, sagittal vertical axis &gt; 50 mm, pelvic tilt &gt; 20\u00b0, pelvic incidence\u2013lumbar lordosis mismatch &gt; 10\u00b0. Patients were treated with circumferential or hybrid minimally invasive techniques at \u2265 3 spinal levels and had a 2-year minimum follow-up. They were then divided into 2 groups depending on whether the UIV was in the UL region, defined as a UIV location of L1\u20132, or the LT region, defined as T10\u201312.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 114 of 223 patients met the inclusion criteria (68 LT and 46 UL). The UL group was older (67.5 vs 62.3 years; p = 0.015). Preoperative spinopelvic parameters were similar, except for sacral slope, which was higher in the UL group (30.5\u00b0 vs 26.5\u00b0; p &lt; 0.001). The percentage of patients with fixation crossing the lumbosacral junction was also similar (70.6% vs 67.4%; p = 0.717). Postoperative lumbar lordosis (42.5\u00b0 vs 35.5\u00b0; p = 0.01) and change in coronal Cobb angle (\u221223.2\u00b0 vs \u22129.6\u00b0; p &lt; 0.001) were greater in the LT group, but other changes in postoperative spinopelvic parameters and changes in health-related quality-of-life scores were similar between groups. Reoperation rates were lower in the UL group (17.4% vs 36.8%; p = 0.025), largely associated with fewer radiographic failures (UL = 10.9% vs LT = 26.5%; p = 0.042); however, overall complication rates were not significantly different (UL = 43.5% vs LT = 60.3%; p = 0.077).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Selecting a UL vertebra for UIV in minimally invasive surgical correction of adult spinal deformity results in lower reoperation rates compared to extending fixation to the LT region. This choice also correlates with shorter operating room times and reduced estimated blood loss. Although extending fixation to the LT region is associated with slightly greater lumbar lordosis and a greater change in the coronal Cobb angle, clinical outcomes were similar between the LT and UL groups for UIV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.8.spine231335","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T21:00:53Z","timestamp":1736542853000},"page":"462-469","source":"Crossref","is-referenced-by-count":0,"title":["The impact of lower thoracic versus upper lumbar upper instrumented vertebra in minimally invasive correction of adult spinal deformity"],"prefix":"10.3171","volume":"42","author":[{"given":"Robert K.","family":"Eastlack","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay I.","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory M.","family":"Mundis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Scripps Clinic, La Jolla, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierce D.","family":"Nunley","sequence":"additional","affiliation":[{"name":"Spine Institute of Louisiana, Shreveport, Louisiana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan S.","family":"Uribe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul J.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Semmes Murphey Clinic, Memphis, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacie","family":"Tran","sequence":"additional","affiliation":[{"name":"San Diego Spine Foundation, San Diego, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Miami, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khoi D.","family":"Than","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David O.","family":"Okonkwo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam S.","family":"Kanter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hoag Neurosciences Institute, Newport Beach, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neel","family":"Anand","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Cedars-Sinai Spine Center, Los Angeles, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard G.","family":"Fessler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rush University, Chicago, Illinois;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai-Ming G.","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical College, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University, New York, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Minimally invasive lateral approach for adult degenerative scoliosis: lessons learned","volume":"35","author":"Deukmedjian AR","year":"2013","unstructured":"Deukmedjian AR, Ahmadian A, Bach K, Zouzias A, Uribe JS. Minimally invasive lateral approach for adult degenerative scoliosis: lessons learned. Neurosurg Focus. 2013;35(2):E4."},{"key":"b2","series-title":"ScientificWorldJournal","first-page":"789698","article-title":"Early outcomes of minimally invasive anterior longitudinal ligament release for correction of sagittal imbalance in patients with adult spinal deformity","volume":"2012","author":"Deukmedjian AR","year":"2012","unstructured":"Deukmedjian AR, Dakwar E, Ahmadian A, Smith DA, Uribe JS. Early outcomes of minimally invasive anterior longitudinal ligament release for correction of sagittal imbalance in patients with adult spinal deformity. 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Acta Neurochir (Wien). 2011;153(3):557."},{"issue":"4","key":"b7","series-title":"J Neurosurg Spine","first-page":"374","article-title":"Comparison of two minimally invasive surgery strategies to treat adult spinal deformity","volume":"22","author":"Park P","year":"2015","unstructured":"Park P, Wang MY, Lafage V,  Comparison of two minimally invasive surgery strategies to treat adult spinal deformity. J Neurosurg Spine. 2015;22(4):374\u2013380."},{"issue":"3","key":"b8","series-title":"Neurosurgery","first-page":"489","article-title":"Does MIS surgery allow for shorter constructs in the surgical treatment of adult spinal deformity?","volume":"80","author":"Uribe JS","year":"2017","unstructured":"Uribe JS, Beckman J, Mummaneni PV,  Does MIS surgery allow for shorter constructs in the surgical treatment of adult spinal deformity?. 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Is the T9, T11, or L1 the more reliable proximal level after adult lumbar or lumbosacral instrumented fusion to L5 or S1?. Spine (Phila Pa 1976).2007;32(24):2653\u20132661."},{"issue":"5","key":"b12","series-title":"Spine J","first-page":"615","article-title":"T9 versus T10 as the upper instrumented vertebra for correction of adult deformity-rationale and recommendations","volume":"17","author":"Hey HWD","year":"2017","unstructured":"Hey HWD, Tan KA, Neo CS,  T9 versus T10 as the upper instrumented vertebra for correction of adult deformity-rationale and recommendations. Spine J. 2017;17(5):615\u2013621."},{"issue":"1","key":"b13","series-title":"Neurosurgery","first-page":"101","article-title":"Does minimally invasive percutaneous posterior instrumentation reduce risk of proximal junctional kyphosis in adult spinal deformity surgery? 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Acta Neurochir (Wien). 2011;153(3):557."},{"issue":"4","key":"b7","series-title":"J Neurosurg Spine","first-page":"374","article-title":"Comparison of two minimally invasive surgery strategies to treat adult spinal deformity","volume":"22","author":"Park P","year":"2015","unstructured":"Park P, Wang MY, Lafage V,  Comparison of two minimally invasive surgery strategies to treat adult spinal deformity. J Neurosurg Spine. 2015;22(4):374\u2013380."},{"issue":"3","key":"b8","series-title":"Neurosurgery","first-page":"489","article-title":"Does MIS surgery allow for shorter constructs in the surgical treatment of adult spinal deformity?","volume":"80","author":"Uribe JS","year":"2017","unstructured":"Uribe JS, Beckman J, Mummaneni PV,  Does MIS surgery allow for shorter constructs in the surgical treatment of adult spinal deformity?. Neurosurgery. 2017;80(3):489\u2013497."},{"issue":"5","key":"b9","series-title":"Neurosurg Focus","first-page":"E9","article-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","volume":"36","author":"Fujimori T","year":"2014","unstructured":"Fujimori T, Inoue S, Le H,  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. Neurosurg Focus. 2014;36(5):E9."},{"issue":"2","key":"b10","series-title":"Evid Based Spine Care J","first-page":"160","article-title":"Predictive factors for acute proximal junctional failure after adult deformity surgery with upper instrumented vertebrae in the thoracolumbar spine","volume":"5","author":"Annis P","year":"2014","unstructured":"Annis P, Lawrence BD, Spiker WR,  Predictive factors for acute proximal junctional failure after adult deformity surgery with upper instrumented vertebrae in the thoracolumbar spine. Evid Based Spine Care J. 2014;5(2):160\u2013162."},{"issue":"24","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"2653","article-title":"Is the T9, T11, or L1 the more reliable proximal level after adult lumbar or lumbosacral instrumented fusion to L5 or S1?","volume":"32","author":"Kim YJ","year":"2007","unstructured":"Kim YJ, Bridwell KH, Lenke LG, Rhim S, Kim YW. 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