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Review Question - QID 3448

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QID 3448 (Type "3448" in App Search)
A 53-year-old woman is seen in the adult spine clinic for long-standing back pain. History reveals she had untreated scoliosis as a child. Her current radiographs are shown in Figures A and B. Due to discomfort with ADLs and progressive pain, surgical intervention is planned. Which of the following factors would increase her risk of nonunion?
  • A
  • B

An anterior thoracoabdominal approach

37%

1528/4142

Preoperative Cobb angle of 60 degrees

20%

811/4142

Age greater than 35 years

30%

1239/4142

A posterior midline approach

5%

199/4142

Positive sagittal balance < 5 cm

8%

339/4142

  • A
  • B

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In the surgical treatment of adult idiopathic scoliosis, a thoracoabdominal approach has been shown to have higher rates of pseudoarthrosis compared to posterior procedures.

Raizman et al reviewed pseudoarthrosis in spinal patients. Multiple factors, including smoking, kyphosis >20 degrees, positive sagittal balance greater than 5cm, preexisting hip arthritis, age greater than 55, and a throacoabdominal approach were determined to be significant risk factors.

Kim et al retrospectively analyzed 144 patients who underwent spinal instrumentation and fusion to S1 at a minimum of a 2-year follow-up. Factors that significantly affected achieving a successful fusion were hip arthritis, age greater than 55 years, and incomplete sacropelvic fixation.

Figures A and B are standing scoliosis films in the coronal and sagittal plan showing a patient with adult idiopathic scoliosis.

Incorrect Answers:
Answer 2: A Cobb angle of 60 degrees has not been shown to correlate with pseudoarthrosis.
Answer 3: Age greater than 55 years is associated with an increased rate of pseudoarthrosis.
Answer 4: A posterior approach with fusion to the upper thoracic spine has not been shown to correlate with pseudoarthrosis.
Answer 5: Positive sagittal balance greater than 5 cm is associated with an increased rates of pseudoarthrosis.

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