ReviewEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2024
A guide to selecting upper thoracic versus lower thoracic uppermost instrumented vertebra in adult spinal deformity correction.
Review in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed.
- Preoperative Thoracic Compensation is Associated With a Lower Risk of Proximal Junctional Kyphosis After Lower Thoracic Fusion for Adult Spinal Deformity.Global spine journal · 2026Article
- Research priorities in Spine Deformity: a machine learning-based topic analysis of the journal's first decade (2013-2026).Spine deformity · 2026Article
- Comparative morbidity and outcomes for adult spinal deformity corrections spanning C2-pelvis compared to T4-pelvis: a propensity score-matched analysis.Spine deformity · 2026Article
- Preoperative Thoracolumbar Mobility (ΔTLK) Predicts Early Upper Instrumented Vertebra-Adjacent Fracture after Lower Thoracic-Pelvic Fusion in Elderly Patients with Adult Spinal Deformity.Spine surgery and related research · 2026Article
- A Predictive Formula for Sagittal Vertical Axis in Japanese Women Using Spinopelvic-Hip Mismatch.Spine surgery and related research · 2026Article
- The role of supine imaging in assessing failure of pelvic compensation and its impact on surgical outcomes in patients with adult spinal deformity.Journal of orthopaedic surgery and research · 2025Article
- Risk factors for mechanical complications in degenerative lumbar scoliosis with concomitant thoracolumbar kyphosis: does the selection of the upper instrumented vertebra matter?Journal of orthopaedic surgery and research · 2025Article
- Harnessing machine learning to predict and prevent proximal junctional kyphosis and failure in adult spinal deformity surgery: A systematic review.Brain & spine · 2025Review
- Surgical Management of Adult Spinal Deformity Patients with Osteoporosis.Journal of clinical medicine · 2024Review
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
purposeOperative treatment of adult spinal deformity (ASD) has been shown to improve patient health-related quality of life (HRQOL). Selection of the uppermost instrumented vertebra (UIV) in either the upper thoracic (UT) or lower thoracic (LT) spine is a pivotal decision with effects on operative and postoperative outcomes. This review overviews the multifaceted decision-making process for UIV selection in ASD correction.
methodsPubMed was queried for articles using the keywords "uppermost instrumented vertebra", "upper thoracic", "lower thoracic", and "adult spinal deformity".
resultsOptimization of UIV selection may lead to superior deformity correction, better patient-reported outcomes, and lower risk of proximal junctional kyphosis (PJK) and failure (PJF). Patient alignment characteristics, including preoperative thoracic kyphosis, coronal deformity, and the magnitude of sagittal correction influence surgical decision-making when selecting a UIV, while comorbidities such as poor body mass index, osteoporosis, and neuromuscular pathology should also be taken in to account. Additionally, surgeon experience and resources available to the hospital may also play a role in this decision. Currently, it is incompletely understood whether postoperative HRQOLs, functional and radiographic outcomes, and complications after surgery differ between selection of the UIV in either the UT or LT spine.
conclusionThe correct selection of the UIV in surgical planning is a challenging task, which requires attention to preoperative alignment, patient comorbidities, clinical characteristics, available resources, and surgeon-specific factors such as experience.
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Registered trials
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