Preoperative alignment and risk of proximal junctional failure : a framework for upper instrumented vertebra selection in adult spinal deformity.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Hills Jeffrey, Lenke Lawrence G, Smith Justin S, Shaffrey Christopher I, Lafage Virginie, Lafage Renaud, Bess Shay, Kelly Michael P, International Spine Study Group, International Spine Study Group member, Turner Jay, Uribe Juan, Daniels Alan, Diebo Bassel, Lenke Lawrence G, Chou Dean, Shaffrey Christopher I, Passias Peter G, Hostin Richard, Kim Han Jo, Kebaish Khaled, Lee Sang, Burton Douglas C, Carlson Brandon, Bunch Joshua, Schwab Frank J, Lafage Virginie, Lafage Renaud, Protopsaltis Themistocles S, Lau Darryl, Bess Shay, Line Breton, Kelly Michael P, Mundis Gregory M, Eastlack Robert K, Klineberg Eric O, Ames Christopher P, Mumanneni Praveen, Theologis Alekos, Alan Nima, Yoon Jon, Soroceanu Alex, Gum Jeffrey L, Hamilton Kojo, Okonkwo David, Buell Thomas, Lewis Stephen, Smith Justin S, Gupta Munish C, Greenberg Jacob, Anand Neel, Scheer Justin, Fu Kai-Ming, Park Paul, Javidan Yashar, Wang Michael, Stephens Byron, Zuckerman Scott
Аннотация
METHODS: From a multicentre, prospective ASD registry, we identified patients who had undergone fusion to the sacrum or pelvis and had an upper (T1-T5) or lower thoracic (T9-L1) UIV, with a two-year or more radiological follow-up, excluding those with a previous fusion over more than four levels. The primary outcome was PJK within two years. Multivariable logistic regression modelled the risk of PJK by UIV region, preoperative C2-T9 pelvic angle (PA), age, sex, and pelvic incidence, testing for interaction between UIV region and C2-T9 PA. Adjusted absolute risk reduction (ARR) and number needed to be exposed (NNEB) were calculated. Multivariable linear regression estimated two-year patient-reported outcome measures, adjusting for baseline scores, age, UIV, and PJK.
RESULTS: A total of 627 patients across 20 centres were included (median age 66 years (IQR 59 to 70); 483 (77%) female). The UIV was lower thoracic in 380 (61%) and upper thoracic in 247 (39%) patients. PJK occurred in 149 (39%) lower thoracic and 38 (15%) upper thoracic UIV patients. There was a significant interaction (p = 0.028) between preoperative C2-T9 PA and UIV region. At a preoperative C2-T9 PA of 14° (cohort median), an upper thoracic UIV had an adjusted ARR of 36% and NNEB was 2.8. Females had an adjusted odds ratio of 1.62 (95% CI 1.03 to 2.59; p = 0.042) for PJK.
CONCLUSION: Worse preoperative sagittal malalignment, measured by C2-T9 PA, was associated with a higher risk of PJK and depended on UIV region. An upper thoracic UIV in patients with high preoperative C2-T9 PA may reduce PJK.