Neurospine · 2024
Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignment Target in Patients With Adult Spinal Deformity: Risk Factor Analysis of 196 Cases Undergoing Low Thoracic to Pelvic Fusion.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Park Se-Jun, Park Jin-Sung, Kang Dong-Ho, Kang Minwook, Jung Kyunghun, Lee Chong-Suh
Аннотация
OBJECTIVE: To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target.
METHODS: The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of >28° plus a difference in PJA of >22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF.
RESULTS: The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001-1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001-1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205-19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109-1.164; p<0.001) were significant risk factors for PJF development.
CONCLUSION: A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.
METHODS: The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of >28° plus a difference in PJA of >22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF.
RESULTS: The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001-1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001-1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205-19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109-1.164; p<0.001) were significant risk factors for PJF development.
CONCLUSION: A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.