Spine deformity · 2026
Postoperative thoracic kyphosis morphology following adult spinal deformity surgery: an analysis of fused and unfused segments.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Lafage Renaud, Elysee Jonathan C, Daniels Alan H, Diebo Bassel G, Chatelain Leonard, Ames Christopher P, Bess Shay, Protopsaltis Themistocles, Eastlack Robert K, Gupta Munish C, Hostin Richard, Kebaish Khaled M, Kim Han Jo, Klineberg Eric O, Mundis Gregory M, Okonkwo David O, Shaffrey Christopher I, Smith Justin S, Schwab Frank J, Lafage Virginie, International Spine Study Group (ISSG)
Аннотация
INTRODUCTION: Predicting post-operative changes in thoracic kyphosis (TK) remains challenging in adult spinal deformity (ASD) surgery. This study aimed to quantify both iatrogenic and reciprocal changes in TK following lumbar correction and assess their maintenance at 2-year follow-up.
METHODS: A retrospective analysis was performed on 356 ASD patients treated with posterior instrumentation from T9-11 to the pelvis, with a minimum 2-year follow-up. TK values were compared with normative data. Multivariate analysis identified thoracolumbar parameters associated with reciprocal thoracic changes and proximal failure.
RESULTS: Pre-op TK (median 34°) was normal for 59.8% and hypokyphotic for 39.0% of patients. At 6 weeks, 79.1% of initially hypokyphotic patients normalized, while 11.3% of normokyphotic patients deteriorated. Postoperative TK increase correlated with lumbar lordosis gain (p<0.001), controlling for pre-op alignment and demographics (R2=0.40). Between 6 weeks and 2 years, 9.3% experienced TK decompensation >15°, and 9.6% required proximal extension for junctional issues-defined collectively as "thoracic failures" (17.4%). Independent predictors of failure included advanced age (OR 3.6), more proximal lumbar correction (OR 1.9), and pronounced early mid-thoracic kyphosis (OR 2.3).
CONCLUSION: In ASD surgery with Upper Instrumented Vertebra (UIV) between T9 and T11, changes in TK were largely proportional to lumbar correction, leading to normalization in most cases. However, age, the location of lumbar correction, and early post-operative thoracic shape independently predicted thoracic failure, highlighting the need for tailored alignment strategies.
METHODS: A retrospective analysis was performed on 356 ASD patients treated with posterior instrumentation from T9-11 to the pelvis, with a minimum 2-year follow-up. TK values were compared with normative data. Multivariate analysis identified thoracolumbar parameters associated with reciprocal thoracic changes and proximal failure.
RESULTS: Pre-op TK (median 34°) was normal for 59.8% and hypokyphotic for 39.0% of patients. At 6 weeks, 79.1% of initially hypokyphotic patients normalized, while 11.3% of normokyphotic patients deteriorated. Postoperative TK increase correlated with lumbar lordosis gain (p<0.001), controlling for pre-op alignment and demographics (R2=0.40). Between 6 weeks and 2 years, 9.3% experienced TK decompensation >15°, and 9.6% required proximal extension for junctional issues-defined collectively as "thoracic failures" (17.4%). Independent predictors of failure included advanced age (OR 3.6), more proximal lumbar correction (OR 1.9), and pronounced early mid-thoracic kyphosis (OR 2.3).
CONCLUSION: In ASD surgery with Upper Instrumented Vertebra (UIV) between T9 and T11, changes in TK were largely proportional to lumbar correction, leading to normalization in most cases. However, age, the location of lumbar correction, and early post-operative thoracic shape independently predicted thoracic failure, highlighting the need for tailored alignment strategies.