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Risk Factors for Recurrent Proximal Junctional Failure Following Adult Spinal Deformity Surgery: Analysis of 60 Patients Undergoing Fusion Extension Surgery for Proximal Junctional Failure.
Park, Se-Jun; Park, Jin-Sung; Kang, Dong-Ho; Lee, Chong-Suh; Kim, Hyun-Jun.
Afiliación
  • Park SJ; Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
  • Park JS; Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
  • Kang DH; Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
  • Lee CS; Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan, South Korea.
  • Kim HJ; Department of Orthopedic Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Guri-si, Gyeonggi Province, South Korea hyunjun89.kim@gmail.com.
Int J Spine Surg ; 2024 Aug 06.
Article en En | MEDLINE | ID: mdl-39107091
ABSTRACT

BACKGROUND:

Despite numerous studies identifying risk factors for proximal junctional failure (PJF), risk factors for recurrent PJF (R-PJF) are still not well established. Therefore, we aimed to identify the risk factors for R-PJF following adult spinal deformity (ASD) surgery.

METHODS:

Among 479 patients who underwent ≥5-level fusion surgery for ASD, the focus was on those who experienced R-PJF at any time or did not experience R-PJF during a follow-up duration of ≥1 year. PJF was defined as a proximal junctional angle (PJA) ≥28° plus a difference in PJA ≥22° or performance of revision surgery regardless of PJA degree. The patients were divided into 2 groups according to R-PJF development no R-PJF and R-PJF groups. Risk factors were evaluated focusing on patient, surgical, and radiographic factors at the index surgery as well as at the revision surgery.

RESULTS:

Of the 60 patients in the final study cohort, 24 (40%) experienced R-PJF. Significant risk factors included greater postoperative sagittal vertical axis (OR = 1.044), overcorrection relative to age-adjusted pelvic incidence-lumbar lordosis (PI-LL; OR = 7.794) at the index surgery, a greater total sum of the proximal junctional kyphosis severity scale (OR = 1.145), and no use of the upper instrumented vertebra cement (OR = 5.494) at the revision surgery.

CONCLUSIONS:

We revealed that the greater postoperative sagittal vertical axis and overcorrection relative to age-adjusted pelvic incidence-lumbar lordosis at the index surgery, a greater proximal junctional kyphosis severity scale score, and no use of upper instrumented vertebra cement at the revision surgery were significant risk factors for R-PJF. CLINICAL RELEVANCE To reduce the risk of R-PJF after ASD surgery, avoiding under- and overcorrection during the initial surgery is recommended. Additionally, close assessment of the severity of PJF with timely intervention is crucial, and cement augmentation should be considered during revision surgery.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Int J Spine Surg Año: 2024 Tipo del documento: Article País de afiliación: Corea del Sur Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Int J Spine Surg Año: 2024 Tipo del documento: Article País de afiliación: Corea del Sur Pais de publicación: Países Bajos