Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis
Objectives To investigate whether the immediate thoracic kyphosis (TK) and acetabular anteversion (AA) postoperatively are correlated with proximal junctional failure (PJF) in adult spinal deformity (ASD) patients underwent surgical treatment. Methods This is a retrospective study. Following institu...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-12-01
|
| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.13159 |
| _version_ | 1818573723006926848 |
|---|---|
| author | Zi‐fang Zhang Deng‐bin Qi Tian‐hao Wang Zheng Wang Guo‐quan Zheng Yan Wang |
| author_facet | Zi‐fang Zhang Deng‐bin Qi Tian‐hao Wang Zheng Wang Guo‐quan Zheng Yan Wang |
| author_sort | Zi‐fang Zhang |
| collection | DOAJ |
| description | Objectives To investigate whether the immediate thoracic kyphosis (TK) and acetabular anteversion (AA) postoperatively are correlated with proximal junctional failure (PJF) in adult spinal deformity (ASD) patients underwent surgical treatment. Methods This is a retrospective study. Following institutional ethics approval, a total of 57 patients (49 Female, eight Male) with ASD underwent surgery fused to sacroiliac bone (S1, S2, or ilium) from March 2014 to January 2019 were included. All of those patients were followed up for at least 2 years. Demographic, radiographic and surgical data were recorded. The maximum range of flexion motion (F‐ROM) and extension motion (E‐ROM) actively of hip joints was measured and recorded at pre‐ and postoperation. The sum of F‐ROM and E‐ROM was defined as the range of hip motion (H‐ROM). Receiver operating characteristic (ROC) curve analysis was used to obtain the cut off value of parameters for PJF. A Kaplan–Meier curve and log‐rank test were used to analyze the differences in PJF‐free survival. Results In all, 14 patients developed PJF during follow‐up. Comparisons between patients with and without PJF showed significant differences in immediate TK (P < 0.001) and AA (P = 0.027) postoperatively. ROC curve analysis determined an optimal threshold of 13° for immediate AA postoperatively (sensitivity = 74.3%, specificity = 85.7%, area under the ROC curve [AUC] = 0.806, 95% CI [0.686–0.926]). Nineteen patients with post‐AA ≤13° were assigned into the observational group, and 38 patients with post‐AA >13° were being as the control group. Patients in the observational group had smaller H‐ROM (P = 0.016) and F‐ROM (P < 0.001), but much larger E‐ROM (P < 0.001). There were 10 patients showing PJF in the observational group and four in the control group (10/9 vs 4/34, P < 0.001). PJF‐free survival time significantly decreased in the observational group (P = 0.001, log‐rank test). Furthermore, patients in the observational group had much larger TK (post‐TK, P = 0.015). The optimal threshold for post‐TK (sensitivity = 85.7%, specificity = 76.7%; AUC = 0.823, 95% CI [0.672–0.974]) was 28.1° after the ROC curve was analyzed. In the observational group, those patients with post‐TK ≥28.1° had significantly higher incidence of PJF (9/2 vs 1/7, P < 0.001) than those with post‐TK < 28.1°. Moreover, PJF‐free survival time in those patients significantly decreased (P = 0.001, log‐rank test). Conclusions ASD patients with acetabular anteversion of ≤13° at early postoperation may suffer significantly restricted hip motion and much higher incidence of PJF during follow‐up, moreover, in those patients, postoperative TK ≥28.1° would be a significant risk factor for PJF developing. |
| first_indexed | 2024-12-15T00:16:22Z |
| format | Article |
| id | doaj.art-6a08398174e2499eb88c7b1bbe1e61d4 |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-12-15T00:16:22Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-6a08398174e2499eb88c7b1bbe1e61d42022-12-21T22:42:27ZengWileyOrthopaedic Surgery1757-78531757-78612021-12-011382289230010.1111/os.13159Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to PelvisZi‐fang Zhang0Deng‐bin Qi1Tian‐hao Wang2Zheng Wang3Guo‐quan Zheng4Yan Wang5Medical College of Nankai University Tianjin ChinaChinese PLA General Hospital Department of Orthopaedics Beijing ChinaChinese PLA General Hospital Department of Orthopaedics Beijing ChinaChinese PLA General Hospital Department of Orthopaedics Beijing ChinaChinese PLA General Hospital Department of Orthopaedics Beijing ChinaChinese PLA General Hospital Department of Orthopaedics Beijing ChinaObjectives To investigate whether the immediate thoracic kyphosis (TK) and acetabular anteversion (AA) postoperatively are correlated with proximal junctional failure (PJF) in adult spinal deformity (ASD) patients underwent surgical treatment. Methods This is a retrospective study. Following institutional ethics approval, a total of 57 patients (49 Female, eight Male) with ASD underwent surgery fused to sacroiliac bone (S1, S2, or ilium) from March 2014 to January 2019 were included. All of those patients were followed up for at least 2 years. Demographic, radiographic and surgical data were recorded. The maximum range of flexion motion (F‐ROM) and extension motion (E‐ROM) actively of hip joints was measured and recorded at pre‐ and postoperation. The sum of F‐ROM and E‐ROM was defined as the range of hip motion (H‐ROM). Receiver operating characteristic (ROC) curve analysis was used to obtain the cut off value of parameters for PJF. A Kaplan–Meier curve and log‐rank test were used to analyze the differences in PJF‐free survival. Results In all, 14 patients developed PJF during follow‐up. Comparisons between patients with and without PJF showed significant differences in immediate TK (P < 0.001) and AA (P = 0.027) postoperatively. ROC curve analysis determined an optimal threshold of 13° for immediate AA postoperatively (sensitivity = 74.3%, specificity = 85.7%, area under the ROC curve [AUC] = 0.806, 95% CI [0.686–0.926]). Nineteen patients with post‐AA ≤13° were assigned into the observational group, and 38 patients with post‐AA >13° were being as the control group. Patients in the observational group had smaller H‐ROM (P = 0.016) and F‐ROM (P < 0.001), but much larger E‐ROM (P < 0.001). There were 10 patients showing PJF in the observational group and four in the control group (10/9 vs 4/34, P < 0.001). PJF‐free survival time significantly decreased in the observational group (P = 0.001, log‐rank test). Furthermore, patients in the observational group had much larger TK (post‐TK, P = 0.015). The optimal threshold for post‐TK (sensitivity = 85.7%, specificity = 76.7%; AUC = 0.823, 95% CI [0.672–0.974]) was 28.1° after the ROC curve was analyzed. In the observational group, those patients with post‐TK ≥28.1° had significantly higher incidence of PJF (9/2 vs 1/7, P < 0.001) than those with post‐TK < 28.1°. Moreover, PJF‐free survival time in those patients significantly decreased (P = 0.001, log‐rank test). Conclusions ASD patients with acetabular anteversion of ≤13° at early postoperation may suffer significantly restricted hip motion and much higher incidence of PJF during follow‐up, moreover, in those patients, postoperative TK ≥28.1° would be a significant risk factor for PJF developing.https://doi.org/10.1111/os.13159Acetabular anteversionAdult spinal deformityProximal junction failureROC analysisThoracic kyphosis |
| spellingShingle | Zi‐fang Zhang Deng‐bin Qi Tian‐hao Wang Zheng Wang Guo‐quan Zheng Yan Wang Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis Orthopaedic Surgery Acetabular anteversion Adult spinal deformity Proximal junction failure ROC analysis Thoracic kyphosis |
| title | Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis |
| title_full | Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis |
| title_fullStr | Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis |
| title_full_unstemmed | Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis |
| title_short | Correlation of Acetabular Anteversion and Thoracic Kyphosis Postoperatively with Proximal Junctional Failure in Adult Spinal Deformity Fused to Pelvis |
| title_sort | correlation of acetabular anteversion and thoracic kyphosis postoperatively with proximal junctional failure in adult spinal deformity fused to pelvis |
| topic | Acetabular anteversion Adult spinal deformity Proximal junction failure ROC analysis Thoracic kyphosis |
| url | https://doi.org/10.1111/os.13159 |
| work_keys_str_mv | AT zifangzhang correlationofacetabularanteversionandthoracickyphosispostoperativelywithproximaljunctionalfailureinadultspinaldeformityfusedtopelvis AT dengbinqi correlationofacetabularanteversionandthoracickyphosispostoperativelywithproximaljunctionalfailureinadultspinaldeformityfusedtopelvis AT tianhaowang correlationofacetabularanteversionandthoracickyphosispostoperativelywithproximaljunctionalfailureinadultspinaldeformityfusedtopelvis AT zhengwang correlationofacetabularanteversionandthoracickyphosispostoperativelywithproximaljunctionalfailureinadultspinaldeformityfusedtopelvis AT guoquanzheng correlationofacetabularanteversionandthoracickyphosispostoperativelywithproximaljunctionalfailureinadultspinaldeformityfusedtopelvis AT yanwang correlationofacetabularanteversionandthoracickyphosispostoperativelywithproximaljunctionalfailureinadultspinaldeformityfusedtopelvis |