Risk Factors for Proximal Junctional Kyphosis in Fusions from the Sacrum to L1 or L2 for Adult Spinal Deformity
Introduction: Several targets have been proposed to achieve satisfactory alignment and favorable outcomes in adult spinal deformity surgery. Stopping the upper instrumented vertebra (UIV) at the thoracolumbar junction levels, especially between T11 and L1, is considered a high-risk factor for the de...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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The Japanese Society for Spine Surgery and Related Research
2022-07-01
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| Series: | Spine Surgery and Related Research |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/ssrr/6/4/6_2021-0157/_pdf/-char/en |
| _version_ | 1798039056633823232 |
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| author | Koichi Murata Shunsuke Fujibayashi Bungo Otsuki Takayoshi Shimizu Shuichi Matsuda |
| author_facet | Koichi Murata Shunsuke Fujibayashi Bungo Otsuki Takayoshi Shimizu Shuichi Matsuda |
| author_sort | Koichi Murata |
| collection | DOAJ |
| description | Introduction: Several targets have been proposed to achieve satisfactory alignment and favorable outcomes in adult spinal deformity surgery. Stopping the upper instrumented vertebra (UIV) at the thoracolumbar junction levels, especially between T11 and L1, is considered a high-risk factor for the development of proximal junctional kyphosis (PJK). Nevertheless, it is unknown in which patients the results of surgery are satisfactory when L1 or L2 is set as UIV with lumbosacral fixation. This study aimed to identify the risk factors for PJK in patients with lumbosacral fixation with L1 or L2 as UIV.
Methods: From January 2011 to December 2019, 21 consecutive patients who underwent lumbopelvic fixation for adult spinal deformity were included. The patients were divided into two groups: the PJK group (n=7) and the nonPJK group (n=14). Patients who experienced PJK within half a year of surgery were included in the PJK group. Pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt (PT), thoracic kyphosis (TK), thoracic compensation (TK compensation), sagittal vertical axis (SVA), T10-L2 angle, and T1 pelvic angle (TPA) were measured before and after surgery.
Results: No difference was found between the two groups in terms of age and sex at the time of surgery. The indices that were significantly different between the two groups were preoperative PT, PI minus LL, TK, TPA, TK compensation, and postoperative T10-L2 angle. No significant differences were found in postoperative LL, PI minus LL, PT, TK, TPA, or SVA.
Conclusions: Preoperative X-ray indices, including preoperative TPA, TK compensation, TK, PT, and PI-LL, determined the risk of PJK in fusions from the sacrum to L1 or L2. Appropriate patient selection is crucial for the success of this surgery. |
| first_indexed | 2024-04-11T21:48:39Z |
| format | Article |
| id | doaj.art-8114f425e31f474a9344ceffacc1f951 |
| institution | Directory Open Access Journal |
| issn | 2432-261X |
| language | English |
| last_indexed | 2024-04-11T21:48:39Z |
| publishDate | 2022-07-01 |
| publisher | The Japanese Society for Spine Surgery and Related Research |
| record_format | Article |
| series | Spine Surgery and Related Research |
| spelling | doaj.art-8114f425e31f474a9344ceffacc1f9512022-12-22T04:01:18ZengThe Japanese Society for Spine Surgery and Related ResearchSpine Surgery and Related Research2432-261X2022-07-016439540110.22603/ssrr.2021-01572021-0157Risk Factors for Proximal Junctional Kyphosis in Fusions from the Sacrum to L1 or L2 for Adult Spinal DeformityKoichi Murata0Shunsuke Fujibayashi1Bungo Otsuki2Takayoshi Shimizu3Shuichi Matsuda4Department of Orthopaedic Surgery, Kyoto University Graduate School of MedicineDepartment of Orthopaedic Surgery, Kyoto University Graduate School of MedicineDepartment of Orthopaedic Surgery, Kyoto University Graduate School of MedicineDepartment of Orthopaedic Surgery, Kyoto University Graduate School of MedicineDepartment of Orthopaedic Surgery, Kyoto University Graduate School of MedicineIntroduction: Several targets have been proposed to achieve satisfactory alignment and favorable outcomes in adult spinal deformity surgery. Stopping the upper instrumented vertebra (UIV) at the thoracolumbar junction levels, especially between T11 and L1, is considered a high-risk factor for the development of proximal junctional kyphosis (PJK). Nevertheless, it is unknown in which patients the results of surgery are satisfactory when L1 or L2 is set as UIV with lumbosacral fixation. This study aimed to identify the risk factors for PJK in patients with lumbosacral fixation with L1 or L2 as UIV. Methods: From January 2011 to December 2019, 21 consecutive patients who underwent lumbopelvic fixation for adult spinal deformity were included. The patients were divided into two groups: the PJK group (n=7) and the nonPJK group (n=14). Patients who experienced PJK within half a year of surgery were included in the PJK group. Pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt (PT), thoracic kyphosis (TK), thoracic compensation (TK compensation), sagittal vertical axis (SVA), T10-L2 angle, and T1 pelvic angle (TPA) were measured before and after surgery. Results: No difference was found between the two groups in terms of age and sex at the time of surgery. The indices that were significantly different between the two groups were preoperative PT, PI minus LL, TK, TPA, TK compensation, and postoperative T10-L2 angle. No significant differences were found in postoperative LL, PI minus LL, PT, TK, TPA, or SVA. Conclusions: Preoperative X-ray indices, including preoperative TPA, TK compensation, TK, PT, and PI-LL, determined the risk of PJK in fusions from the sacrum to L1 or L2. Appropriate patient selection is crucial for the success of this surgery.https://www.jstage.jst.go.jp/article/ssrr/6/4/6_2021-0157/_pdf/-char/enadult spinal deformitythoracolumbar junctionupper instrumented vertebra |
| spellingShingle | Koichi Murata Shunsuke Fujibayashi Bungo Otsuki Takayoshi Shimizu Shuichi Matsuda Risk Factors for Proximal Junctional Kyphosis in Fusions from the Sacrum to L1 or L2 for Adult Spinal Deformity Spine Surgery and Related Research adult spinal deformity thoracolumbar junction upper instrumented vertebra |
| title | Risk Factors for Proximal Junctional Kyphosis in Fusions from the Sacrum to L1 or L2 for Adult Spinal Deformity |
| title_full | Risk Factors for Proximal Junctional Kyphosis in Fusions from the Sacrum to L1 or L2 for Adult Spinal Deformity |
| title_fullStr | Risk Factors for Proximal Junctional Kyphosis in Fusions from the Sacrum to L1 or L2 for Adult Spinal Deformity |
| title_full_unstemmed | Risk Factors for Proximal Junctional Kyphosis in Fusions from the Sacrum to L1 or L2 for Adult Spinal Deformity |
| title_short | Risk Factors for Proximal Junctional Kyphosis in Fusions from the Sacrum to L1 or L2 for Adult Spinal Deformity |
| title_sort | risk factors for proximal junctional kyphosis in fusions from the sacrum to l1 or l2 for adult spinal deformity |
| topic | adult spinal deformity thoracolumbar junction upper instrumented vertebra |
| url | https://www.jstage.jst.go.jp/article/ssrr/6/4/6_2021-0157/_pdf/-char/en |
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