Establishment of an Individualized Distal Junctional Kyphosis Risk Index following the Surgical Treatment of Adult Cervical Deformities.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Jan 2023
01 Jan 2023
Historique:
received:
18
11
2021
accepted:
06
01
2022
pubmed:
20
7
2022
medline:
15
12
2022
entrez:
19
7
2022
Statut:
ppublish
Résumé
A retrospective review of a multicenter comprehensive cervical deformity (CD) database. To develop a novel risk index specific to each patient to aid in patient counseling and surgical planning to minimize postop distal junctional kyphosis (DJK) occurrence. DJK is a radiographic finding identified after patients undergo instrumented spinal fusions which can result in sagittal spinal deformity, pain and disability, and potentially neurological compromise. DJK is considered multifactorial in nature and there is a lack of consensus on the true etiology of DJK. CD patients with baseline (BL) and at least one-year postoperative radiographic follow-up were included. A patient-specific DJK score was created through use of unstandardized Beta weights of a multivariate regression model predicting DJK (end of fusion construct to the second distal vertebra change in this angle by <-10° from BL to postop). A total of 110 CD patients included (61 yr, 66.4% females, 28.8 kg/m 2 ). In all, 31.8% of these patients developed DJK (16.1% three males, 11.4% six males, 62.9% one-year). At BL, DJK patients were more frail and underwent combined approach more (both P <0.05). Multivariate model regression analysis identified individualized scores through creation of a DJK equation: -0.55+0.009 (BL inclination)-0.078 (preinflection)+5.9×10 -5 (BL lowest instrumented vertebra angle) + 0.43 (combine approach)-0.002 (BL TS-CL)-0.002 (BL pelvic tilt)-0.031 (BL C2 - C7) + 0.02 (∆T4-T12)+ 0.63 (osteoporosis)-0.03 (anterior approach)-0.036 (frail)-0.032 (3 column osteotomy). This equation has a 77.8% accuracy of predicting DJK. A score ≥81 predicted DJK with an accuracy of 89.3%. The BL reference equation correlated with two year outcomes of Numeric Rating Scales of Back percentage ( P =0.003), reoperation ( P =0.04), and minimal clinically importance differences for 5-dimension EuroQol questionnaire ( P =0.04). This study proposes a novel risk index of DJK development that focuses on potentially modifiable surgical factors as well as established patient-related and radiographic determinants. The reference model created demonstrated strong correlations with relevant two-year outcome measures, including axial pain-related symptoms, occurrence of related reoperations, and the achievement of minimal clinically importance differences for 5-dimension EuroQol questionnaire.
Sections du résumé
STUDY DESIGN
METHODS
A retrospective review of a multicenter comprehensive cervical deformity (CD) database.
OBJECTIVE
OBJECTIVE
To develop a novel risk index specific to each patient to aid in patient counseling and surgical planning to minimize postop distal junctional kyphosis (DJK) occurrence.
BACKGROUND
BACKGROUND
DJK is a radiographic finding identified after patients undergo instrumented spinal fusions which can result in sagittal spinal deformity, pain and disability, and potentially neurological compromise. DJK is considered multifactorial in nature and there is a lack of consensus on the true etiology of DJK.
MATERIALS AND METHODS
METHODS
CD patients with baseline (BL) and at least one-year postoperative radiographic follow-up were included. A patient-specific DJK score was created through use of unstandardized Beta weights of a multivariate regression model predicting DJK (end of fusion construct to the second distal vertebra change in this angle by <-10° from BL to postop).
RESULTS
RESULTS
A total of 110 CD patients included (61 yr, 66.4% females, 28.8 kg/m 2 ). In all, 31.8% of these patients developed DJK (16.1% three males, 11.4% six males, 62.9% one-year). At BL, DJK patients were more frail and underwent combined approach more (both P <0.05). Multivariate model regression analysis identified individualized scores through creation of a DJK equation: -0.55+0.009 (BL inclination)-0.078 (preinflection)+5.9×10 -5 (BL lowest instrumented vertebra angle) + 0.43 (combine approach)-0.002 (BL TS-CL)-0.002 (BL pelvic tilt)-0.031 (BL C2 - C7) + 0.02 (∆T4-T12)+ 0.63 (osteoporosis)-0.03 (anterior approach)-0.036 (frail)-0.032 (3 column osteotomy). This equation has a 77.8% accuracy of predicting DJK. A score ≥81 predicted DJK with an accuracy of 89.3%. The BL reference equation correlated with two year outcomes of Numeric Rating Scales of Back percentage ( P =0.003), reoperation ( P =0.04), and minimal clinically importance differences for 5-dimension EuroQol questionnaire ( P =0.04).
CONCLUSIONS
CONCLUSIONS
This study proposes a novel risk index of DJK development that focuses on potentially modifiable surgical factors as well as established patient-related and radiographic determinants. The reference model created demonstrated strong correlations with relevant two-year outcome measures, including axial pain-related symptoms, occurrence of related reoperations, and the achievement of minimal clinically importance differences for 5-dimension EuroQol questionnaire.
Identifiants
pubmed: 35853172
doi: 10.1097/BRS.0000000000004372
pii: 00007632-202301010-00007
doi:
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
49-55Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Lafage R, Schwab F, Glassman S, et al. Age-adjusted alignment goals have the potential to reduce PJK. Spine (Phila Pa 1976). 2017;42:1275–1282.
Scheer JK, Fakurnejad S, Lau D, et al. Results of the 2014 SRS Survey on PJK/PJF: a report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development. Spine (Phila Pa 1976). 2015;40:829–840.
Glassman SD, Coseo MP, Carreon LY. Sagittal balance is more than just alignment: why PJK remains an unresolved problem. Scoliosis Spinal Disord. 2016;11:1.
Smith JS, Ramchandran S, Lafage V, et al. Prospective multicenter assessment of early complication rates associated with adult cervical deformity surgery in 78 patients. Neurosurgery. 2016;79:1.
Denis F, Sun EC, Winter RB. Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spine (Phila Pa 1976). 2009;34:E729–E734.
Passias PG, Horn SR, Oh C, et al. Predicting the occurrence of postoperative distal junctional kyphosis in cervical deformity patients. Neurosurgery. 2020;86:E38–E46.
Passias PG, Vasquez-Montes D, Poorman GW, et al. Predictive model for distal junctional kyphosis after cervical deformity surgery. Spine J. 2018;18:2187–2194.
Lowe TG, Lenke L, Betz R, et al. Distal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention. Spine (Phila Pa 1976). 2006;31:299–302.
Smith JS, Line B, Bess S, et al. The health impact of adult cervical deformity in patients presenting for surgical treatment: comparison to United States population norms and chronic disease states based on the EuroQuol-5 Dimensions Questionnaire. Neurosurgery. 2017;80:716–725.
McCarthy MJH, Grevitt MP, Silcocks P, et al. The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire. Eur Spine J. 2007;16:2111–2117.
Tetreault L, Kopjar B, Nouri A, et al. The modified Japanese Orthopaedic Association scale: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy. Eur Spine J. 2017;26:78–84.
Lafage R, Challier V, Liabaud B, et al. Natural head posture in the setting of sagittal spinal deformity: validation of chin-brow vertical angle, slope of line of sight, and McGregor’s slope with health-related quality of life. Neurosurgery. 2016;79:108–115.
Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–1379.
Passias PG, Oh C, Jalai CM, et al. Predictive model for cervical alignment and malalignment following surgical correction of adult spinal deformity. Spine (Phila Pa 1976). 2016;41:E1096–E1103.
Lau D, Clark AJ, Scheer JK, et al. Proximal junctional kyphosis and failure after spinal deformity surgery: A systematic review of the literature as a background to classification development. Spine (Phila Pa 1976). 2014;39:2093–2102.
Wang J, Zhao Y, Shen B, et al. Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis. Injury. 2010;41:415–420.
Safaee MM, Osorio JA, Verma K, et al. Proximal junctional kyphosis prevention strategies: a video technique guide. Oper Neurosurg. 2017;13:581–585.
Protopsaltis TS, Ramchandran S, Kim HJ, et al. Analysis of early distal junctional kyphosis (DJK) after cervical deformity correction. Spine J. 2016;16:S355–S356.
Lee J-H, Kim J-U, Jang J-S, et al. Analysis of the incidence and risk factors for the progression of proximal junctional kyphosis following surgical treatment for lumbar degenerative kyphosis: minimum 2-year follow-up. Br J Neurosurg. 2014;28:252–258.
Cho SK, Shin JI, Kim YJ. Proximal junctional kyphosis following adult spinal deformity surgery. Eur Spine J. 2014;23:2726–2736.
Yagi M, Ohne H, Konomi T, et al. Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity. Osteoporos Int. 2016;27:3495–3502.
Berjano P, Damilano M, Pejrona M, et al. Revision surgery in distal junctional kyphosis. Eur Spine J. 2020;29(suppl 1):86–102.