Should the pelvis be included? An analysis of distal junctional failure risk factors in correcting adult spinal deformity in women with fusion to L5.
Deformity correction
Junctional failure
Spinal deformity
Spinal fusion
Surgical revision
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
09 Jul 2024
09 Jul 2024
Historique:
received:
12
09
2023
accepted:
23
06
2024
revised:
17
06
2024
medline:
9
7
2024
pubmed:
9
7
2024
entrez:
9
7
2024
Statut:
aheadofprint
Résumé
To identify the risk factors for distal junctional failure (DJF) in women treated for adult spine deformity with fusion to L5 and to highlight the significance of preoperative assessment, surgical decision-making, and postoperative care. This is a retrospective study of data collected prospectively on the local institutional spine surgery registry (2016-2021). All patients, women older than 18 years, with a diagnosis of adult spine deformity who underwent long posterior instrumentation to L5 and had a minimum of 2-years follow-up were included in the study (two groups: with or without DJF). Demographic and radiographic data, corrective strategy, preoperative level of degeneration at L5/S1 and GAP score were compared between the two groups. Forty-eight patients (n = 48) satisfied eligibility criteria. At two-years follow-up, nine patients (18,7%) developed a DJF that required surgical revision. Thirty-nine patients did not present distal junctional complications. Patients with or without DJF showed significant differences in terms of preoperative spinopelvic parameters (PT: 28°± 6° vs. 23°± 9°, p-value 0.05; DJF group vs. not DJF) and degeneration of L5-S1 (Pfirmann grade L5-S1 disc 3.7 ± 1.0 vs. 2.6 ± 0.8, p-value 0.001; DJF group vs. not DJF) (L5-S1 Facet joint Osteoarthritis 3.1 ± 0.8 vs.2.4 ± 0.8, p-value 0.023; DJF group vs. not DJF). DJF following spinal deformity correction surgery is influenced by a combination of patient-related, surgical and implant-related factors. Fusion construct length, preoperative and postoperative sagittal alignment and the grade of degeneration of the distal disc have been identified as significant risk factors. Surgeons should carefully evaluate these factors and employ appropriate strategies.
Identifiants
pubmed: 38980366
doi: 10.1007/s00586-024-08385-5
pii: 10.1007/s00586-024-08385-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Ministero della Salute
ID : CO-2016-02364645
Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Yeramaneni S, Robinson C, Hostin R (2016) Impact of spine surgery complications on costs associated with management of adult spinal deformity. Curr Rev Musculoskelet Med 9
Yagi M, King AB, Boachie-Adjei O (2012) Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0b013e31824e4888
doi: 10.1097/BRS.0b013e31824e4888
pubmed: 22772572
Berjano P, Damilano M, Pejrona M et al (2020) Revision surgery in distal junctional kyphosis. Eur Spine J 29. https://doi.org/10.1007/s00586-020-06304-y
Azzam MM, Guiroy AJ, Galgano MA (2023) Surgical correction of distal junctional kyphosis. World Neurosurg 170. https://doi.org/10.1016/j.wneu.2022.11.032
Smith JS, Shaffrey CI, Berven S et al (2009) Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976) 34. https://doi.org/10.1097/BRS.0b013e3181ac5fcd
doi: 10.1097/BRS.0b013e3181ac5fcd
pubmed: 19927104
von Elm E, Altman DG, Egger M et al (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013
doi: 10.1016/j.ijsu.2014.07.013
Le Huec JC, Hasegawa K (2016) Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects. Eur Spine J 25. https://doi.org/10.1007/s00586-016-4485-5
Yilgor C, Sogunmez N, Boissiere L et al (2017) Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am 99:1661–1672. https://doi.org/10.2106/JBJS.16.01594
doi: 10.2106/JBJS.16.01594
pubmed: 28976431
Pfirrmann CW, Metzdorf A, Zanetti M et al (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878
doi: 10.1097/00007632-200109010-00011
pubmed: 11568697
Fujiwara A, Tamai K, Yamato M et al (1999) The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 8. https://doi.org/10.1007/s005860050193
Banitalebi H, Aaen J, Storheim K et al (2022) A novel MRI index for paraspinal muscle fatty infiltration: reliability and relation to pain and disability in lumbar spinal stenosis: results from a multicentre study. Eur Radiol Exp 6. https://doi.org/10.1186/s41747-022-00284-y
doi: 10.1186/s41747-022-00284-y
pubmed: 35854201
pmcid: 9296716
Berjano P, Lamartina C (2014) Classification of degenerative segment disease in adults with deformity of the lumbar or thoracolumbar spine. Eur Spine J 23:1815–1824. https://doi.org/10.1007/s00586-014-3219-9
doi: 10.1007/s00586-014-3219-9
pubmed: 24563272
Han X, Ren J (2022) Risk factors for proximal junctional kyphosis in adult spinal deformity after correction surgery: a systematic review and meta-analysis. Acta Orthop Traumatol Turc 56
Virk S, Platz U, Bess S et al (2021) Factors influencing upper-most instrumented vertebrae selection in adult spinal deformity patients: qualitative case-based survey of deformity surgeons. J Spine Surg 7. https://doi.org/10.21037/jss-20-598
Smith JS, Klineberg E, Schwab F et al (2013) Change in classification grade by the SRS-Schwab adult spinal deformity classification predicts impact on health-related quality of life measures. Spine (Phila Pa 1976) 38:1663–1671. https://doi.org/10.1097/BRS.0b013e31829ec563
doi: 10.1097/BRS.0b013e31829ec563
pubmed: 23759814
Kim JS, Phan K, Cheung ZB et al (2019) Surgical, Radiographic, and patient-related risk factors for proximal junctional kyphosis: a Meta-analysis. Glob Spine J 9. https://doi.org/10.1177/2192568218761362
Line BG, Bess S, Lafage R et al (2020) Effective prevention of proximal junctional failure in adult spinal deformity surgery requires a combination of surgical implant prophylaxis and avoidance of sagittal alignment overcorrection. Spine (Phila Pa 1976) 45. https://doi.org/10.1097/BRS.0000000000003249
Floccari LV, Su AW, McIntosh AL et al (2019) Distal junctional failure following Pediatric spinal Fusion. J Pediatr Orthop 39. https://doi.org/10.1097/BPO.0000000000000898