| Autor: |
Varun Puvanesarajah, Floreana Naef, Micheal Raad, Matthew W. Wilkening, Khaled M. Kebaish, Andrew B. Harris, Brian J. Neuman, David B. Cohen |
| Rok vydání: |
2019 |
| Předmět: |
|
| Zdroj: |
The Spine Journal. 19:S171-S172 |
| ISSN: |
1529-9430 |
| DOI: |
10.1016/j.spinee.2019.05.453 |
| Popis: |
BACKGROUND CONTEXT Proximal junctional kyphosis (PJK) and Proximal Junctional Failure (PJF) are significant complications following Adult Spinal Deformity (ASD) surgery. Orientation of the Upper Instrumented Vertebra (UIV) pedicle screw has not been studied as a potential risk factor for PJK/PJF. PURPOSE To demonstrate the association between UIV pedicle screw cranial-caudal trajectory and the development of both PJK and PJF in ASD patients with thoracolumbar fusion to the pelvis. STUDY DESIGN/SETTING Retrospective case series. PATIENT SAMPLE A total of 96 ASD patients (>5 levels fused) were identified from a multiprovider academic institution with fusion from T8-T12 to pelvis and 2-year follow-up. OUTCOME MEASURES Our primary outcomes were the development of PJK, defined as a proximal junction sagittal Cobb angle ≥10° and proximal junction sagittal Cobb angle ≥10° higher than preoperative measurement; and PJF, defined as revision surgery for PJK. METHODS We defined a novel measurement of the UIV Screw Angle (UIVSA) as the mean of the angles between the UIV superior endplate and each UIV pedicle screw using intraoperative sagittal radiographs. A screw pointed cranially was measured as (+) UIVSA and a screw pointed caudally was measured as (-)UIVSA. A threshold UIVSA of +3° was determined by the maximum likelihood of PJK using the area under a Receiver Operating Curve. Using binary logistic regression, we examined the development of PJK and PJF in patients with UIVSA above and below +3°, while controlling for preoperative TK, osteoporosis and age. RESULTS Ninety-six patients were studied with 2-year follow up. Mean age was 62 ± 11 years, 68% female. Mean follow-up was 4.6 ± 2.3 years. Patients had the following mean preoperative radiographic parameters: SVA: 10.7 ± 8.7 cm; TK: 33 ± 16°; Coronal Cobb 31 ± 17°. Mean UIVSA was -0.9° ± 6.0° (range -12.99° to 11.93°). 38 (40%) of patients had PJK at any time point and 28 (29%) went on to develop PJF. Patients with UIVSA greater than +3° had significantly greater odds of developing both PJK (OR 2.7 95% CI: 1.3, 7.0) and PJF (OR 3.6 95% CI: 1.3, 10.0). Screw-rod angle was not significantly associated with development of PJK/PJF, p>0.05. CONCLUSIONS In surgically treated ASD patients with lower thoracic fusion to the sacrum, a UIVSA of greater than +3° is associated with 2.7 times greater odds of PJK and 3.6 times greater odds of PJF. Pedicle screws at the UIV should be directed caudally in ASD patients and thoracolumbar fusion to the pelvis to minimize the risk of proximal junctional failure. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect