Clinical and Radiographic Features of Subtypes of Acute Proximal Junctional Failures Following Correction Surgery for Degenerative Sagittal Imbalance
| Autor: | In-Soo Oh, Hyung-Youl Park, Kee-Yong Ha, Jun-Yeong Seo, Young Hoon Kim, Hyung-Ki Min, Dong-Gune Chang, Sang Il Kim |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Radiography Body Mass Index 03 medical and health sciences 0302 clinical medicine Postoperative Complications Bone Density Risk Factors Medicine Humans Mass index Kyphosis Treatment Failure Risk factor Fixation (histology) Aged Retrospective Studies Subluxation Lumbar Vertebrae business.industry Middle Aged medicine.disease Sagittal plane Vertebra Surgery medicine.anatomical_structure Spinal Fusion 030220 oncology & carcinogenesis Spinal Fractures Female Neurology (clinical) business Densitometry 030217 neurology & neurosurgery |
| Zdroj: | World neurosurgery. 125 |
| ISSN: | 1878-8769 |
| Popis: | Objective To identify clinical and radiographic features of subtypes of acute proximal junctional failures (PJFs) following correction surgery for degenerative sagittal imbalance. Methods The study included 157 patients with mean age 68.0 ± 6.3 years who underwent correction surgery for degenerative sagittal imbalance. Acute PJFs were categorized into 4 subtypes: fracture at uppermost instrumented vertebra (UIV), fracture at vertebra just proximal to UIV (UIV+1), fixation failure at UIV, and junctional subluxation. Demographic, clinical, and radiographic data were analyzed retrospectively. Results There were 18 patients with acute PJFs. PJF group had significantly lower T-score (−3.3 ± 1.1 vs. −1.9 ± 1.5) on bone densitometry and lower body mass index (BMI) (23.0 ± 3.9 kg/m2 vs. 25.6 ± 3.7 kg/m2) than non-PJF group. Radiographic parameters exhibited no significant differences. UIV fracture, UIV+1 fracture, UIV fixation failure, and junctional subluxation were observed in 5, 6, 4, and 3 patients. Fixation failure developed the earliest (median 1.3 months), followed by UIV fracture (1.5 months). UIV fracture occurred earlier than UIV+1 fracture (36 months). Patients with UIV or UIV+1 fracture had significantly lower T-scores than others. Although BMI and T-score were significant risk factors for all PJFs (P = 0.043 and P = 0.021, respectively), different risk factors for each subtype of PJFs were identified on separate risk factor analysis. Conclusions Patients with acute PJFs had lower T-score and BMI. Each subtype of PJFs had different clinical and radiographic features. Although BMI and T-score were associated with all PJFs, each subtype may have different risk factors. Identifying risk factors for each subtype of acute PJFs may help avoid it. |
| Databáze: | OpenAIRE |
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