Upper instrumented vertebra-femoral angle and correlation with proximal junctional kyphosis in adult spinal deformity
| Autor: | Shane Burch, Kevork Hindoyan, Sigurd Berven, Dean Chou, Joshua Rivera, Minghao Wang, Andrew Y. Lee, Jeremy M V Guinn, Zhuo Xi, Praveen V. Mummaneni, Hao-Hua Wu, Bo Li, Ping-Guo Duan |
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| Rok vydání: | 2022 |
| Předmět: |
Pelvic tilt
Adult medicine.medical_specialty Proximal junctional kyphosis Clinical Sciences Kyphosis Biomedical Engineering Adult spinal deformity Thoracic Vertebrae Femoral head Clinical Research Surgical complication Medicine Humans Orthopedics and Sports Medicine Pelvis Retrospective Studies Lumbar Vertebrae business.industry Rehabilitation Retrospective cohort study medicine.disease Sagittal plane Surgery Vertebra medicine.anatomical_structure Spinal Fusion Orthopedic surgery Patient Safety business |
| Zdroj: | Spine deformity, vol 10, iss 2 |
| Popis: | Introduction Although matching lumbar lordosis (LL) with pelvic incidence (PI) is an important surgical goal for adult spinal deformity (ASD), there is concern that overcorrection may lead to proximal junctional kyphosis (PJK). We introduce the upper instrumented vertebra–femoral angle (UIVFA) as a measure of appropriate postoperative position in the setting of lower thoracic to pelvis surgical correction for patients with sagittal imbalance. We hypothesize that a more posterior UIV position in relation to the center of the femoral head is associated with an increased risk of PJK given compensatory hyperkyphosis above the UIV. Methods In this retrospective cohort study, adult patients undergoing lower thoracic (T9–T12) to pelvis correction of ASD with a minimum of 2-year follow-up were included. UIVFA was measured as the angle subtended by a line from the UIV centroid to the femoral head center to the vertical axis. Patients who developed PJK and those who did not were compared with preoperative and postoperative UIVFA as well as change between postoperative and preoperative UIVFA (deltaUIVFA). Results Of 119 patients included with an average 3.6-year follow-up, 51 (42.9%) had PJK and 24 (20.2%) had PJF. Patients with PJK had significantly higher postoperative UIVFA (12.6 ± 4.8° vs. 9.4 ± 6.6°, p = 0.04), deltaUIVFA (6.1 ± 7.6° vs. 2.1 ± 5.6°, p p = 0.04), postoperative lumbar lordosis (47.7 ± 13.9° vs. 42.4 ± 13.1, p = 0.04) and postoperative thoracic kyphosis (44.9 ± 13.2 vs. 31.6 ± 18.8) than patients without PJK. With multivariate logistic regression, postoperative UIVFA and deltaUIVFA were found to be independent risk factors for PJK (p p Conclusion The more posterior the UIV is from the femoral head center after lower thoracic to pelvis surgical correction for ASD, the more patients are at risk for PJK. The greater the magnitude of posterior translation of the UIV from the femoral head center from preop to postop, the greater the likelihood for PJF. |
| Databáze: | OpenAIRE |
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