Distal Junctional Failure After Fusion Stopping at L5 in Patients With Adult Spinal Deformity: Incidence, Risk Factors, and Radiographic Criteria

Autor: Sung Ho Do, Sungsoo Bae, Dae Jean Jo, Ho Yong Choi
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Neurospine, Vol 21, Iss 3, Pp 856-864 (2024)
Druh dokumentu: article
ISSN: 2586-6583
2586-6591
DOI: 10.14245/ns.2448122.061
Popis: Objective To identify risk factors and establish radiographic criteria for distal junctional failure (DJF) in patients with adult spinal deformity (ASD), who underwent fusion surgery stopping at L5. Methods This retrospective study was undertaken from January 2016 to December 2020. Patients with ASD who underwent fusion surgery (≥5 levels) stopping at L5 were analyzed. DJF was defined as symptomatic adjacent segment pathology at the lumbosacral junction necessitating consideration for revision surgery. Demographic data and radiographic measurements were compared between the DJF and non-DJF groups. Receiver operating characteristic curve analysis was performed to identify the radiographic cutoff value for DJF. Results Among 76 patients, 16 (21.1%) experienced DJF. DJF was associated with older age, antidepressant/anxiolytic medication, longer level of fusions, and worse preoperative sagittal alignment. Antidepressant/anxiolytic medication (odds ratio, 5.60) and preoperative pelvic incidence (PI)–lumbar lordosis (LL) mismatch>40° (odds ratio, 5.87) were independent risk factors for DJF. Without both factors, the incidence of DJF has been greatly reduced (9.1%). Two radiographic criteria were determined for DJF: last distal junctional angle (DJA)>-5° and Δ last DJA–post DJA>5°. When both criteria were met, the sensitivity and specificity of the DJF were 93.3% and 91.7%, respectively. Conclusion Use of antidepressant/anxiolytic medication and preoperative PI–LL mismatch >40° were independent risk factors for DJF. DJF could be diagnosed using postoperative changes in the DJA. If both criteria were met, DJF could be strongly suggested.
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