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Chance Fracture Pattern Presenting in Proximal Junctional Failure – Lumbar Fusion

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The article presents a case series of proximal junctional failure caused by Chance-type fractures. The study involved a retrospective review of patients who experienced proximal junctional kyphosis after spinal fusion for adult spinal deformity. Fifteen patients were identified, with an average age of 61.4 years. The mean time to fracture identification was 25.4 days. The study found that overcorrection of lumbar lordosis and/or lower lordosis was present in cases with a lumbar upper instrumented vertebra, while significant correction of preoperative thoracolumbar junction kyphosis was observed in cases with a lower thoracic UIV. Treatment involved extension of fusion and salvaging of pedicle screws by changing to an anatomic trajectory. The article concludes that persistent pain at 6 to 12 weeks, along with radiographic evidence of increased proximal junctional angle and cephalocaudal pedicle widening at the UIV, should raise suspicion for this unique fracture pattern. Factors contributing to the fracture risk include low bone density, overcorrection of lordosis, and selection of a lower thoracic UIV with notable thoracolumbar junction correction

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Published article

CONCLUSION: Continued pain at 6 to 12 weeks with radiographs showing an increased proximal junctional angle and cephalocaudal pedicle widening at the UIV should raise suspicion for this unique fracture pattern. A CT scan is recommended. Low bone density, LL and/or lower LL overcorrection, and selection of lower thoracic UIV in the setting of notable thoracolumbar junction correction may contribute to fracture risk.

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J Am Acad Orthop Surg Glob Res Rev. 2023 Aug 4;7(8). doi: 10.5435/JAAOSGlobal-D-23-00039. eCollection 2023 Aug 1.ABSTRACTINTRODUCTION: We present a case series of proximal junctional failure due to a Chance-type fracture.METHODS: This is a retrospective review of patients who developed proximal junctional kyphosis because of Chance-type proximal junctional failure after spinal fusion for adult spinal,

J Am Acad Orthop Surg Glob Res Rev. 2023 Aug 4;7(8). doi: 10.5435/JAAOSGlobal-D-23-00039. eCollection 2023 Aug 1.

ABSTRACT

INTRODUCTION: We present a case series of proximal junctional failure due to a Chance-type fracture.

METHODS: This is a retrospective review of patients who developed proximal junctional kyphosis because of Chance-type proximal junctional failure after spinal fusion for adult spinal deformity.

RESULTS: Fifteen patients were identified (4M:11F). The average age was 61.4 years (range, 39 to 77). The mean time to fracture identification was 25.4 days (range, 3 to 65). The average number of levels instrumented was 6.7 (range, 2 to 17). No patients had antecedent trauma before fracture onset. In 67% of cases with a lumbar upper instrumented vertebra (UIV), there was overcorrection of lumbar lordosis (LL) and/or lower LL. The five cases with a lower thoracic UIV had undergone notable correction of preoperative thoracolumbar junction kyphosis. 14 of 15 patients were treated with extension of fusion. Pedicle screws at the fracture level were salvaged by changing to an anatomic trajectory.

CONCLUSION: Continued pain at 6 to 12 weeks with radiographs showing an increased proximal junctional angle and cephalocaudal pedicle widening at the UIV should raise suspicion for this unique fracture pattern. A CT scan is recommended. Low bone density, LL and/or lower LL overcorrection, and selection of lower thoracic UIV in the setting of notable thoracolumbar junction correction may contribute to fracture risk.

PMID:37540797 | DOI:10.5435/JAAOSGlobal-D-23-00039

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Chance Fracture Pattern Presenting in Proximal Junctional Failure

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J Am Acad Orthop Surg Glob Res Rev. 2023 Aug 4;7(8). doi: 10.5435/JAAOSGlobal-D-23-00039. eCollection 2023 Aug 1.ABSTRACTINTRODUCTION: We present a case series of proximal junctional failure due to a Chance-type fracture.METHODS: This is a retrospective review of patients who developed proximal junctional kyphosis because of Chance-type proximal junctional failure after spinal fusion for adult spinal
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