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Clinical outcomes and proximal junctional failure in adult spinal deformity patients corrected to normative alignment versus functional alignment – Lumbar Fusion

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This article discusses a study that aimed to examine the rate of proximal junctional failure (PJF) and functional outcomes of normative alignment goals compared to alignment targets based on age-appropriate physical function in adult spinal deformity (ASD) patients. The study analyzed the baseline relationships between age, pelvic incidence (PI), and a component of the T1 pelvic angle (TPA) in ASD patients and asymptomatic patients. The results showed that patients with normative alignment had higher rates of proximal junctional kyphosis (PJK) and PJF compared to those with functional alignment. There were no differences in baseline alignment or health-related quality of life (HRQOL) between the two groups. Therefore, the study recommends correction in ASD patients to functional alignment that mirrors the physical function of their age-matched asymptomatic peers

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSIONS: Correction in ASD patients to normative alignment resulted in higher rates of PJK and PJF without improvements in HRQOL. Correction in ASD patients to functional alignment that mirrors the physical function of their age-matched asymptomatic peers is recommended.

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J Neurosurg Spine. 2023 Jul 21:1-8. doi: 10.3171/2023.5.SPINE221266. Online ahead of print.ABSTRACTOBJECTIVE: The objective of this study was to explore the rate of proximal junctional failure (PJF) and functional outcomes of normative alignment goals compared with alignment targets based on age-appropriate physical function.METHODS: Baseline relationships between age, pelvic incidence (PI), and a component of the,

J Neurosurg Spine. 2023 Jul 21:1-8. doi: 10.3171/2023.5.SPINE221266. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this study was to explore the rate of proximal junctional failure (PJF) and functional outcomes of normative alignment goals compared with alignment targets based on age-appropriate physical function.

METHODS: Baseline relationships between age, pelvic incidence (PI), and a component of the T1 pelvic angle (TPA) within the fusion were analyzed in adult spinal deformity (ASD) patients and compared with those of asymptomatic patients. Linear regression modeling was used to determine alignment based on PI and age in asymptomatic patients (normative alignment), and in ASD patients, alignment corresponding to age-appropriate functional status (functional alignment). A cohort of 288 ASD patients was split into two groups based on whether the patient was closer to their normative or functional alignment goal at their 6-week postoperative radiographic follow-up. The rates of proximal junctional kyphosis (PJK) and PJF were determined for each cohort.

RESULTS: In the 288 ASD patients included in this pre- to postoperative analysis, there was no difference in baseline alignment or health-related quality of life (HRQOL) between the normative alignment and functional alignment groups. At 6 weeks, patients with normative alignment had a smaller TPA (4.45° vs 14.1°) and PI minus lumbar lordosis (-7.24° vs 7.4°) (both p < 0.0001) and higher PJK (40% vs 27.2%, p = 0.03) and PJF (17% vs 6.8%, p = 0.008) rates than patients with functional alignment.

CONCLUSIONS: Correction in ASD patients to normative alignment resulted in higher rates of PJK and PJF without improvements in HRQOL. Correction in ASD patients to functional alignment that mirrors the physical function of their age-matched asymptomatic peers is recommended.

PMID:37503890 | DOI:10.3171/2023.5.SPINE221266

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Clinical outcomes and proximal junctional failure in adult spinal deformity patients corrected to normative alignment versus functional alignment

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J Neurosurg Spine. 2023 Jul 21:1-8. doi: 10.3171/2023.5.SPINE221266. Online ahead of print.ABSTRACTOBJECTIVE: The objective of this study was to explore the rate of proximal junctional failure (PJF) and functional outcomes of normative alignment goals compared with alignment targets based on age-appropriate physical function.METHODS: Baseline relationships between age, pelvic incidence (PI), and a component of the

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