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Clinical significance of lordosis orientation on proximal junctional kyphosis development in long-segment fusion surgery for adult spinal deformity – Lumbar Fusion

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The article titled “Clinical Impact of Lordosis Orientation on Proximal Junctional Failure in Adult Spinal Deformity Surgery” examines the relationship between lordosis orientation (LO) and the development of proximal junctional failure (PJK) in adult spinal deformity (ASD) surgery. The study included 152 patients who underwent fusion surgery and were followed up for at least two years. Six radiographic parameters representing LO were evaluated, and various clinical and radiographic factors were analyzed to identify risk factors for PJK using logistic regression analysis. The results showed that small postoperative pelvic incidence (PI) – lumbar lordosis (LL) and large uppermost instrumented vertebra-femoral angle (UIVFA) were significant risk factors for PJK development. Surgeons should aim to avoid both undercorrection and overcorrection to prevent PJK

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Published article

S: LO significantly increases the risk of PJK development in ASD surgery. Multivariate analysis revealed that smaller postoperative PI-LL and greater UIVFA were significant risk factors for PJK. Surgeons should avoid undercorrection as well as overcorrection to prevent PJK development.

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World Neurosurg. 2023 Dec 20:S1878-8750(23)01816-8. doi: 10.1016/j.wneu.2023.12.082. Online ahead of print.ABSTRACTOBJECTIVE: To evaluate the clinical impact of lordosis orientation (LO) on proximal junctional failure (PJK) development in adult spinal deformity (ASD) surgery METHODS: This study included 152 patients who underwent low thoracic (T9 -T12) to pelvis fusion and followed up for ≥2 years. In the,

World Neurosurg. 2023 Dec 20:S1878-8750(23)01816-8. doi: 10.1016/j.wneu.2023.12.082. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical impact of lordosis orientation (LO) on proximal junctional failure (PJK) development in adult spinal deformity (ASD) surgery METHODS: This study included 152 patients who underwent low thoracic (T9 -T12) to pelvis fusion and followed up for ≥2 years. In the literature, six radiographic parameters representing LO were introduced, such as uppermost instrumented vertebra (UIV) slope, UIV inclination, UIV – femoral angle (UIVFA), thoracolumbar tilt, thoracolumbar slope, and lordosis tilt. Various clinical and radiographic factors, including six LO parameters, were investigated using logistic regression analysis to identify risk factors for PJK.

RESULTS: The mean age was 69.4 years, and 136 patients were females (89.5%). PJK developed in 65 patients (42.8%). Multivariate logistic regression analysis revealed that only small postoperative pelvic incidence (PI) – lumbar lordosis (LL) (Odds ratio [OR] = 0.962, 95% CI : 0.929 – 0.996, P = 0.030) and large UIVFA (OR = 1.089, 95% CI : 1.028 – 1.154, P = 0.004) were significant for PJK development. UIVFA showed significantly positive correlation with pelvic tilt (CC = 0.509), thoracic kyphosis (CC = 0.384), and lordosis distribution index (CC = 0.223). UIVFA was also negatively correlated with sagittal vertical axis (CC = -0.371). However, UIVFA did not correlate with LL, PI-LL, or T1 pelvic angle.

S: LO significantly increases the risk of PJK development in ASD surgery. Multivariate analysis revealed that smaller postoperative PI-LL and greater UIVFA were significant risk factors for PJK. Surgeons should avoid undercorrection as well as overcorrection to prevent PJK development.

PMID:38135150 | DOI:10.1016/j.wneu.2023.12.082

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Clinical significance of lordosis orientation on proximal junctional kyphosis development in long-segment fusion surgery for adult spinal deformity

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World Neurosurg. 2023 Dec 20:S1878-8750(23)01816-8. doi: 10.1016/j.wneu.2023.12.082. Online ahead of print.ABSTRACTOBJECTIVE: To evaluate the clinical impact of lordosis orientation (LO) on proximal junctional failure (PJK) development in adult spinal deformity (ASD) surgery METHODS: This study included 152 patients who underwent low thoracic (T9 -T12) to pelvis fusion and followed up for ≥2 years. In the

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