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Junctional Failures at Both Ends After Long Fusion Arthrodesis Stopping at L5: Incidences and Risk Factors – Lumbar Fusion

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This article published in World Neurosurgery discusses the incidences and risk factors of proximal and distal junctional failures after long lumbar instrumented fusion stopping at L5 for adult spinal deformity (ASD). The study included 63 patients with a minimum follow-up of three years. The results showed that both proximal junctional failure (PJF) and distal junctional failure (DJF) occurred in similar rates, with PJF and DJF occurring in 27% and 25.4% of the patients, respectively. Risk factors for PJF included lower BMI, higher preoperative lumbar lordosis (LL), and higher postoperative sagittal vertical axis (SVA), while higher preoperative SVA was identified as an independent risk factor for DJF

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Published article

S: After long fusion surgery stopping at L5, PJF and DJF occurred in similar rates. Less BMI, higher preoperative LL, and higher postoperative SVA were risk factors for PJF. Higher preoperative SVA was an independent risk factor for DJF.

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World Neurosurg. 2023 Sep 23:S1878-8750(23)01331-1. doi: 10.1016/j.wneu.2023.09.063. Online ahead of print.ABSTRACTOBJECTIVES: Junctional failures after long fusion stopping at L5 can present at both proximal and distal ends. The purpose of this study was to investigate incidences and risk factors of proximal and distal junctional failures after long lumbar instrumented fusion stopping at L5 for adult,

World Neurosurg. 2023 Sep 23:S1878-8750(23)01331-1. doi: 10.1016/j.wneu.2023.09.063. Online ahead of print.

ABSTRACT

OBJECTIVES: Junctional failures after long fusion stopping at L5 can present at both proximal and distal ends. The purpose of this study was to investigate incidences and risk factors of proximal and distal junctional failures after long lumbar instrumented fusion stopping at L5 for adult spinal deformity (ASD).

METHODS: Sixty-three patients who underwent long fusion surgery stopping at L5 with a minimum follow-up of three years were reviewed retrospectively. PJF and DJF were defined as newly developed back pain and/or radiculopathy with corresponding radiographic failures. The incidence and risk factors of each junctional failure were analyzed using a log rank test and Cox proportional hazards model.

RESULTS: Twelve men and 51 women were included in our study. Their mean age was 68.5 ± 7.0 years and mean follow-up period was 84.5 ± 45.3 months. PJF and DJF occurred in 17 (27%) and 16 patients (25.4%), respectively. PJF and DJF developed at median durations of 32.1 months and 13.3 months, respectively, showing no significant difference between the two. Three patients presented both PJF and DJF. Risk factors for PJF included less BMI, higher preoperative LL, and higher postoperative SVA (HR: 0.570, 1.055, 1.040, respectively). For DJF, higher preoperative SVA was an independent risk factor (HR: 1.010).

S: After long fusion surgery stopping at L5, PJF and DJF occurred in similar rates. Less BMI, higher preoperative LL, and higher postoperative SVA were risk factors for PJF. Higher preoperative SVA was an independent risk factor for DJF.

PMID:37748733 | DOI:10.1016/j.wneu.2023.09.063

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Junctional Failures at Both Ends After Long Fusion Arthrodesis Stopping at L5: Incidences and Risk Factors

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World Neurosurg. 2023 Sep 23:S1878-8750(23)01331-1. doi: 10.1016/j.wneu.2023.09.063. Online ahead of print.ABSTRACTOBJECTIVES: Junctional failures after long fusion stopping at L5 can present at both proximal and distal ends. The purpose of this study was to investigate incidences and risk factors of proximal and distal junctional failures after long lumbar instrumented fusion stopping at L5 for adult

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