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Pelvic Incidence as a Predictor of Proximal Junctional Failure in Patients undergoing Anterior Column Realignment with Anterior Longitudinal Ligament Release to Restore Lordosis in Adult Spinal Deformity – A Retrospective Cohort – Lumbar Fusion

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This article examines the variables that may contribute to the development of proximal junctional failure (PJF) in patients with long lumbo-sacral and thoraco-lumbo-pelvic constructs undergoing anterior column realignment (ACR) with anterior longitudinal ligament release (ALLR). The study collected data from patients with adult spinal deformity (ASD) who underwent ACR with ALLR at L3-4 between 2016 and 2022. The results showed that twelve patients (41%) developed PJF at a mean of 24 months after the index surgery. The study found that sagittal pelvic alignment (PI), spinopelvic alignment (SS), and postoperative PI-LL mismatch were significant predictors of PJF. The researchers also identified a cutoff PI value of ≤53º, below which the risk of PJF becomes significantly higher in patients undergoing ACR with ALLR at L3-4. The study concludes that preoperative planning based on normal sagittal alignment may help mitigate the risk of PJF in ASD patients treated with ACR-ALLR

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Published article

S: PI may be a predictor of PJF and highly correlates with ACR-ALLR levels. In patients undergoing L3-4 ACR-ALLR, a PI value of ≤53º is associated with a significantly elevated risk of PJF. Preoperative planning of ACR-ALLR level based on normal sagittal alignment in otherwise healthy individuals may mitigate the risk of PJF development in ASD patients treated with ACR-ALLR.

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World Neurosurg. 2023 Dec 11:S1878-8750(23)01755-2. doi: 10.1016/j.wneu.2023.12.036. Online ahead of print.ABSTRACTOBJECTIVE: To identify variables that may contribute to the development of proximal junctional failure (PJF) in patients with long lumbo-sacral and thoraco-lumbo-pelvic constructs undergoing ACR with ALLR.METHODS: Data of patients with ASD who underwent ACR with ALLR at L3-4 was collected retrospectively from medical records,

World Neurosurg. 2023 Dec 11:S1878-8750(23)01755-2. doi: 10.1016/j.wneu.2023.12.036. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify variables that may contribute to the development of proximal junctional failure (PJF) in patients with long lumbo-sacral and thoraco-lumbo-pelvic constructs undergoing ACR with ALLR.

METHODS: Data of patients with ASD who underwent ACR with ALLR at L3-4 was collected retrospectively from medical records and a prospectively maintained spine research database between 2016 and 2022.

RESULTS: Eleven (41%) developed PJF at a mean of 24 ± 21 months from the index surgery. The cohort was then divided into two groups for analysis, 13 subjects in the high PI group (defined as PI ≥55º) and 14 subjects in the low PI group (defined as PI <55º). VAS for back pain and ODI decreased from 9.5 to 2.1 and 61 to 10 in the high PI group, and from 8.9 to 2.4 and 60.9 to 10.3 in the low PI group, respectively. PI (p=0.004), SS (p=0.005), and postoperative PI-LL mismatch (p=0.02) were found to be significant predictors of PJF. The ROC curve revealed a cutoff PI value ≤53º (95%CI: 52º to 64º), below which the risk of PJF becomes significantly higher in patients undergoing ACR with ALLR at L3-4.

S: PI may be a predictor of PJF and highly correlates with ACR-ALLR levels. In patients undergoing L3-4 ACR-ALLR, a PI value of ≤53º is associated with a significantly elevated risk of PJF. Preoperative planning of ACR-ALLR level based on normal sagittal alignment in otherwise healthy individuals may mitigate the risk of PJF development in ASD patients treated with ACR-ALLR.

PMID:38092350 | DOI:10.1016/j.wneu.2023.12.036

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Pelvic Incidence as a Predictor of Proximal Junctional Failure in Patients undergoing Anterior Column Realignment with Anterior Longitudinal Ligament Release to Restore Lordosis in Adult Spinal Deformity – A Retrospective Cohort

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World Neurosurg. 2023 Dec 11:S1878-8750(23)01755-2. doi: 10.1016/j.wneu.2023.12.036. Online ahead of print.ABSTRACTOBJECTIVE: To identify variables that may contribute to the development of proximal junctional failure (PJF) in patients with long lumbo-sacral and thoraco-lumbo-pelvic constructs undergoing ACR with ALLR.METHODS: Data of patients with ASD who underwent ACR with ALLR at L3-4 was collected retrospectively from medical records

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