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Radiographic Factors of Proximal Junctional Failure According to Age Groups in Adult Spinal Deformity – Lumbar Fusion

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This article investigates the radiographic risk factors associated with proximal junctional failure (PJF) in two different age groups undergoing thoracolumbar fusion for adult spinal deformity (ASD). The study included patients aged ≥ 60 years, and PJF was defined as proximal junctional angle (PJA) ≥ 20°, fixation failure, fracture, myelopathy, or the need for revision surgery. The results showed that PJF developed more frequently in patients aged 70 years or older. In patients younger than 70 years, a greater change in lumbar lordosis (LL) was associated with PJF development, while in older patients, overcorrection of pelvic incidence (PI)-LL relative to the age-adjusted ideal target was a significant risk factor. These findings suggest that age may influence the radiographic risk factors for PJF in patients with ASD undergoing thoracolumbar fusion

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best recognised day surgery spinal centre in UK

Published article

CONCLUSIONS: In patients younger than 70 years, a greater change in LL was associated with PJF development regardless of PI-related values. However, in older patients, overcorrection of PI-LL relative to the age-adjusted PI-LL target was a significant risk factor of PJF.

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Clin Orthop Surg. 2023 Aug;15(4):606-615. doi: 10.4055/cios22329. Epub 2023 Jul 13.ABSTRACTBACKGROUND: Patient age has been associated with the development of proximal junctional failure (PJF). The characteristics of adult spinal deformity (ASD) are considered different between younger and older age groups. We hypothesized that the radiographic risk factors of PJF would be different according to age,

Clin Orthop Surg. 2023 Aug;15(4):606-615. doi: 10.4055/cios22329. Epub 2023 Jul 13.

ABSTRACT

BACKGROUND: Patient age has been associated with the development of proximal junctional failure (PJF). The characteristics of adult spinal deformity (ASD) are considered different between younger and older age groups. We hypothesized that the radiographic risk factors of PJF would be different according to age groups. This study aimed to evaluate different radiographic risk factors of PJF between two age groups undergoing thoracolumbar fusion for ASD.

METHODS: ASD patients aged ≥ 60 years who underwent thoracolumbar fusion from the low thoracic level (T9-T12) to the sacrum were included. The minimum follow-up duration was 2 years. PJF was defined as proximal junctional angle (PJA) ≥ 20°, fixation failure, fracture, myelopathy, or necessity of revision surgery. Using various radiographic risk factors including age-adjusted ideal pelvic incidence (PI)-lumbar lordosis (LL), univariate and multivariate analyses were performed separately in two age groups: < 70 years and ≥ 70 years.

RESULTS: A total of 186 patients (90.3% women) with a mean age of 69 years were enrolled. The mean follow-up duration was 67.4 months. PJF developed in 97 patients (52.2%). There were fractures in 53 patients, PJA ≥ 20° in 26, fixation failure in 12, and myelopathy in 6. PJF developed more frequently in patients 70 years or older than in those younger than 70 years. In patients aged less than 70 years, preoperative LL, PI-LL, and a change in LL were significant risk factors in univariate analysis. Multivariate analysis showed only a change in LL was significant for PJF development (odds ratio [OR], 1.025; p = 0.021). On the other hand, in patients 70 years or older, postoperative LL, postoperative PI-LL, and overcorrection relative to the conventional PI-LL target (within ± 10°) and age-adjusted ideal PI-LL target were significant risk factors. On multivariate analysis, only overcorrection of PI-LL relative to the age-adjusted ideal target was a single significant risk factor of PJF (OR, 5.250; p = 0.024).

CONCLUSIONS: In patients younger than 70 years, a greater change in LL was associated with PJF development regardless of PI-related values. However, in older patients, overcorrection of PI-LL relative to the age-adjusted PI-LL target was a significant risk factor of PJF.

PMID:37529186 | PMC:PMC10375815 | DOI:10.4055/cios22329

The London Spine Unit : best recognised day surgery spinal centre in UK

Read the original publication:

Radiographic Factors of Proximal Junctional Failure According to Age Groups in Adult Spinal Deformity

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Clin Orthop Surg. 2023 Aug;15(4):606-615. doi: 10.4055/cios22329. Epub 2023 Jul 13.ABSTRACTBACKGROUND: Patient age has been associated with the development of proximal junctional failure (PJF). The characteristics of adult spinal deformity (ASD) are considered different between younger and older age groups. We hypothesized that the radiographic risk factors of PJF would be different according to age

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