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Risk Factors for Distal Junctional Problems Following Long Instrumented Fusion for Degenerative Lumbar Scoliosis: Are they Related to the Paraspinal Muscles – Lumbar Fusion

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This article discusses a study that aimed to identify risk factors associated with distal junctional problems (DJPs) in patients undergoing long construct-based treatment for degenerative lumbar scoliosis (DLS). The study analyzed 182 DLS patients who underwent long instrumented fusion surgery and found that longer instrumented levels, a greater preoperative sagittal vertical axis (SVA), and a smaller pelvic tilt (PT) were significant independent risk factors for DJPs. The degeneration of the paraspinal muscles did not appear to be related to the occurrence of DJPs. The study suggests that selecting appropriate fusion segments and evaluating sagittal balance and spino-pelvic parameters before surgery can help reduce the occurrence of DJPs

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : the highest rated day surgery hospital on Harley Street UK

Published article

: Longer instrumented levels, a greater preoperative SVA and a smaller PT were found to be strongly associated with the presence of DJPs in patients treated for DLS. The degeneration of the paraspinal muscles may not be related to the occurrence of DJPs. For DLS patients, the occurrence of DJP can be reduced by selecting reasonable fusion segments and evaluating the patient’s sagittal balance and spino-pelvic parameters before operation.

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Orthop Surg. 2023 Sep 25. doi: 10.1111/os.13878. Online ahead of print.ABSTRACTPURPOSE: Although the incidence of distal junctional problems (DJPs) following long construct-based treatment for degenerative lumbar scoliosis (DLS) is lower, affected patients are more likely to require revision surgery when they occur. So the aim of this study is to identify risk factors associated with,

Orthop Surg. 2023 Sep 25. doi: 10.1111/os.13878. Online ahead of print.

ABSTRACT

PURPOSE: Although the incidence of distal junctional problems (DJPs) following long construct-based treatment for degenerative lumbar scoliosis (DLS) is lower, affected patients are more likely to require revision surgery when they occur. So the aim of this study is to identify risk factors associated with DJPs to avoid its occurrence by at least 1-year follow-up.

METHODS: A total of 182 DLS patients undergoing long instrumented fusion surgery (≥4 levels) between February 2011 and March 2022 were retrospectively analyzed. Patients were placed into the DJP group if a DJP occurred at the final follow-up; patients without mechanical complications were matched 1:2 according to age, sex and BMI as the control group. Patient characteristics, surgical variables, radiographic parameters, lumbar muscularity and fatty degeneration were analyzed statistically. The statistical differences in the results between the two groups (p values <0.05) and other variables selected by experts were entered into a multivariate logistic regression model, and the forwards likelihood ratio method was used to analyze the independent risk factors for DJPs.

RESULTS: Twenty-four (13.2%) patients suffered a DJP in the postoperative period and the reoperation rate was 8.8%. On univariate analysis, the lowest instrumented vertebra (LIV) CT value (p = 0.042); instrumented levels (p = 0.030); preoperative coronal vertical axis (CVA) (p = 0.046), thoracolumbar kyphosis (TLK) (p = 0.006), L4-S1 lordosis (p = 0.013), sacral slop (SS) (p = 0.030), pelvic tilt (PT) classification (p = 0.004), and sagittal vertical axis (SVA) (p = 0.021); TLK correction (p = 0.049); post-operative CVA (p = 0.029); Overall, There was no significant difference in the paraspinal muscle parameters between the two groups. On multivariate analysis, instrumented levels (OR = 1.595; p = 0.035), preoperative SVA (OR = 1.016; p = 0.022) and preoperative PT (OR = 0.873; p = 0.001) were identified as significant independent risk factors for DJP.

: Longer instrumented levels, a greater preoperative SVA and a smaller PT were found to be strongly associated with the presence of DJPs in patients treated for DLS. The degeneration of the paraspinal muscles may not be related to the occurrence of DJPs. For DLS patients, the occurrence of DJP can be reduced by selecting reasonable fusion segments and evaluating the patient’s sagittal balance and spino-pelvic parameters before operation.

PMID:37749777 | DOI:10.1111/os.13878

The London Spine Unit : the highest rated day surgery hospital on Harley Street UK

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Risk Factors for Distal Junctional Problems Following Long Instrumented Fusion for Degenerative Lumbar Scoliosis: Are they Related to the Paraspinal Muscles

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Orthop Surg. 2023 Sep 25. doi: 10.1111/os.13878. Online ahead of print.ABSTRACTPURPOSE: Although the incidence of distal junctional problems (DJPs) following long construct-based treatment for degenerative lumbar scoliosis (DLS) is lower, affected patients are more likely to require revision surgery when they occur. So the aim of this study is to identify risk factors associated with

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