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This article discusses the risk factors for radiographic progression of proximal junctional fractures (PJFx) in the surgical treatment of adult spinal deformity. The study included 76 patients with PJFx development who underwent ≥ 5-level fusion from the sacrum. The patients were divided into two groups based on the change in the proximal junctional angle (PJA) – progression group (group P) and nonprogression group (group NP). The study found that overcorrection relative to the age-adjusted ideal pelvic incidence (PI)-lumbar lordosis (LL) target at index surgery, PJA > 21° at initial presentation, and fracture at the uppermost instrumented vertebra (UIV) were significant risk factors for PJFx progression. The study concludes that close monitoring is necessary for these patients to avoid missing timely revision surgery. Clinical outcomes were also found to be better in the nonprogression group
Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most experienced spinal clinic in UK
Published article
CONCLUSIONS: The risk factors for further progression of PJFx were overcorrection relative to the age-adjusted PI-LL target at index surgery, PJA > 21° at initial presentation, and fracture at the UIV level. Close monitoring is warranted for such patients in order to not miss timely revision surgery.
Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
J Neurosurg Spine. 2023 Sep 1:1-9. doi: 10.3171/2023.7.SPINE23103. Online ahead of print.ABSTRACTOBJECTIVE: Proximal junctional fracture (PJFx) at the uppermost instrumented vertebra (UIV) or UIV+1 is the most common mechanism of proximal junctional failure (PJF). Few studies have assessed radiographic progression after PJFx development. Therefore, this study sought to identify the risk factors for radiographic progression,
J Neurosurg Spine. 2023 Sep 1:1-9. doi: 10.3171/2023.7.SPINE23103. Online ahead of print.
ABSTRACT
OBJECTIVE: Proximal junctional fracture (PJFx) at the uppermost instrumented vertebra (UIV) or UIV+1 is the most common mechanism of proximal junctional failure (PJF). Few studies have assessed radiographic progression after PJFx development. Therefore, this study sought to identify the risk factors for radiographic progression of PJFx in the surgical treatment for adult spinal deformity.
METHODS: In this retrospective study, among 317 patients aged > 60 years who underwent ≥ 5-level fusion from the sacrum, 76 with PJFx development were included. On the basis of the change in the proximal junctional angle (PJA), 2 groups were created: progression group (group P) (change ≥ 10°) and nonprogression group (group NP) (change < 10°). Patient, surgical, and radiographic variables were compared between the groups with univariate and multivariate analyses to demonstrate the risk factors for PJFx progression. The receiver operating characteristic (ROC) curve was used to calculate cutoff values. Clinical outcomes, such as visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) score, the Scoliosis Research Society (SRS)-22 score, and the revision rate were compared between the 2 groups.
RESULTS: The mean age at index surgery was 71.1 years, and 67 women were enrolled in the study (88.2%). There were 45 patients in group P and 31 in group NP. The mean increase in PJA was 15.6° (from 23.2° to 38.8°) in group P and 3.7° (from 17.2° to 20.9°) in group NP. Clinical outcomes were significantly better in group NP than group P, including VAS-back score, ODI score, and SRS-22 scores for all items. The revision rate was significantly greater in group P than in group NP (53.3% vs 25.8%, p = 0.001). Multivariate analysis revealed that overcorrection relative to the age-adjusted ideal pelvic incidence (PI)-lumbar lordosis (LL) target at index surgery (OR 4.484, p = 0.030), PJA at the time of PJFx identification (OR 1.097, p = 0.009), and fracture at UIV (vs UIV+1) (OR 3.410, p = 0.027) were significant risk factors for PJFx progression. The cutoff value of PJA for PJFx progression was calculated as 21° by using the ROC curve.
CONCLUSIONS: The risk factors for further progression of PJFx were overcorrection relative to the age-adjusted PI-LL target at index surgery, PJA > 21° at initial presentation, and fracture at the UIV level. Close monitoring is warranted for such patients in order to not miss timely revision surgery.
PMID:37657113 | DOI:10.3171/2023.7.SPINE23103
The London Spine Unit : most experienced spinal clinic in UK
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Risk factors for radiographic progression of proximal junctional fracture in patients undergoing surgical treatment for adult spinal deformity
