Analysis of Risk Factors Associated with Proximal Junctional Kyphosis Following Long Instrumented Fusion from L1 to Sacrum: Age Itself Does Not Independently Increase the Risk
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patient Population
2.2. Data Collection
3. Results
3.1. Baseline Demographics and PJK Incidence of Included Patients
3.2. Univariate Analysis of Demographic or Surgical Risk Factors
3.3. Univariate Analysis of Radiographic Risk Factors after L1-Sacrum Instrumented Fusion
3.4. Logistic Regression Analysis of Potential Risk Factors Associated with PJK after L1-Sacrum Instrumented Fusion
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
PJK | Proximal junctional kyphosis |
PJA | Proximal junctional angle |
ASD | Adult spinal deformity |
TK | Thoracic kyphosis |
TLK | Thoracolumbar kyphosis |
LL | Lumbar lordosis |
PT | Pelvic tilt |
SS | Sacral slope |
PI | Pelvic incidence |
SVA | Sagittal vertical axis |
BMI | Body mass index |
BMD | Bone mineral density |
ASA | American Society of Anesthesiologists |
CSA | Cross-sectional area |
MR | Magnetic resonance |
SRS | Scoliosis Research Society |
ODI | Oswestry disability index |
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Variables | Values |
---|---|
No. of included patients | 56 |
Age at surgery (years) | 67.3 ± 7.9 (range, 45–79) |
Sex | Female 46; Male 10 |
BMI (kg/m2) | 26.1 ± 3.9 (range, 19.3–40.1) |
BMD (T-score) | −1.8 ± 1.1 (range, −3.50–1.40) |
Osteoporosis, n (%) | 18 (32.1) |
Follow-up period (months) | 43.5 ± 31.7 (range, 24–136) |
Smoker, n (%) | 7 (12.5) |
ASA grade | |
I, n (%) | 9 (16.1) |
II, n (%) | 39 (69.6) |
III, n (%) | 8 (14.3) |
Iliac screw fixation, n (%) | 30 (53.6) |
Previous spinal fusion, n (%) | 18 (32.1) |
Incidence of PJK Until Final Follow-Up, n/Total (%) | 23/56 (41.1) |
---|---|
PJK within postoperative 1 year out of total PJK, n/total PJK (%) | 20/23 (87.0) |
Compression fracture, n/total PJK (%) | 17/23 (73.9) |
Screw loosening/pull-out, n/total PJK (%) | 4/23 (17.4) |
Screw loosening with L1 upper endplate penetration, n/total PJK (%) | 2/23 (8.7) |
Instability or subluxation of proximal adjacent segment, n/total PJK (%) | 3/23 (13.0) |
PJF within PJK | 6/23 (26.1) |
Parameters | PJK Group (n = 23) | Non-PJK Group (n = 33) | p |
---|---|---|---|
Age (years) | 66.4 ± 5.3 | 67.7 ± 9.2 | 0.134 |
Female sex, n (%) | 23 (100) | 23 (72.7) | 0.011 * |
BMD (T-score) | −2.4 ± 0.8 | −1.5 ± 1.1 | 0.006 * |
Osteoporosis, n (%) | 14 (60.9) | 4 (12.1) | <0.001 * |
BMI (kg/m2) | 24.4 ± 2.4 | 27.1 ± 4.3 | 0.004 * |
Follow-up period (months) | 61.1 ± 40.6 | 23.6 ± 24.2 | <0.001 * |
ASA grade | 0.970 | ||
Grade I, n (%) | 6 | 8 | |
Grade II, n (%) | 14 | 20 | |
Grade III, n (%) | 3 | 5 | |
Smoking, n (%) | 2 (8.7) | 5 (15.2) | 0.758 |
Previous spinal fusion, n (%) | 7 (30.4) | 11 (33.3) | 0.995 |
Iliac fixation, n (%) | 12 (52.2) | 18 (54.5) | 0.997 |
Muscular quantity of T12-L1 (CSA of erector spinae), cm2 | 23.8 ± 4.2 | 32.2 ± 10.1 | <0.001 * |
Muscular quality of T12-L1 (Fat infiltration in CSA of erector spinae) | <0.001 * | ||
Mild to moderate (<50%), n | 4 | 21 | |
Severe (≥50%), n | 13 | 3 | |
Disc degeneration of T12-L1 | 0.923 | ||
Mild to Moderate (Pfirrmann grade 1~3) | 7 | 12 | |
Severe (Pfirrmann grade 4 and 5) | 10 | 12 |
Risk Factors | PJK Group (n = 23) | Non-PJK Group (n = 33) | p |
---|---|---|---|
Preoperative Parameters | |||
TK (°), mean ± SD | 7.6 ± 14.3 | 13.9 ± 12.7 | 0.153 |
TLK (°), mean ± SD | 0.75 ± 0.9 | 0.67 ± 1.0 | 0.082 |
PJA (°), mean ± SD | 2.98 ± 8.0 | 1.99 ± 12.2 | 0.583 |
LL (°), mean ± SD | 7.2 ± 24.7 | 20.2 ± 24.5 | 0.115 |
SS (°), mean ± SD | 23.0 ± 8.5 | 30.1 ± 12.3 | 0.057 |
PT (°), mean ± SD | 34.0 ± 7.2 | 25.8 ± 13.0 | 0.032 * |
PI (°), mean ± SD | 56.9 ± 7.0 | 55.5 ± 10.9 | 0.663 |
C7 SVA (mm), mean ± SD | 92.0 ± 48.5 | 85.1 ± 43.4 | 0.720 |
Immediate (3 months) postoperative parameters | |||
TK (°), mean ± SD | 20.7 ± 8.4 | 19.9 ± 17.3 | 0.876 |
TLK (°), mean ± SD | 23.5 ± 9.9 | 8.7 ± 12.2 | <0.001 * |
PJA (°), mean ± SD | 20.9 ± 7.7 | 10.7 ± 8.1 | <0.001 * |
LL (°), mean ± SD | 43.8 ± 13.5 | 45.9 ± 9.4 | 0.569 |
SS (°), mean ± SD | 32.0 ± 9.4 | 35.6 ± 8.1 | 0.215 |
PT (°), mean ± SD | 24.1 ± 11.2 | 18.7 ± 8.6 | 0.092 |
PI (°), mean ± SD | 55.8 ± 7.4 | 53.7 ± 7.0 | 0.376 |
C7 SVA (mm), mean ± SD | 49.9 ± 38.9 | 37.3 ± 35.6 | 0.303 |
Changes between preoperative and immediate postoperative parameters | |||
ΔTK (°), mean ± SD | −13.1 ± 11.5 | −5.8 ± 22.1 | 0.231 |
ΔLL (°), mean ± SD | 36.6 ± 27.7 | 24.8 ± 27.2 | 0.180 |
ΔSS (°), mean ± SD | 8.9 ± 10.8 | 5.2 ± 9.8 | 0.249 |
ΔPT (°), mean ± SD | −9.9 ± 12.2 | −6.8 ± 8.3 | 0.338 |
ΔC7 SVA (mm), mean ± SD | −42.1 ± 56.8 | −47.7 ± 45.9 | 0.724 |
Parameters | p | OR | 95% CI |
---|---|---|---|
Female sex | 0.167 | ||
Osteoporosis | 0.021 * | 20.50 | 1.59–264.99 |
BMI (kg/m2) | 0.620 | ||
Muscle quantity of T12-L1 (CSA of erector spinae) | 0.082 | ||
Muscle quality of T12-L1 (Fat infiltration in CSA of erector spinae) | 0.002 * | 43.60 | 4.11–463.06 |
Preoperative PT (°) | 0.852 | ||
Immediate postoperatve TLK (°) | 0.161 | ||
Immediate postoperatve PJA (°) | 0.124 |
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Ahn, J.; Kim, Y.-H.; Kim, Y.-C.; Kim, K.-T.; Kim, S.-M.; Park, J.B.; Ha, K.-Y. Analysis of Risk Factors Associated with Proximal Junctional Kyphosis Following Long Instrumented Fusion from L1 to Sacrum: Age Itself Does Not Independently Increase the Risk. Medicina 2024, 60, 1441. https://doi.org/10.3390/medicina60091441
Ahn J, Kim Y-H, Kim Y-C, Kim K-T, Kim S-M, Park JB, Ha K-Y. Analysis of Risk Factors Associated with Proximal Junctional Kyphosis Following Long Instrumented Fusion from L1 to Sacrum: Age Itself Does Not Independently Increase the Risk. Medicina. 2024; 60(9):1441. https://doi.org/10.3390/medicina60091441
Chicago/Turabian StyleAhn, Joonghyun, Young-Hoon Kim, Yong-Chan Kim, Ki-Tack Kim, Sung-Min Kim, Jun Bum Park, and Kee-Yong Ha. 2024. "Analysis of Risk Factors Associated with Proximal Junctional Kyphosis Following Long Instrumented Fusion from L1 to Sacrum: Age Itself Does Not Independently Increase the Risk" Medicina 60, no. 9: 1441. https://doi.org/10.3390/medicina60091441