Risk factors of proximal junctional angle increase after selective posterior thoracolumbar/lumbar fusion in patients with adolescent idiopathic scoliosis

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• 作者：Zhijian Sun ; Guixing Qiu ; Yu Zhao ; Shigong Guo ; Yipeng Wang…
• 关键词：Adolescent idiopathic scoliosis ; Thoracolumbar/lumbar curve ; Proximal junctional angle ; Proximal junctional kyphosis ; Risk factors
• 刊名：European Spine Journal
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：24
• 期：2
• 页码：290-297
• 全文大小：1,235 KB
• 参考文献：1. Kim HJ, Lenke LG, Shaffrey CI, Van Alstyne EM, Skelly AC (2012) Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review. Spine (Phila Pa 1976) 37:S144–S164. doi:10.1097/BRS.0b013e31826d611b CrossRef
  2. Yagi M, Akilah KB, Boachie-Adjei O (2011) Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Spine (Phila Pa 1976) 36:E60–E68. doi:10.1097/BRS.0b013e3181eeaee2 CrossRef
  3. Kim HJ, Bridwell KH, Lenke LG, Park MS, Ahmad A, Song KS, Piyaskulkaew C, Hershman S, Fogelson J, Mesfin A (2013) Proximal junctional kyphosis results in inferior SRS pain subscores in adult deformity patients. Spine (Phila Pa 1976) 38:896-01. doi:10.1097/BRS.0b013e3182815b42 CrossRef
  4. Kim YJ, Bridwell KH, Lenke LG, Glattes CR, Rhim S, Cheh G (2008) Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up. Spine (Phila Pa 1976) 33:2179-184. doi:10.1097/BRS.0b013e31817c0428 CrossRef
  5. Hart R, McCarthy I, O’Brien M, Bess S, Line B, Burton D, Gupta M, Ames C, Deviren V, Kebaish K, Shaffrey C, Wood K, Hostin R, International SSG (2013) Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity. Spine (Phila Pa 1976) 38:E1223–E1227. doi:10.1097/BRS.0b013e31829fedde CrossRef
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  7. Helgeson MD, Shah SA, Newton PO, Clements, Betz RR, Marks MC, Bastrom T (2010) Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation. Spine (Phila Pa 1976) 35:177-81. doi:10.1097/BRS.0b013e3181c77f8c CrossRef
  8. Lee GA, Betz RR, Clements, Huss GK (1999) Proximal kyphosis after posterior spinal fusion in patients with idiopathic scoliosis. Spine (Phila Pa 1976) 24:795-99 CrossRef
  9. Rhee JM, Bridwell KH, Won DS, Lenke LG, Chotigavanichaya C, Hanson DS (2002) Sagittal plane analysis of adolescent idiopathic scoliosis: the effect of anterior versus posterior instrumentation. Spine (Phila Pa 1976) 27:2350-356. doi:10.1097/01.BRS.0000030301.48250.3D CrossRef
  10. Kim YJ, Bridwell KH, Lenke LG, Kim J, Cho SK (2005) Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up. Spine (Phila Pa 1976) 30:2045-050 CrossRef
  11. Kim YJ, Lenke LG, Bridwell KH, Kim J, Cho SK, Cheh G, Yoon J (2007) Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases. Spine (Phila Pa 1976) 32:2731-738. doi:10.1097/BRS.0b013e31815a7ead CrossRef
  12. Wang J, Zhao Y, Shen B, Wang C, Li M (2010) Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis.
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgical Orthopedics
  Neurosurgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-0932

文摘

Purpose To analyze risk factors for an increase in proximal junctional angle (PJA) after posterior selective thoracolumbar/lumbar (TL/L) curve fusion in patients with adolescent idiopathic scoliosis (AIS). Methods AIS patients that underwent selective posterior TL/L curve fusion with a minimum of 2-year follow-up were identified. Demographic and radiographic data were collected before surgery, at first erect after surgery and at final follow-up. Multiple linear regression analysis was performed to determine the relation of PJA changes during follow-up and eight potential risk?factors, including locations of upper instrumented vertebra (UIV), locations of lower instrumented vertebra (LIV), length of fusion segments, types of pedicle screw alignment, lumbar lordosis (LL) at first erect after surgery, LL changes before and after surgery, sagittal vertical axis (SVA) at first erect after surgery and SVA changes before and after surgery. Results A total of 41 patients were included in this study. There were 37 female and 4 male with a mean age of 14.7?years at surgery. PJA was increased from 5.5° immediately after surgery to 10.8° at the last follow-up (P? Conclusions Location of LIV above or equal to L3, higher postoperative LL and deteriorative negative SVA with surgery were potential risk?factors for increased PJA during follow-up. Postoperative LIV inclination more than 5omight be also an indicator for an increase in PJA.