Analysis of mechanical failure associated with reoperation in spinal fusion to the sacrum in adult spinal deformity

Inoue, Shinichi; Khashan, Morsi; Fujimori, Takahito; Berven, Sigurd

doi:10.1007/s00776-015-0729-1

Cited by 33 publications

(15 citation statements)

References 29 publications

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“…In contrast to Inoue et al [10], our data suggest that PJK is not generally linked to sacral extension except in patients with an UIV of T9-T12.…”

Section: Discussioncontrasting

confidence: 99%

“…Though, our results contradict previously findings, it should be noted that others including Bridwell et al [8] focused on the PJK angle in adult scoliosis patients, rather than SE as a potential risk factor for PJK. Inoue et al [10] showed increased PJK rates in patients with fusion down to the sacrum after ASD realigning surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the risk of PJK increased with greater baseline deformity and consequently large surgical correction [6,7]. Other variables that affected PJK were high body mass index (BMI), older age, smoking and low bone density [8][9][10]. Whether the level of the UIV and the number of fused vertebrae increases the risk of developing PJK is currently being debated [8,11,12].…”

Section: Introductionmentioning

confidence: 99%

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Is Sacral Extension a Risk Factor for Early Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery?

et al. 2020

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Study Design: Retrospective cohort study.Purpose: To investigate the role of sacral extension (SE) for the development of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery.Overview of Literature: The development of PJK is multifactorial and different risk factors have been identified. Of these, there is some evidence that SE also affects the development of PJK, but data are insufficient. Methods: Using a combined database comprising two propensity-matched groups of fusions following ASD surgery, one with fixation to S1 or S1 and the ilium (SE) and one without SE but with a lower instrumented vertebra of L5 or higher (lumbar fixation, LF), PJK and the role of further parameters were analyzed. The propensity-matched variables included age, the upper-most instrumented vertebra (UIV), preoperative sagittal alignment, and the baseline to one year change of the sagittal alignment.Results: Propensity matching led to two groups of 89 patients each. The UIV, pelvic incidence minus lumbar lordosis, sagittal vertical axis, pelvic tilt, age, and body mass index were similar in both groups (p >0.05). The incidence of PJK at postoperative one year was similar for SE (30.3%) and LF (22.5%) groups (p =0.207). The PJK angle was comparable (p =0.963) with a change of −8.2° (SE) and −8.3° (LF) from the preoperative measures (p =0.954). A higher rate of PJK after SE (p =0.026) was found only in the subgroup of patients with UIV levels between T9 and T12.Conclusions: Instrumentation to the sacrum with or without iliac extension did not increase the overall risk of PJK. However, an increased risk for PJK was found after SE with UIV levels between T9 and T12.

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“…In contrast to Inoue et al [10], our data suggest that PJK is not generally linked to sacral extension except in patients with an UIV of T9-T12.…”

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is Sacral Extension a Risk Factor for Early Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery?

et al. 2020

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“…Mechanical failures, including but not limited to PJK, PJF, DJK, and implant breakage, after spine deformity surgery occur in 12% to 47% of postoperative patients. [11][12][13] Given the high rates of mechanical failures, there has been a conscientious effort to limit such postoperative complications by screening and optimizing patients preoperatively, utilizing newly designed instrumentation, and developing new radiographic parameters to predict postoperative failures. 2,4,12 The recently developed GAP score is an example of a proposed way to predict postoperative mechanical complications using new radiographic parameters.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 The Global Alignment and Proportion (GAP) score is a recently developed score assessing sagittal balance and predicting mechanical complications. 10,11 The GAP score is a pelvic incidence based proportional method of analyzing the sagittal alignment that assigns a cumulative score obtained from the patient's age and 4 different radiographic parameters. The GAP score is divided into 3 categories: proportioned (total score 0-2), moderately disproportioned (total score 3-6), and severely disproportioned (total score 7 and more), which reliably predicted increasing mechanical failure rates for groups with higher scores.…”

Section: Introductionmentioning

confidence: 99%

Partial Intraoperative Global Alignment and Proportion Scores Do Not Reliably Predict Postoperative Mechanical Failure in Adult Spinal Deformity Surgery

Hong

Coury

et al. 2020

Global Spine Journal

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Study Design: Retrospective radiographic review. Objectives: The Global Alignment and Proportion (GAP) score allows sagittal plane analysis for deformity patients and may be predictive of mechanical complications. This study aims to assess the effectiveness of predicting mechanical failure based on partial intraoperative GAP (iGAP) scores. Methods: A retrospective radiographic review was performed on 48 deformity patients between July 2015 to January 2017 with a 2-year follow-up. Using the same methodology as the original GAP study, the partial iGAP score was calculated with the sum of the scores for age, relative lumbar lordosis (RLL), and lordosis distribution index (LDI). Therefore, the iGAP score (0-7) was grouped into proportional (0-2), mildly disproportionate (3-5), and severely disproportionate (6-7). Logistic regression was performed to assess the ability of the partial iGAP score to predict postoperative mechanical failure. Results: The mean iGAP for patients with a mechanical failure was 3.54, whereas the iGAP for those without a mechanical failure was 3.46 ( P = .90). The overall mechanical failure rate was 27.1%. The mechanical failures included 8 proximal junctional kyphosis, 7 rod fractures, and 1 rod slippage from the distal end of the construct. Logistic regression analysis revealed that the partial iGAP score was not able to predict postoperative mechanical failure (χ2 = 1.4; P = .49). Conclusion: The iGAP scores for RLL or LDI did not show any significant correlation to postoperative mechanical failure. Ultimately, the proposed partial iGAP score did not predict postoperative mechanical failure and thus, cannot be used as an intraoperative alignment assessment to avoid postoperative mechanical complications.

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Modifiable Factors in a Standard Work Protocol for Adult Deformity Surgery

Burton¹

2019

Value-Based Approaches to Spine Care

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Analysis of mechanical failure associated with reoperation in spinal fusion to the sacrum in adult spinal deformity

Cited by 33 publications

References 29 publications

Is Sacral Extension a Risk Factor for Early Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery?

Is Sacral Extension a Risk Factor for Early Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery?

Partial Intraoperative Global Alignment and Proportion Scores Do Not Reliably Predict Postoperative Mechanical Failure in Adult Spinal Deformity Surgery

Modifiable Factors in a Standard Work Protocol for Adult Deformity Surgery

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