Surgical Correction of Distal Junctional Kyphosis

Azzam, Moatasem M.; Guiroy, Alfredo; Galgano, Michael A.

doi:10.1016/j.wneu.2022.11.032

Cited by 3 publications

(1 citation statement)

References 8 publications

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“… 7 This finding indicates that although the incidence of DJPs is lower than that of PJK/PJF, affected patients are more likely to require revision surgery when they occur. 8 , 9 The pathogenic mechanisms underlying DJPs are multifactorial, and older age, 7 large preoperative sagittal parameters, 10 fusion short of including the first lordotic disc, 11 selection of the incorrect lowest instrumented vertebra (LIV), 12 , 13 and inability to match the postoperative sagittal plane with the pelvic incidence (PI) 14 have been reported to be involved. Recently, lower muscularity and higher fatty degeneration have been reported as risk factors for PJK.…”

Section: Introductionmentioning

confidence: 99%

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

Liu,

Yuan,

Zeng

et al. 2023

Orthopaedic Surgery

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PurposeAlthough 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.MethodsA 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.ResultsTwenty‐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.ConclusionLonger 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.

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