Surgical outcomes for late neurological deficits after long segment instrumentation for degenerative adult spinal deformity

Abstract

OBJECTIVE The most catastrophic symptom of proximal junctional failure (PJF) following long instrumented fusion surgery for adult spinal deformity (ASD) is neurological deficits. Although previous reports have shown that PJF usually developed during the early postoperative period, some patients showed late neurological deficits. The aim of this study was to report the incidence, characteristics, and surgical outcomes of PJF with late neurological deficits. METHODS Patients surgically treated for ASD at a single institution were retrospectively reviewed. Among them, the patients requiring revision surgery for newly developed neurological deficits at least 6 months after the initial surgery were included. Patient demographic, radiographic, surgical, and clinical data were investigated. Neurological status was assessed using the Frankel grading system. RESULTS PJF with late neurological deficits developed in 18 of 385 patients (4.7%). The mean age at the onset of neurological deficits was 72.0 ± 6.0 years, and the median time from the initial surgery was 4.5 years. The most common pathology of PJF was adjacent disc degeneration and subsequent canal stenosis (11 patients). Five patients showed disc degeneration with aseptic bone destruction. Fractures at the upper instrumented vertebra (UIV), UIV + 1, and UIV + 2 occurred in 2, 3, and 2 patients, respectively. Ossification of the yellow ligament, which had not been found at the first surgery, was identified in 6 patients. Eight patients showed improvement of their neurological deficits and 10 patients showed no improvement by the final follow-up. Perioperative major complications occurred in 8 of 18 patients. CONCLUSIONS The incidence of PJF with late neurological deficits following ASD surgery was 4.7% in this cohort. The patients showed several morphological features. After revision surgery, perioperative complications were common and the prognosis for improved neurological status was not favorable.

Anterior Lateral Approach for Anterior Decompression, Corpectomy, and Fixation with Webb Morley Procedure for Dorsolumbar Spinal Fracture

“…Notably, upon undergoing revision surgery, a high incidence of perioperative complications was identified. 11 In a report, they had 85% of patient injury 'fall from height', and they had 55% of the fracture presentation at dorsal-lumbar junction (T12-L1). Burst-type morphology was reported in a maximum number of patients (65%).…”

Occupancy Rate of Pedicle Screw Below 80% is a Risk Factor for Upper Instrumented Vertebral Fracture After Adult Spinal Deformity Surgery

“…However, effective approaches to prevent UIVFs remain unclear. Strengthening bone density is considered an important measure,8,9 but some reports indicate that bone density and PJF are not related 5,10,11. Recently, Oe et al 12 named the ratio of pedicle screw (PS) length to the anterior-posterior diameter of the vertebral body at the UIV as the occupancy rate of a pedicle screw (ORPS) and, using finite element analysis, reported that the stress on the UIV decreased the most when the ORPS was 81.8% or more.…”