Iatrogenic posterior translation of the construct at the uppermost instrumented vertebrae is associated with proximal junctional kyphosis.

• Tác giả: Christopher P Ames, Mariah Balmaceno-Criss, Shay Bess, Thomas Buell, Douglas C Burton, Mohammad Daher, Alan H Daniels, Bassel G Diebo, Robert K Eastlack, Richard Fessler, Jeffrey L Gum, Munish C Gupta, D Kojo Hamilton, Richard Hostin, Khaled M Kebaish, Han Jo Kim, Eric O Klineberg, Renaud Lafage, Virginie Lafage, Lawrence G Lenke, Stephen Lewis, Breton G Line, Jeffery Mullin, Gregory M Mundis, Pierce D Nunley, Peter G Passias, Themistocles S Protopsaltis, Justin K Scheer, Frank J Schwab, Christopher I Shaffrey, Manjot Singh, Justin S Smith, Alex Soroceanu
• Ngôn ngữ: eng
• Ký hiệu phân loại: 612.665 Climacteric
• Thông tin xuất bản: Germany : European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society , 2025
• Bộ sưu tập: NCBI
• ID: 180556

Tóm tắt

 PURPOSE: To determine if iatrogenic posterior translation (UIV SPi) at the upper instrumented vertebrae (UIV) is associated with increased mechanical complications and secondarily to generate and validate a UIV SPi threshold for increased complications. METHODS: Two patient databases were utilized: one for generating a UIV SPi threshold and another for validation. Patients with a UIV between T8-L1 and a LIV at ilium were included. A receiver operating curve (ROC) curve analyses was performed to generate a threshold that predicted proximal junctional complications. This UIV SPi angle (-16.0°) was rounded to -15.0° for practical clinical use and validated in a separate cohort. Patients were stratified as above (most translated, MT) or below (least translated, LT) the threshold for comparative demographic and outcomes analyses. RESULTS: Generation of the threshold on 192 patients (122 LT, 70 MT) revealed that the MT group had higher absolute postoperative UIV SVA (MT=-56.1 ± 23.1 mm vs. LT=-10.4 ± 31.8 mm, p <
  0.001), higher PT (25.7° vs. 19.3°, p <
  0.001), and 2.8-5.8 times greater odds of postoperative proximal junctional complications at 2-years (p <
  0.05). Validation on 135 patients (95 LT, 40 MT) revealed that the MT group had 11.7 times greater odds of radiographic PJK and had 4.5 times greater odds of all-cause reoperations (p <
  0.05). CONCLUSION: Patients with UIV posterior translation, despite similar PI-LL and T1PA, exhibit a high PT and experience higher odds of proximal junctional complications. Our findings support limiting the UIV SPi to <
  15° of posterior translation to mitigate postoperative mechanical complications. LEVEL OF EVIDENCE: IV.