Novel Radiological Predictors for the Progression of Proximal Junctional Kyphosis in Osteoporotic Vertebral Compression Fracture with Kyphosis Following Posterior Corrective Surgery

Overview

Journal Spine Deform

Publisher Springer Nature

Date 2024 Nov 2

PMID 39487893

Authors

Junyu Li

Yinghong Ma

Baitao Liu

Junjie Ma

Zhuoran Sun

Yongqiang Wang

Miao Yu

Weishi Li

Yan Zeng

Affiliations

Soon will be listed here.

Abstract

Objective: This study aimed to identify the effect of some novel risk factors associated with L1 vertebrae and parameters closely related to the sagittal alignment for the occurrence of proximal junctional kyphosis (PJK) following surgery for patients with osteoporotic vertebral compression fractures (OVCF) kyphosis.

Methods: 74 OVCF patients undergoing posterior corrective surgery between January 2008 and June 2021 with a minimum 2-year follow-up were included. These patients were divided into PJK and non-PJK groups. Spinopelvic parameters, including thoracolumbar slope (TLS) and the L1 plumb line (L1PL) were measured preoperatively, postoperatively, and at follow-up. Multivariate logistic analysis was performed on various risk factors and Global Alignment and Proportion (GAP) scores. Associations between novel parameters and PJK were analyzed using receiver operating characteristic (ROC) analysis.

Results: PJK was identified in 28.4% of patients. The mean age and follow-up were 63.45 years and 38.17 months, respectively. There was no difference between the PJK and the non-PJK groups in baseline demographics, pre-operative and immediate post-operative pelvic incidence-lumbar lordosis mismatch. Multiple comparisons showed that the proportion of PJK in the severely disproportioned group(the group with the highest GAP scores) and that of the other two groups with lower GAP scores were statistically different (P < 0.001). Potential risk factors for PJK included preoperative thoracic kyphosis (TK) (P < 0.001), TLS (P = 0.016), postoperative TLS (P < 0.001), and L1PL (P < 0.001). Postoperative TLS and L1PL were respectively independent risk factors for PJK, with the cut-off values set at 8.6° and 10.4 mm to predict the occurrence of PJK.

Conclusions: TLS and L1PL can be used to predict the occurrence of PJK in patients undergoing surgery for OVCF and are crucial for preventing the progression of PJK. Achieving a proportionate GAP Score postoperatively seems to be a viable option as higher GAP scores were associated with higher rates of PJK.

References

Silverman S . The clinical consequences of vertebral compression fracture. Bone. 1992; 13 Suppl 2:S27-31. DOI: 10.1016/8756-3282(92)90193-z. View

Kou Y, Zhang D, Zhang J, Han N, Yang M . Vertebroplasty with high-viscosity cement versus conventional kyphoplasty for osteoporotic vertebral compression fractures: a meta-analysis. ANZ J Surg. 2022; 92(11):2849-2858. DOI: 10.1111/ans.17894. View

Nakajima H, Uchida K, Honjoh K, Sakamoto T, Kitade M, Baba H . Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience. J Neurosurg Spine. 2015; 24(1):39-47. DOI: 10.3171/2015.4.SPINE14847. View

Uchida K, Nakajima H, Yayama T, Miyazaki T, Hirai T, Kobayashi S . Vertebroplasty-augmented short-segment posterior fixation of osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine: comparisons with posterior surgery without vertebroplasty and anterior surgery. J Neurosurg Spine. 2010; 13(5):612-21. DOI: 10.3171/2010.5.SPINE09813. View

Nguyen N, Kong C, Hart R . Proximal junctional kyphosis and failure-diagnosis, prevention, and treatment. Curr Rev Musculoskelet Med. 2016; 9(3):299-308. PMC: 4958385. DOI: 10.1007/s12178-016-9353-8. View

Li Q, Yang J, He B, Liu T, Gao L, Chai X . Risk factors for proximal junctional kyphosis after posterior long-segment internal fixation for chronic symptomatic osteoporotic thoracolumbar fractures with kyphosis. BMC Surg. 2022; 22(1):189. PMC: 9107743. DOI: 10.1186/s12893-022-01598-9. View

Ham D, Kim H, Park S, Park S, Park J, Yeom J . The importance of thoracolumbar junctional orientation, change in thoracolumbar angle, and overcorrection of lumbar lordosis in development of proximal junctional kyphosis in adult spinal deformity surgery. J Neurosurg Spine. 2022; 37(6):874-882. DOI: 10.3171/2022.5.SPINE211528. View

Chen K, Chen Y, Shao J, Zhoutian J, Wang F, Chen Z . Long-Term Follow-up of Posterior Selective Thoracolumbar/Lumbar Fusion in Patients With Lenke 5C Adolescent Idiopathic Scoliosis: An Analysis of 10-Year Outcomes. Global Spine J. 2020; 12(5):840-850. PMC: 9344518. DOI: 10.1177/2192568220965566. View

10.

Scheer J, Osorio J, Smith J, Schwab F, Lafage V, Hart R . Development of Validated Computer-based Preoperative Predictive Model for Proximal Junction Failure (PJF) or Clinically Significant PJK With 86% Accuracy Based on 510 ASD Patients With 2-year Follow-up. Spine (Phila Pa 1976). 2016; 41(22):E1328-E1335. DOI: 10.1097/BRS.0000000000001598. View

11.

Kim H, Bridwell K, Lenke L, Park M, Song K, Piyaskulkaew C . Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections. Spine (Phila Pa 1976). 2014; 39(9):E576-80. DOI: 10.1097/BRS.0000000000000246. View

12.

Yagi M, Rahm M, Gaines R, Maziad A, Ross T, Kim H . Characterization and surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity. Spine (Phila Pa 1976). 2014; 39(10):E607-14. DOI: 10.1097/BRS.0000000000000266. View

13.

Lafage R, Bess S, Glassman S, Ames C, Burton D, Hart R . Virtual Modeling of Postoperative Alignment After Adult Spinal Deformity Surgery Helps Predict Associations Between Compensatory Spinopelvic Alignment Changes, Overcorrection, and Proximal Junctional Kyphosis. Spine (Phila Pa 1976). 2017; 42(19):E1119-E1125. DOI: 10.1097/BRS.0000000000002116. View

14.

Yilgor C, Sogunmez N, Boissiere L, Yavuz Y, Obeid I, Kleinstuck F . Global Alignment and Proportion (GAP) Score: Development and Validation of a New Method of Analyzing Spinopelvic Alignment to Predict Mechanical Complications After Adult Spinal Deformity Surgery. J Bone Joint Surg Am. 2017; 99(19):1661-1672. DOI: 10.2106/JBJS.16.01594. View

15.

Ye J, Yin T, Gupta S, Farooqi A, Wan W, Yilgor C . Use of the Global Alignment and Proportion score to predict postoperative health-related quality of life in adult spinal deformity surgery. J Neurosurg Spine. 2023; 38(3):340-347. DOI: 10.3171/2022.9.SPINE22809. View

16.

Lafage R, Schwab F, Glassman S, Bess S, Harris B, Sheer J . Age-Adjusted Alignment Goals Have the Potential to Reduce PJK. Spine (Phila Pa 1976). 2017; 42(17):1275-1282. DOI: 10.1097/BRS.0000000000002146. View

17.

Wen Z, Mo X, Zhao S, Lin W, Chen Z, Huang Z . Comparison of Percutaneous Kyphoplasty and Pedicle Screw Fixation for Treatment of Thoracolumbar Severe Osteoporotic Vertebral Compression Fracture with Kyphosis. World Neurosurg. 2021; 152:e589-e596. DOI: 10.1016/j.wneu.2021.06.030. View

18.

OLeary P, Bridwell K, Lenke L, Good C, Pichelmann M, Buchowski J . Risk factors and outcomes for catastrophic failures at the top of long pedicle screw constructs: a matched cohort analysis performed at a single center. Spine (Phila Pa 1976). 2009; 34(20):2134-9. DOI: 10.1097/BRS.0b013e3181b2e17e. View

19.

Oe S, Togawa D, Hasegawa T, Yamato Y, Yoshida G, Kobayashi S . The Risk of Proximal Junctional Kyphosis Decreases in Patients With Optimal Thoracic Kyphosis. Spine Deform. 2019; 7(5):759-770. DOI: 10.1016/j.jspd.2018.12.007. View

20.

Zhang X, Shu S, Zhu Z, Gu Q, Liu Z, Qiu Y . Proximal junctional kyphosis is a compensation for post-operative negative C2-FH in ASD patients: a cross-sectional study. J Orthop Surg Res. 2022; 17(1):442. PMC: 9547422. DOI: 10.1186/s13018-022-03336-6. View

21.

Liang J, Dong Y, Zhao H . Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion. J Orthop Surg Res. 2014; 9:97. PMC: 4197214. DOI: 10.1186/s13018-014-0097-0. View