Browsing by Author "Kim, Han-Jo"
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Item Open Access Assessing Abnormal Proximal Junctional Angles in Adult Spinal Deformity: A Normative Data Approach to Define Proximal Junctional Kyphosis.(Spine, 2024-10) Khalifé, Marc; Lafage, Renaud; Daniels, Alan H; Diebo, Bassel G; Elysée, Jonathan; Ames, Christopher P; Bess, Shay R; Burton, Douglas C; Eastlack, Robert K; Gupta, Munish C; Hostin, Richard A; Kebaish, Khaled; Kim, Han-Jo; Klineberg, Eric O; Mundis, Gregory; Okonkwo, David O; Gille, Olivier; Guigui, Pierre; Ferrero, Emmanuelle; Skalli, Wafa; Assi, Ayman; Vergari, Claudio; Shaffrey, Christopher I; Smith, Justin S; Schwab, Frank J; Lafage, Virginie; International Spine Study GroupStudy design
Multicentric retrospective study of prospectively collected data.Objective
Based on normative data from a cohort of asymptomatic volunteers, this study sought to determine the rate of abnormal values of proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, and compare it with PJK rate.Summary of background data
Proximal junctional kyphosis (PJK) definition does not take the vertebral level into account.Methods
This study included 721 healthy volunteers and 824 ASD surgery patients with 2-year postoperative follow-up. Normative values for each disc and vertebral body between T1 and T12 were analyzed, then normative values for PJA at each thoracic level were defined in the volunteer cohort as the mean±2 standard deviations. PJA abnormal values at the upper instrumented vertebra (UIV) were compared with Glattes' and Lovecchio's definitions for PJK in the ASD population at two years.Results
Mean age was 37.7±16.3 in the volunteer cohort, with 50.5% of females. Mean thoracic kyphosis (TK) was -50.9±10.8°. Corridors of normality included PJA greater than 20° between T3 and T12. Mean age was 60.5±14.0 years in the ASD cohort, with 77.2% of females. Mean baseline TK was -37.4±19.9°, with a significant increase after surgery (-15.6±15.3°, P<0.001). There was 46.2% of PJK according to Glattes' versus 8.7% according to Lovecchio's and 22.9% of kyphotic PJA compared to normative values (P<0.001).Conclusion
This study provides normative values for segmental and regional alignment of thoracic spine, used to describe abnormal values of PJA for each level. Using level-adjusted PJA values allows a more precise assessment of abnormal proximal angles and question the definition for PJK.Level of evidence
II.Item Open Access Distal junctional kyphosis in adult cervical deformity patients: where does it occur?(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, 2023-05) Ye, Jichao; Rider, Sean M; Lafage, Renaud; Gupta, Sachin; Farooqi, Ali S; Protopsaltis, Themistocles S; Passias, Peter G; Smith, Justin S; Lafage, Virginie; Kim, Han-Jo; Klineberg, Eric O; Kebaish, Khaled M; Scheer, Justin K; Mundis, Gregory M; Soroceanu, Alex; Bess, Shay; Ames, Christopher P; Shaffrey, Christopher I; Gupta, Munish C; International Spine Study Group (ISSG)Purpose
To evaluate the impact of the lowest instrumented vertebra (LIV) on Distal Junctional kyphosis (DJK) incidence in adult cervical deformity (ACD) surgery.Methods
Prospectively collected data from ACD patients undergoing posterior or anterior-posterior reconstruction at 13 US sites was reviewed up to 2-years postoperatively (n = 140). Data was stratified into five groups by level of LIV: C6-C7, T1-T2, T3-Apex, Apex-T10, and T11-L2. DJK was defined as a kyphotic increase > 10° in Cobb angle from LIV to LIV-1. Analysis included DJK-free survival, covariate-controlled cox regression, and DJK incidence at 1-year follow-up.Results
25/27 cases of DJK developed within 1-year post-op. In patients with a minimum follow-up of 1-year (n = 102), the incidence of DJK by level of LIV was: C6-7 (3/12, 25.00%), T1-T2 (3/29, 10.34%), T3-Apex (7/41, 17.07%), Apex-T10 (8/11, 72.73%), and T11-L2 (4/8, 50.00%) (p < 0.001). DJK incidence was significantly lower in the T1-T2 LIV group (adjusted residual = -2.13), and significantly higher in the Apex-T10 LIV group (adjusted residual = 3.91). In covariate-controlled regression using the T11-L2 LIV group as reference, LIV selected at the T1-T2 level (HR = 0.054, p = 0.008) or T3-Apex level (HR = 0.081, p = 0.010) was associated with significantly lower risk of DJK. However, there was no difference in DJK risk when LIV was selected at the C6-C7 level (HR = 0.239, p = 0.214).Conclusion
DJK risk is lower when the LIV is at the upper thoracic segment than the lower cervical segment. DJK incidence is highest with LIV level in the lower thoracic or thoracolumbar junction.Item Open Access Mechanisms of lumbar spine “flattening” in adult spinal deformity: defining changes in shape that occur relative to a normative population(European Spine Journal, 2024-01-01) Lafage, Renaud; Mota, Frank; Khalifé, Marc; Protopsaltis, Themistocles; Passias, Peter G; Kim, Han-Jo; Line, Breton; Elysée, Jonathan; Mundis, Gregory; Shaffrey, Christopher I; Ames, Christopher P; Klineberg, Eric O; Gupta, Munish C; Burton, Douglas C; Lenke, Lawrence G; Bess, Shay; Smith, Justin S; Schwab, Frank J; Lafage, Virginie; ISSGPurpose: Previous work comparing ASD to a normative population demonstrated that a large proportion of lumbar lordosis is lost proximally (L1-L4). The current study expands on these findings by collectively investigating regional angles and spinal contours. Methods: 119 asymptomatic volunteers with full-body free-standing radiographs were used to identify age-and-PI models of each Vertebra Pelvic Angle (VPA) from L5 to T10. These formulas were then applied to a cohort of primary surgical ASD patients without coronal malalignment. Loss of lumbar lordosis (LL) was defined as the offset between age-and-PI normative value and pre-operative alignment. Spine shapes defined by VPAs were compared and analyzed using paired t-tests. Results: 362 ASD patients were identified (age = 64.4 ± 13, 57.1% females). Compared to their age-and-PI normative values, patients demonstrated a significant loss in LL of 17 ± 19° in the following distribution: 14.1% had “No loss” (mean = 0.1 ± 2.3), 22.9% with 10°-loss (mean = 9.9 ± 2.9), 22.1% with 20°-loss (mean = 20.0 ± 2.8), and 29.3% with 30°-loss (mean = 33.8 ± 6.0). “No loss” patients’ spine was slightly posterior to the normative shape from L4 to T10 (VPA difference of 2°), while superimposed on the normative one from S1 to L2 and became anterior at L1 in the “10°-loss” group. As LL loss increased, ASD and normative shapes offset extended caudally to L3 for the “20°-loss” group and L4 for the “30°-loss” group. Conclusion: As LL loss increases, the difference between ASD and normative shapes first occurs proximally and then progresses incrementally caudally. Understanding spinal contour and LL loss location may be key to achieving sustainable correction by identifying optimal and personalized postoperative shapes.Item Open Access Patient Satisfaction After Adult Spinal Deformity Surgery Does Not Strongly Correlate With Health-Related Quality of Life Scores, Radiographic Parameters, or Occurrence of Complications.(Spine, 2017-05) Hamilton, David Kojo; Kong, Christopher; Hiratzka, Jayme; Contag, Alec G; Ailon, Tamir; Line, Breton; Daniels, Alan; Smith, Justin S; Passias, Peter; Protopsaltis, Themistocles; Sciubba, Daniel; Burton, Douglas; Shaffrey, Christopher; Klineberg, Eric; Mundis, Gregory; Kim, Han-Jo; Lafage, Virginie; Lafage, Renaud; Scheer, Justin; Boachie-Adjei, Oheneba; Bess, Shay; Hart, Robert AStudy design
This is a multicenter retrospective review of prospectively collected cases.Objective
Our objective was to evaluate the relationship between patient satisfaction, health-related quality of life (HRQoL) scores, complications, and radiographic measures at 2 years postoperative follow-up.Summary of background data
For patients receiving operative management for adult spine deformity (ASD), the relationship between HRQoL measures, radiographic parameters, postoperative complications, and self-reported satisfaction remains unclear.Methods
Data from 248 patients across 11 centers within the United States who underwent thoracolumbar fusion for ASD and had a minimum of 2 years follow-up was collected. Pre- and postoperative scores were obtained from the Scoliosis Research Society 22-item (SRS-22r), the Oswestry Disability Index (ODI), the 36-Item Short Form Health Survey (SF-36), and the Visual Analogue Scale. Sagittal vertical axis, coronal C7 plumbline, lumbar lordosis, pelvic tilt, T1 pelvic angle, and the difference between pelvic incidence and lumbar lordosis were assessed using postoperative radiographic films. Satisfaction (SAT) was assessed using the SRS-22r; patients were categorized as highly satisfied (HS) or less satisfied (LS). The correlation between SAT and HRQoL scores, radiographic parameters, and complications was determined.Results
When compared with LS (n = 60) patients, HS (n = 188) patients demonstrated greater improvement in final ODI, SF-36 component scores, SRS-Total, and Visual Analogue Scale back scores (P < 0.05). The correlations between SAT and the final follow-up and 2 year change from baseline values were moderate for Mental Component Summary, Physical Component Summary, and ODI or weak for HRQoL scores (P < 0.0001). The HS and LS groups were equal in pre- or final postoperative radiographic parameters. Occurrence of complications had no effect on satisfaction.Conclusion
Among operatively treated ASD patients, satisfaction was moderately correlated with some HRQoL measures, and not with radiographic changes or postoperative complications. Other factors, such as patient expectations and relationship with the surgeon, may be stronger drivers of patient satisfaction.Level of evidence
3.Item Open Access Revision Strategy for Proximal Junctional Failure: Combined Effect of Proximal Extension and Focal Correction.(Global spine journal, 2024-05) Lafage, Renaud; Kim, Han-Jo; Eastlack, Robert K; Daniels, Alan H; Diebo, Bassel G; Mundis, Greg; Khalifé, Marc; Smith, Justin S; Bess, Shay R; Shaffrey, Christopher I; Ames, Christopher P; Burton, Douglas C; Gupta, Munish C; Klineberg, Eric O; Schwab, Frank J; Lafage, Virginie; ISSGStudy design
Retrospective review of a prospectively-collected multicenter database.Objectives
The objective of this study was to determine optimal strategies in terms of focal angular correction and length of proximal extension during revision for PJF.Methods
134 patients requiring proximal extension for PJF were analyzed in this study. The correlation between amount of proximal junctional angle (PJA) reduction and recurrence of proximal junctional kyphosis (PJK) and/or PJF was investigated. Following stratification by the degree of PJK correction and the numbers of levels extended proximally, rates of radiographic PJK (PJA >28° & ΔPJA >22°), and recurrent surgery for PJF were reported.Results
Before revision, mean PJA was 27.6° ± 14.6°. Mean number of levels extended was 6.0 ± 3.3. Average PJA reduction was 18.8° ± 18.9°. A correlation between the degree of PJA reduction and rate of recurrent PJK was observed (r = -.222). Recurrent radiographic PJK (0%) and clinical PJF (4.5%) were rare in patients undergoing extension ≥8 levels, regardless of angular correction. Patients with small reductions (<5°) and small extensions (<4 levels) experienced moderate rates of recurrent PJK (19.1%) and PJF (9.5%). Patients with large reductions (>30°) and extensions <8 levels had the highest rate of recurrent PJK (31.8%) and PJF (16.0%).Conclusion
While the degree of focal PJK correction must be determined by the treating surgeon based upon clinical goals, recurrent PJK may be minimized by limiting reduction to <30°. If larger PJA correction is required, more extensive proximal fusion constructs may mitigate recurrent PJK/PJF rates.Item Open Access Spinopelvic sagittal compensation in adult cervical deformity.(Journal of neurosurgery. Spine, 2023-03) Ye, Jichao; Rider, Sean M; Lafage, Renaud; Gupta, Sachin; Farooqi, Ali S; Protopsaltis, Themistocles S; Passias, Peter G; Smith, Justin S; Lafage, Virginie; Kim, Han-Jo; Klineberg, Eric O; Kebaish, Khaled M; Scheer, Justin K; Mundis, Gregory M; Soroceanu, Alex; Bess, Shay; Ames, Christopher P; Shaffrey, Christopher I; Gupta, Munish C; International Spine Study Group (ISSG)Objective
The objective of this study was to evaluate spinopelvic sagittal alignment and spinal compensatory changes in adult cervical kyphotic deformity.Methods
A database composed of 13 US spine centers was retrospectively reviewed for adult patients who underwent cervical reconstruction with radiographic evidence of cervical kyphotic deformity: C2-7 sagittal vertical axis > 4 cm, chin-brow vertical angle > 25°, or cervical kyphosis (T1 slope [T1S] cervical lordosis [CL] > 15°) (n = 129). Sagittal parameters were evaluated preoperatively and in the early postoperative window (6 weeks to 6 months postoperatively) and compared with asymptomatic control patients. Adult cervical deformity patients were further stratified by degree of cervical kyphosis (severe kyphosis, C2-T3 Cobb angle ≤ -30°; moderate kyphosis, ≤ 0°; and minimal kyphosis, > 0°) and severity of sagittal malalignment (severe malalignment, sagittal vertical axis T3-S1 ≤ -60 mm; moderate malalignment, ≤ 20 mm; and minimal malalignment > 20 mm).Results
Compared with asymptomatic control patients, cervical deformity was associated with increased C0-2 lordosis (32.9° vs 23.6°), T1S (33.5° vs 28.0°), thoracolumbar junction kyphosis (T10-L2 Cobb angle -7.0° vs -1.7°), and pelvic tilt (PT) (19.7° vs 15.9°) (p < 0.01). Cervicothoracic kyphosis was correlated with C0-2 lordosis (R = -0.57, p < 0.01) and lumbar lordosis (LL) (R = -0.20, p = 0.03). Cervical reconstruction resulted in decreased C0-2 lordosis, increased T1S, and increased thoracic and thoracolumbar junction kyphosis (p < 0.01). Patients with severe cervical kyphosis (n = 34) had greater C0-2 lordosis (p < 0.01) and postoperative reduction of C0-2 lordosis (p = 0.02) but no difference in PT. Severe cervical kyphosis was also associated with a greater increase in thoracic and thoracolumbar junction kyphosis postoperatively (p = 0.01). Patients with severe sagittal malalignment (n = 52) had decreased PT (p = 0.01) and increased LL (p < 0.01), as well as a greater postoperative reduction in LL (p < 0.01).Conclusions
Adult cervical deformity is associated with upper cervical hyperlordotic compensation and thoracic hypokyphosis. In the setting of increased kyphotic deformity and sagittal malalignment, thoracolumbar junction kyphosis and lumbar hyperlordosis develop to restore normal center of gravity. There was no consistent compensatory pelvic retroversion or anteversion among the adult cervical deformity patients in this cohort.Item Open Access The Contribution of Lower Limbs to Pelvic Tilt: A Baseline and Postoperative Full-Body AnalysisKhalifé, Marc; Lafage, Renaud; Diebo, Bassel; Daniels, Alan; Gupta, Munish; Ames, Christopher; Bess, Shay; Burton, Douglas; Kebaish, Khaled; Kelly, Michael; Kim, Han-Jo; Klineberg, Eric; Lenke, Lawrence; Lewis, Stephen; Passias, Peter; Shaffrey, Christopher; Smith, Justin S; Schwab, Frank; Lafage, Virginie