Proximal junctional kyphosis and failure: How much can we attribute to known risk factors?

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2024-09-01

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Abstract

BACKGROUND CONTEXT: Despite advancements in the understanding of spinal alignment and in instrumentation for adult spine deformity (ASD) surgery, complications such as proximal junctional kyphosis and proximal junctional failure (PJK/PJF) continue to be a significant concern. PURPOSE: To assess the attributable risk of various reported contributors to development of PJK/PJF. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: A total of 464 ASD patients. OUTCOME MEASURES: Odds ratios of PJK/F risk factors. METHODS: We included ASD patients with complete baseline (BL) and up to 2Y clinical, radiographic and HRQL data. Stratified according to development of PJK/PJF by 2 years. Means comparison analyses compared outcomes between groups. Backstep logistic regression assessed factors predictive of PJK/F development. RESULTS: There were 464 patients included (age: 59.8 ± 14.3 years, BMI: 26.9 ± 5.5 kg/m2, CCI: 1.65 ± 1.68). 80.5% of patients were female; 173 patients (37.3%) formed the PJK/F+ group, as at 2 years (173 PJK and 28 PJF patients). At BL, PJK/F+ patients were older (63.2 vs 57.9 years, p<0.001) and had worse deformity (PI-LL 20.3 vs 11.8, p<0.001). There were no differences between groups in baseline disability, demographic, frailty or comorbidity factors. Controlling for age and baseline deformity, PJK/F+ patients were more likely to develop mechanical complications (OR 2.1, 95% CI: 1.2-3.7, p=0.007). Use of PJK prophylaxis techniques did not have a significant effect on risk of developing PJK/F (p=0.307). Factors associated with increased risk of developing PJK/F were significant baseline deformity (OR 1.02, 95% CI: 1.01-1.03, p=0.026), peripheral vascular disease (OR 5.5, 1.3-23.6, p=0.023), undergoing an osteotomy (OR 1.7, 1.1-2.8, p=0.017) and age >60 (OR 1.1, 1.1-1.2, p=0.026) and hypertension (OR 2.01, 1.04-3.87, p=0.038). Diabetes was associated with lower odds for developing PJK/F+ (OR: 0.3, 95% CI: 0.1-0.8, p=0.018). CONCLUSIONS: Proximal junctional kyphosis/failure remains a significant postoperative concern in the ASD population. With currently known risk factors, we are still unable to fully quantify and predict a patient's total risk for developing postoperative PJK/F. Further work is needed to delineate contributing factors that are yet to be determined. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.

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10.1016/j.spinee.2024.06.181

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Shaffrey

Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.


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