The Benefit of Addressing Malalignment In Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery.

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2022-09

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Abstract

Study design

Retrospective cohort study.

Objective

Understand the benefit of addressing malalignment in revision surgery for PJK.

Summary of background data

Proximal junctional kyphosis(PJK) is a common cause of revision surgery for ASD patients. During a revision, surgeons may elect to perform a proximal extension of the fusion, or also correct the source of the lumbo-pelvic mismatch.

Methods

Recurrent PJK following revision surgery was the primary outcome. Revision surgical strategy was the primary predictor(proximal extension of fusion alone compared to combined sagittal correction and proximal extension). Multivariable logistic regression determined rates of recurrent PJK between the two surgical groups with lumbo-pelvic surgical correction assessed through improving ideal alignment in one or more alignment criteria(Global Alignment and Proportionality[GAP],Roussouly-type, and Sagittal Age-Adjusted Score[SAAS]).

Results

151 patients underwent revision surgery for PJK. PJK occurred at a rate of 43.0%, and PJF at 12.6%. Patients proportioned in GAP post-revision had lower rates of recurrent PJK(23% vs. 42%;OR: 0.3,95% CI:[0.1-0.8];P=0.024). Following adjusted analysis, patients who were ideally aligned in 1 of 3 criteria (Matching in SAAS and/or Roussouly matched and/or achieved GAP proportionality) had lower rates of recurrent PJK (36% vs. 53%;OR: 0.4,95% CI:[0.1-0.9];P=0.035) and recurrent PJF(OR: 0.1,95% CI:[0.02-0.7];P=0.015). Patients ideally aligned in 2 of 3 criteria avoid any development of PJF(0% vs. 16%, P<0.001).

Conclusion

Following revision surgery for proximal junctional kyphosis, patients with persistent poor sagittal alignment showed increased rates of recurrent proximal junctional kyphosis compared with patients who had abnormal lumbo-pelvic alignment corrected during the revision. These findings suggest addressing the root cause of surgical failure in addition to proximal extension of the fusion may be beneficial.

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Journal article

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International Spine Study Group

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https://hdl.handle.net/10161/28000

Published Version (Please cite this version)

10.1097/brs.0000000000004476

Publication Info

Passias, Peter G, Oscar Krol, Tyler K Williamson, Virginie Lafage, Renaud Lafage, Justin S Smith, Breton Line, Shaleen Vira, et al. (2022). The Benefit of Addressing Malalignment In Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery. Spine, Publish Ahead of Print. 10.1097/brs.0000000000004476 Retrieved from https://hdl.handle.net/10161/28000.

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Passias

Peter Passias

Instructor in the Department of Orthopaedic Surgery

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