Objective To investigate the risk factors of proximal junctional kyphosis (PJK) after posterior long segmental lumbar fusion for degenerative lumbar disease. Methods From October, 2012 to July, 2014, 118 degenerative lumbar disease patients who accepted posterior long segmental fusion and followed up at least 1.5 years were reviewed. All the PJK were evaluated with X-ray. Results Sixty-six patients completed the follow-up (mean of 3.2 years), in which 12 patients with PJK (PJK group), and the others without (non-PJK group, n=54). There was significant difference in body mass index, bone density and the last Oswestry Disability Index scores (t>2.194, P<0.05) between both groups, as well as the rate of the upper instrumented vertebra (UIV) located in the thoracolumbar segment (T11-L1) (χ2=4.63, P<0.05). The PJK angle was more in PJK group than non-PJK group pre-surgery, post-surgery and finally (t>3.862, P<0.001). Binary Logistic regression showed that osteoporosis (OR=5.328, 95% CI: 1.110~25.581), UIV located in the thoracolumbar segment (T11-L1) (OR=6.239, 95% CI: 1.157~33.648) and the pre-surgery PJK angle >10° (OR=5.789, 95% CI: 1.075~31.183) were the independent risk factors of PJK. Conclusion Osteoporosis, UIV located in the thoracolumbar segment (T11-L1) and the pre-surgery PJK angle >10° are risk factors of PJK after posterior long segmental lumbar fusion.
ZHENG Bo
,
WANG Fei
,
ZHANG Zhi-cheng
,
ZHAO Xiao-feng
,
HUANG Dao-yu
,
LI Fang
. Risk Factors for Proximal Junctional Kyphosis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2017
, 23(5)
: 607
-611
.
DOI: 10.3969/j.issn.1006-9771.2017.05.026
[1] 李淳德. 脊柱内固定融合术在腰椎退变性疾病治疗中的作用[J]. 中华医学杂志, 2006, 86(25): 1734-1736.
[2] 毛路,沈忆新,王磊. 椎间盘源性下腰痛临床治疗研究[J]. 中国矫形外科杂志, 2007, 15(1): 39-41.
[3] Watanabe K, Lenke LG, Bridwell KH, et al. Proximal junctional vertebral fracture in adults after spinal deformity surgery using pedicle screw constructs: analysis of morphological features [J]. Spine (Phila Pa 1976), 2010, 35(2): 138-145.
[4] Kim YJ, Bridwell KH, Lenke LG, et al. Is the T 9 , T 11 , or L 1 the more reliable proximal level after adult lumbar or lumbosacral instrumented fusion to L 5 or S 1 ? [J]. Spine (Phila Pa 1976), 2007, 32(24): 2653-2661.
[5] Shufflebarger H, Suk SI, Mardjetko S. Debate: determining the upper instrumented vertebra in the management of adult degenerative scoliosis: stopping at T 10 versus L 1 [J]. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S185-S194.
[6] Bridwell KH, Lenke LG, Cho SK, et al. Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle [J]. Neurosurgery, 2013, 72(6): 899-906.
[7] Yagi M, Akilah KB, Boachie-Adjei O. Incidence, risk factors and classification of proximal junctional kyphosis [J]. Spine, 2011, 36(1): E60-E68.
[8] Maruo K, Ha Y, Inoue S, et al. Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity [J]. Spine, 2013, 38(23): E1469-E1476.
[9] Cammarata M, Aubin C, Wang X, et al. Biomechanical risk factors for proximal junctional kyphosis [J]. Spine, 2014, 39(8): E500-E507.
[10] O'Shaughnessy BA, Bridwell KH, Lenke LG, et al. Does a long-fusion "T 3 -sacrum" portend a worse outcome than a short-fusion "T 10 -sacrum" in primary surgery for adult scoliosis? [J]. Spine, 2012, 37(10): 884-890.
[11] Glattes RC, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis [J]. Spine (Phila Pa 1976), 2005, 30(14): 1643-1649.
[12] Yagi M, King AB, Boachie-Adjei O. Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up [J]. Spine (Phila Pa 1976), 2012, 37(17): 1479-1489.
[13] Kim YJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up [J]. Spine (Phila Pa 1976), 2008, 33(20): 2179-2184.
[14] Kim HJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis results in inferior SRS pain subscores in adult deformity patients [J]. Spine (Phila Pa 1976), 2013, 38(11): 896-901.
[15] Wang H, Ma L, Yang D, et al. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion [J]. Medicine (Baltimore), 2016, 95(32): e4443.
[16] Cho KJ, Suk SI, Park SR, et al. Selection of proximal fusion level for adult degenerative lumbar scoliosis [J]. Eur Spine J, 2013, 22(2): 394-401.
[17] Hart RA, Prendergast MA, Roberts WG, et al. Proximal junctional acute collapse cranial to multi-level lumbar fusion: a cost analysis of prophylactic vertebral augmentation [J]. Spine J, 2008, 8(6): 875-881.
[18] Kebaish KM, Martin CT, O'Brien JR, et al. Use of vertebroplasty to prevent proximal junctional fractures in adult deformity surgery: a biomechanical cadaveric study [J]. Spine J, 2013, 13(12): 1897-1903.
