Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine

<b>Background:</b> Patients with proximal junctional kyphosis (PJK) or failure (PJF) may demonstrate disparate outcomes and recovery when fused to the upper (UT) versus lower (LT) thoracic spine. Few studies have distinguished the reoperation and recovery abilities of patients with PJK or PJF when fused to the upper (UT) versus lower (LT) thoracic spine. <b>Methods:</b> Adult spine deformity patients ≥ 18 yrs with preoperative and 5-year (5Y) data fused to the sacrum/pelvis were included. The rates of PJK, PJK revision, and radiographic PJF were compared between patients with upper instrumented vertebra (UIV) in the upper thoracic spine (UT; T1-T7) and lower thoracic spine (LT; T8-L1). Mean differences were assessed via analyses of covariance, factoring in any differences between cohorts at baseline and any use of PJF prophylaxis. Backstep logistic regressions assessed predictors of achieving Smith et al.'s Best Clinical Outcomes (BCOs) and complications, controlling for similar covariates. <b>Results:</b> A total of 232 ASD patients were included (64.2 ± 10.2 years, 78% female); 36.3% were UT and 63.7% were LT. Postoperatively, the rates of PJK for UT were lower than LT at 1Y (34.6 vs. 50.4%, <i>p</i> = 0.024), 2Y (29.5 vs. 49.6% (<i>p</i> = 0.003), and 5Y (48.7 vs. 62.8%, <i>p</i> = 0.048), with comparable rates of PJF. In total, 4.0% of UT patients underwent subsequent reoperation, compared to 13.0% of LT patients (<i>p</i> = 0.025). A total of 6.0% of patients had recurrent PJK, and 3.9% had recurrent PJF (both <i>p</i> > 0.05). After reoperation, UT patients reported higher rates of improvement in the minimum clinically important difference for ODI by 2Y (<i>p</i> = 0.007) and last follow-up (<i>p</i> < 0.001). While adjusted regression revealed that, for UT patients, the minimization of construct extension was predictive of achieving BCOs by last follow-up (model <i>p</i> < 0.001), no such relationship was identified in LT patients. <b>Conclusions:</b> Patients initially fused to the lower thoracic spine demonstrate an increased incidence of PJK and lower rates of disability improvement, but are at a lessened risk of neurologic complications if reoperation is required.

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Journal
Journal of Clinical Medicine
Published
2024-12-18
DOI
https://doi.org/10.3390/jcm13247722
Citations
4
Primary Topic
Scoliosis diagnosis and treatment
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article
Field-Weighted Citation Impact
2.29
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article

Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine

Lawrence G. Lenke, Peter Gust Passias, Renaud Lafage, Thomas J. Buell et al.
4 citations
Journal of Clinical Medicine
Scoliosis diagnosis and treatment
2.29
article

Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine

Lawrence G. Lenke, Peter Gust Passias, Renaud Lafage, Thomas J. Buell, Alex Soroceanu, Justin S. Smith, Bassel Georges Diebo, Breton Line, Mitsuru Yagi, Themistocles Stavros Protopsaltis, Eric O. Klineberg, Khaled M. Kebaish, Alan H. Daniels, Jeffrey Lynn Gum, Gregory M. Mundis, Richard A. Hostin, Stephen J. Lewis, Shay R. Bess, Peter Tretiakov, Neel Anand, Justin K. Scheer, Munish Chandra Gupta, Oluwatobi Onafowokan, Jeffrey P. Mullin, Douglas Burton, Virginie Lafage, Han Jo Kim, David Kojo Hamilton, Michael Y. Wang, Frank J. Schwab, Naobumi Hosogane, Robert K. Eastlack, Christopher I. Shaffrey, David O. Okonkwo, Christopher P. Ames
article en
4 citations

Abstract

<b>Background:</b> Patients with proximal junctional kyphosis (PJK) or failure (PJF) may demonstrate disparate outcomes and recovery when fused to the upper (UT) versus lower (LT) thoracic spine. Few studies have distinguished the reoperation and recovery abilities of patients with PJK or PJF when fused to the upper (UT) versus lower (LT) thoracic spine. <b>Methods:</b> Adult spine deformity patients ≥ 18 yrs with preoperative and 5-year (5Y) data fused to the sacrum/pelvis were included. The rates of PJK, PJK revision, and radiographic PJF were compared between patients with upper instrumented vertebra (UIV) in the upper thoracic spine (UT; T1-T7) and lower thoracic spine (LT; T8-L1). Mean differences were assessed via analyses of covariance, factoring in any differences between cohorts at baseline and any use of PJF prophylaxis. Backstep logistic regressions assessed predictors of achieving Smith et al.'s Best Clinical Outcomes (BCOs) and complications, controlling for similar covariates. <b>Results:</b> A total of 232 ASD patients were included (64.2 ± 10.2 years, 78% female); 36.3% were UT and 63.7% were LT. Postoperatively, the rates of PJK for UT were lower than LT at 1Y (34.6 vs. 50.4%, <i>p</i> = 0.024), 2Y (29.5 vs. 49.6% (<i>p</i> = 0.003), and 5Y (48.7 vs. 62.8%, <i>p</i> = 0.048), with comparable rates of PJF. In total, 4.0% of UT patients underwent subsequent reoperation, compared to 13.0% of LT patients (<i>p</i> = 0.025). A total of 6.0% of patients had recurrent PJK, and 3.9% had recurrent PJF (both <i>p</i> > 0.05). After reoperation, UT patients reported higher rates of improvement in the minimum clinically important difference for ODI by 2Y (<i>p</i> = 0.007) and last follow-up (<i>p</i> < 0.001). While adjusted regression revealed that, for UT patients, the minimization of construct extension was predictive of achieving BCOs by last follow-up (model <i>p</i> < 0.001), no such relationship was identified in LT patients. <b>Conclusions:</b> Patients initially fused to the lower thoracic spine demonstrate an increased incidence of PJK and lower rates of disability improvement, but are at a lessened risk of neurologic complications if reoperation is required.

Journal of Clinical MedicineVol. 13(24)
Hospital for Special Surgery (US), Cedars-Sinai Medical Center (US), Johns Hopkins University (US), University of Miami (US), University of Calgary (CA), University of Pittsburgh (US), Duke University (US), University of California, San Francisco (US), University of Toronto (CA), Norton Healthcare (US), Washington University in St. Louis (US), Brown University (US), Lenox Hill Hospital (US), Johns Hopkins Bayview Medical Center (US), NYU Langone Health (US), University of Kansas Medical Center (US), Rocky Mountain Hospital for Children (US), Southwest Scoliosis Institute (US), Scripps Clinic (US), Neurological Surgery (US), University of Virginia (US), National Defense Medical College (JP), University at Buffalo, State University of New York (US), Columbia University (US), International University of Health and Welfare (JP), The University of Texas Health Science Center at Houston (US)
Good health and well-being
Openalex Percentile: Top 11%
Scoliosis diagnosis and treatment
2.29
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