Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan.
Spine (Phila Pa 1976). 2012 Aug 1;37(17):1479-89. doi: 10.1097/BRS.0b013e31824e4888.
A retrospective case series of surgically treated patients with adult scoliosis.
The purpose of this study was to evaluate the incidence, risk factors, and natural course of proximal junctional kyphosis (PJK) in a long-term follow-up of patients with adult idiopathic scoliosis undergoing long instrumented spinal fusion.
Although recent reports have showed the prevalence, clinical outcomes, and the possible risk factors of PJK, quite a few reports have showed long-term follow-up outcome.
This is a retrospective review of the charts and radiographs of 76 consecutive patients with adult scoliosis treated with long instrumented spinal fusion. Radiographical measurements and demographic data were reviewed on preoperation, immediate postoperation, 2 years postoperation, 5 years postoperation, and at follow-up. Postoperative Scoliosis Research Society scores and Oswestry Disability Index were also evaluated. Means were compared with Student t test. A P value of less than 0.05 with 95% confidence interval was considered significant.
The mean age was 48.8 years (range, 23-75 yr) and the average follow-up was 7.3 years (range, 5-14 yr). PJK has been identified in 17 patients. The Scoliosis Research Society and Oswestry Disability Index did not demonstrate significant differences between PJK group and non-PJK group; 2 patients had additional surgeries performed for local pain. Seventy-six percent of PJK has been identified within 3 months after surgery. Despite the fact that 53% of total degree of PJK was progressed within 3 months after surgery, PJK continuously progressed to the final follow-up. Pre-existing low bone mineral density, posterior spinal fusion (PSF), fusion to sacrum, inappropriate global spine alignment, and greater sagittal vertical axis change were identified as significant risk factors for PJK (P = 0.04, P < 0.001, P = 0.02, P < 0.0001, and P = 0.01).
In a long-term review of minimum 5 years, 76% of PJK occurred within 3 months after surgery. Pre-existing low bone mineral density, PSF, fusion to the sacrum, inappropriate global spine alignment, and greater sagittal vertical axis change were significant risk factors for PJK. Careful long-term follow-up should be done for a patient with PJK.
对接受手术治疗的成人脊柱侧凸患者进行回顾性病例系列研究。
本研究旨在评估接受长节段脊柱融合术治疗的成人特发性脊柱侧凸患者的近端交界性后凸（PJK）的发生率、危险因素和自然病程。
尽管最近的报告显示了 PJK 的患病率、临床结果和可能的危险因素，但仍有许多报告显示了长期随访结果。
这是对 76 例接受长节段脊柱融合术治疗的成人脊柱侧凸患者的图表和影像学资料进行的回顾性分析。对术前、术后即刻、术后 2 年、术后 5 年和随访时的影像学测量值和人口统计学数据进行了回顾。还评估了术后脊柱侧凸研究协会（SRS）评分和 Oswestry 残疾指数。采用学生 t 检验比较均值。置信区间为 95%，P 值小于 0.05 被认为有统计学意义。
平均年龄为 48.8 岁（范围：23-75 岁），平均随访时间为 7.3 年（范围：5-14 年）。17 例患者发生了 PJK。SRS 和 Oswestry 残疾指数在 PJK 组和非 PJK 组之间没有显著差异；2 例患者因局部疼痛接受了额外的手术。76%的 PJK 在术后 3 个月内被发现。尽管术后 3 个月内 PJK 的总度数有 53%进展，但 PJK 持续进展至最终随访。术前低骨密度、后路脊柱融合术（PSF）、融合至骶骨、整体脊柱矢状位排列不当和矢状垂直轴（SVA）变化较大被确定为 PJK 的显著危险因素（P=0.04、P＜0.001、P=0.02、P＜0.0001 和 P=0.01）。
在至少 5 年的长期随访中，76%的 PJK 发生在术后 3 个月内。术前低骨密度、PSF、融合至骶骨、整体脊柱矢状位排列不当和 SVA 变化较大是 PJK 的显著危险因素。对于 PJK 患者应进行仔细的长期随访。
