Lonner Baron S, Ren Yuan, Newton Peter O, Shah Suken A, Samdani Amer F, Shufflebarger Harry L, Asghar Jahangir, Sponseller Paul, Betz Randal R, Yaszay Burt
Mount Sinai Medical Center, E 101st St, New York, NY 10029, USA.
Mount Sinai Medical Center, E 101st St, New York, NY 10029, USA.
Spine Deform. 2017 May;5(3):181-188. doi: 10.1016/j.jspd.2016.10.003.
Prospective multicenter database study.
To assess the incidence of proximal junctional kyphosis (PJK) in operative adolescent idiopathic scoliosis (AIS) using contemporary surgical techniques and to identify risk factors for PJK.
The incidence of PJK has been reported as high as 46% in AIS. Factors associated with PJK have been incompletely explored.
Prospectively enrolled 851 AIS patients (2000-2011, 78.5% female, average 14.4 years) were evaluated 2 years postoperatively. Radiographic and sagittal spinopelvic parameters and rod contour angle (RCA), a new measure that reflects the proximal contouring of the rod, were independently evaluated for association with PJK based on Lenke type. Multivariate logistic regression with backward elimination was performed to identify risk factors for PJK.
Overall PJK incidence was 7.05% and varies based on Lenke type (Lenke 1, 6.35%; Lenke 2 and 4, 4.39%; Lenke 3 and 6, 11.64%; and Lenke 5, 8.49%; p = .06). Among patients with Lenke 1 curves, risk factors for PJK were loss of kyphosis after surgery, and stopping caudal to the upper end vertebra (UEV). The risk of developing PJK increases by 7.1% with each lost degree of kyphosis compared with preoperation that occurs after the instrumentation is placed. For Lenke 2 and 4 curves, loss of kyphosis and more lordotic (negative) RCA were risk factors for PJK. For Lenke 3 and 6 curves, larger preoperative T5-T12 kyphosis was the only significant risk factor for PJK. Upper instrumented vertebra (UIV) at or cephalad to the UEV was associated with increased risk of PJK in Lenke 5 curves, which was contrary to the finding for Lenke 1 curves. No significant correlation was found between sagittal pelvic parameters and developing PJK.
The incidence of PJK in patients after surgery for AIS is 7.05% and varies based on Lenke type. Loss of kyphosis, larger preoperative kyphosis, UIV caudal to the proximal UEV (Lenke 1), UIV at or cephalad to the UEV (Lenke 5), and decreased RCA were the major risk factors for PJK in AIS.
Level II.
前瞻性多中心数据库研究。
使用当代手术技术评估手术治疗青少年特发性脊柱侧凸（AIS）后近端交界性后凸（PJK）的发生率，并确定PJK的危险因素。
据报道，AIS中PJK的发生率高达46%。与PJK相关的因素尚未得到充分研究。
前瞻性纳入851例AIS患者（2000 - 2011年，女性占78.5%，平均年龄14.4岁），术后2年进行评估。根据Lenke分型，独立评估影像学和矢状面脊柱骨盆参数以及棒轮廓角（RCA，一种反映棒近端轮廓的新指标）与PJK的相关性。采用向后逐步回归的多因素逻辑回归分析确定PJK的危险因素。
总体PJK发生率为7.05%，并因Lenke分型而异（Lenke 1型，6.35%；Lenke 2型和4型，4.39%；Lenke 3型和6型，11.64%；Lenke 5型，8.49%；p = 0.06）。在Lenke 1型曲线患者中，PJK的危险因素是术后后凸丢失以及在近端上终椎（UEV）尾侧停止置棒。与置棒后术前相比，后凸每丢失1度，发生PJK的风险增加7.1%。对于Lenke 2型和4型曲线，后凸丢失和更前凸（负值）的RCA是PJK的危险因素。对于Lenke 3型和6型曲线，术前T5 - T12更大的后凸是PJK唯一的显著危险因素。在Lenke 5型曲线中，上固定椎（UIV）位于UEV或其头侧与PJK风险增加相关，这与Lenke 1型曲线的结果相反。矢状面骨盆参数与发生PJK之间未发现显著相关性。
AIS手术患者中PJK的发生率为7.05%，并因Lenke分型而异。后凸丢失、术前较大的后凸、近端UEV尾侧的UIV（Lenke 1型）、UEV或其头侧的UIV（Lenke 5型）以及RCA降低是AIS中PJK的主要危险因素。
二级。
