Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Neurosurgery. 2019 Feb 1;84(2):442-450. doi: 10.1093/neuros/nyy061.
Development of proximal junctional kyphosis (PJK) after correction of adult spinal deformity (ASD) undermines sagittal alignment. Minimally invasive anterior column realignment (ACR) is a powerful tool for correction of ASD; however, long-term PJK rates are unknown.
To characterize PJK after utilization of ACR in ASD correction.
A retrospective multi-institution cohort analysis per STROBE criteria was conducted of all patients who underwent lateral lumbar interbody fusion (LLIF) or ACR for ASD from 2010 to 2015. All patients obtained preoperative and follow-up upright radiographs, assessing spinal alignment and development of PJK. Patients without proper imaging or minimum 1-yr follow-up were excluded.
A total of 73 of 112 patients who underwent either LLIF or ACR for ASD met inclusion criteria. Mean follow-up was 22.8 mo. There was significant improvement of all spinopelvic parameters. Overall, PJK and proximal junctional failure (PJF) rates were 20.5% and 11%, respectively. The incidence of PJK increased with greater corrective surgery (0% LLIF, 30% ACR, 42.9% ACR + posterior column osteotomy (PCO); P < .001). PJF rates increased (0% LLIF, 11% ACR, 40% ACR + PCO; P = .005). Risk factors included location of the upper-instrumented vertebra at T10-L1 vs L2-L4 (P = .007), age (P = .029), severity of ASD, and overcorrection of sagittal imbalance.
The incidence of PJK after minimally invasive ACR is slightly lower than reported after open surgery but greater than in LLIF only and increases with PCO utilization. The PJK rate increases when crossing the TL junction, sagittal imbalance severity, and overcorrection. Elderly patients are at an increased risk, suggesting need for age appropriate correction goals.
成人脊柱畸形（ASD）矫正后近端交界性后凸（PJK）的发展破坏矢状位平衡。微创前路柱矫正（ACR）是矫正 ASD 的有力工具；然而，长期 PJK 发生率尚不清楚。
描述 ASD 矫正中使用 ACR 后 PJK 的特征。
按照 STROBE 标准，对 2010 年至 2015 年间接受侧路腰椎间融合术（LLIF）或 ACR 治疗 ASD 的所有患者进行回顾性多机构队列分析。所有患者均获得术前和随访的直立位 X 线片，评估脊柱的排列和 PJK 的发生情况。没有适当影像学或 1 年以上随访的患者被排除。
共 112 例接受 LLIF 或 ACR 治疗 ASD 的患者中，有 73 例符合纳入标准。平均随访时间为 22.8 个月。所有脊柱骨盆参数均有显著改善。总体而言，PJK 和近端交界性失败（PJF）的发生率分别为 20.5%和 11%。随着矫正手术的增加，PJK 的发生率也增加（0%的 LLIF，30%的 ACR，42.9%的 ACR+后路截骨术（PCO）；P<0.001）。PJF 发生率增加（0%的 LLIF，11%的 ACR，40%的 ACR+PCO；P=0.005）。危险因素包括上节段椎位于 T10-L1 与 L2-L4（P=0.007）、年龄（P=0.029）、ASD 严重程度和矢状位失衡的过度矫正。
微创 ACR 后 PJK 的发生率略低于开放手术后的报道，但高于仅接受 LLIF 治疗的患者，并且随着 PCO 的应用而增加。当越过 TL 交界处、矢状位失衡严重程度和过度矫正时，PJK 发生率增加。老年患者风险增加，提示需要根据年龄制定适当的矫正目标。
