Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
World Neurosurg. 2019 Sep;129:e522-e529. doi: 10.1016/j.wneu.2019.05.198. Epub 2019 May 29.
This study aimed to investigate the risk of proximal junction kyphosis (PJK) and proximal junction failure (PJF) associated with screw trajectory (straightforward vs. mixed vs. anatomic) at upper instrumented vertebra (UIV).
A single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥4 levels (the UIV of the thoracolumbar spine, T9-L2, and the lower instrumented vertebra at the sacrum or pelvis) was retrospectively reviewed. Patients were divided into 3 groups according to UIV screw trajectory: group S, 2 straightforward screws; group M, 1 straightforward screw and 1 anatomic trajectory screw; and group A, 2 anatomic trajectory screws.
A total of 83 patients were included in this study, including 51 in group S, 16 in group M, and 16 in group A. The incidence of PJK in group S (12 patients, 23.5%), group M (7 patients, 43.8%), and group A (9 patients, 56.3%) significantly increased in sequence by group (P = 0.044). Anatomic trajectory screw fixation increased the risk for PJF requiring revision surgery compared with straightforward screw fixation (3 patients [18.8%] vs. 1 patient [2.0%]; P = 0.040). Multivariable analysis identified that anatomic trajectory screw fixation was a significant risk factor for PJK (P = 0.008; adjusted odds ratio = 7.591; 95% confidence interval, 1.69-34.093).
Anatomic trajectory screw fixation at the UIV is a substantial risk factor for PJK and PJF. To reduce PJK and PJF, straightforward screw fixation at the UIV is recommended in adult spinal deformity correction surgery.
本研究旨在探讨上椎弓根螺钉轨迹（直接、混合与解剖）与上节段交界区后凸（PJK）和上节段交界区失败（PJF）的相关性。
回顾性分析了单中心、单术者连续行腰椎融合术≥4 个节段（胸腰椎 T9-L2 的上椎弓根、下椎弓根位于骶骨或骨盆）的成年患者。根据 UIV 螺钉轨迹将患者分为 3 组：S 组，2 枚直接螺钉；M 组，1 枚直接螺钉和 1 枚解剖轨迹螺钉；A 组，2 枚解剖轨迹螺钉。
共纳入 83 例患者，其中 S 组 51 例，M 组 16 例，A 组 16 例。S 组（12 例，23.5%）、M 组（7 例，43.8%）和 A 组（9 例，56.3%）的 PJK 发生率依次增高（P=0.044）。与直接螺钉固定相比，解剖轨迹螺钉固定增加了需要翻修手术的 PJF 风险（3 例[18.8%]比 1 例[2.0%]；P=0.040）。多变量分析发现，解剖轨迹螺钉固定是 PJK 的显著危险因素（P=0.008；调整比值比=7.591；95%置信区间，1.69-34.093）。
UIV 解剖轨迹螺钉固定是 PJK 和 PJF 的重要危险因素。为了降低 PJK 和 PJF，成人脊柱畸形矫正术中推荐 UIV 直接螺钉固定。
