Decker Sebastian, Lafage Renaud, Krettek Christian, Hart Robert, Ames Christopher, Smith Justin S, Burton Douglas, Klineberg Eric, Bess Shay, Schwab Frank J, Lafage Virginie
Spine Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany.
Asian Spine J. 2020 Apr;14(2):212-219. doi: 10.31616/asj.2018.0314. Epub 2019 Nov 1.
Retrospective cohort study.
To investigate the role of sacral extension (SE) for the development of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery.
The development of PJK is multifactorial and different risk factors have been identified. Of these, there is some evidence that SE also affects the development of PJK, but data are insufficient.
Using a combined database comprising two propensity-matched groups of fusions following ASD surgery, one with fixation to S1 or S1 and the ilium (SE) and one without SE but with a lower instrumented vertebra of L5 or higher (lumbar fixation, LF), PJK and the role of further parameters were analyzed. The propensity-matched variables included age, the upper-most instrumented vertebra (UIV), preoperative sagittal alignment, and the baseline to one year change of the sagittal alignment.
Propensity matching led to two groups of 89 patients each. The UIV, pelvic incidence minus lumbar lordosis, sagittal vertical axis, pelvic tilt, age, and body mass index were similar in both groups (p >0.05). The incidence of PJK at postoperative one year was similar for SE (30.3%) and LF (22.5%) groups (p =0.207). The PJK angle was comparable (p =0.963) with a change of -8.2° (SE) and -8.3° (LF) from the preoperative measures (p =0.954). A higher rate of PJK after SE (p =0.026) was found only in the subgroup of patients with UIV levels between T9 and T12.
Instrumentation to the sacrum with or without iliac extension did not increase the overall risk of PJK. However, an increased risk for PJK was found after SE with UIV levels between T9 and T12.
回顾性队列研究。
探讨骶骨延伸（SE）在成人脊柱畸形（ASD）手术中对近端交界性后凸（PJK）发生发展的作用。
PJK的发生是多因素的，已确定了不同的危险因素。其中，有证据表明SE也会影响PJK的发生，但数据不足。
使用一个合并数据库，该数据库包含两组ASD手术后融合的倾向匹配组，一组固定至S1或S1及髂骨（SE），另一组无SE但最低固定椎为L5或更高（腰椎固定，LF），分析PJK及其他参数的作用。倾向匹配变量包括年龄、最高固定椎（UIV）、术前矢状面排列以及矢状面排列从基线到一年的变化。
倾向匹配产生两组，每组89例患者。两组的UIV、骨盆入射角减去腰椎前凸、矢状垂直轴、骨盆倾斜、年龄和体重指数相似（p>0.05）。SE组（发生率30.3%）和LF组（发生率22.5%）术后一年PJK的发生率相似（p = 0.207）。PJK角度具有可比性（p = 0.963），与术前测量值相比，SE组变化为-8.2°，LF组变化为-8.3°（p = 0.954）。仅在UIV水平在T9至T12之间的患者亚组中发现SE后PJK发生率更高（p = 0.026）。
无论有无髂骨延伸，固定至骶骨均未增加PJK的总体风险。然而，在UIV水平在T9至T12之间的患者中，SE后PJK风险增加。
