Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Spine (Phila Pa 1976). 2021 Apr 15;46(8):520-529. doi: 10.1097/BRS.0000000000003850.
Retrospective study.
To identify the risk factors for revision surgery among neurologically intact patients with proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery.
PJF following long fusion for ASD is a well-recognized complication that negatively affects clinical outcomes. However, revision surgery is not required for every patient with PJF especially if the patient does not present with neurologic deficit. Identifying the risk factors of revision surgery is necessary to determine who will need revision surgery as well as when is the right time for the revision surgery.
Sixty-nine neurologically intact patients with PJF following ASD surgery were followed up with more than 2 years after PJF development or until undergoing revision surgery. PJF was divided into ligamentous failure (proximal junctional angle [PJA] of more than 20°) and bony failure. According to the conduct of revision surgery, two groups (revision and no revision) were created. Risk factors for revision surgery were analyzed in univariate and multivariate analysis with regard to patient, surgical and radiographic variables.
The mean age at the time of PJF development was 70.9 years. There were 45 patients with bony failure and 24 with ligamentous failure. Revision surgery was performed for 23 patients (33.3%). Multivariate analysis revealed that bony failure (odds ratio: 10.465) and PJA (odds ratio: 1.131) were significant risk factors. For those with bony failure, the cutoff value of PJA for performing revision surgery was calculated as 22°. The revision rate was significantly highest in patients (63.6%) with bony failure + PJA 22° or higher followed by patients (26.1%) with bony failure + PJA less than 22° and patients (12.5%) with ligamentous failure (P = 0.002).
Bony failure with PJA of greater than 22° increased the likelihood for revision surgery. Therefore, early surgical intervention should be considered in these patients.Level of Evidence: 4.
回顾性研究。
确定成人脊柱畸形（ASD）手术后神经功能完整的近端交界区失败（PJF）患者行翻修手术的危险因素。
ASD 后路长节段融合术后发生的 PJF 是一种公认的并发症，会对临床结果产生负面影响。然而，并非所有发生 PJF 的患者都需要行翻修手术，特别是对于那些没有神经功能缺损的患者。确定行翻修手术的危险因素有助于确定哪些患者需要行翻修手术以及何时是行翻修手术的合适时机。
对 69 例 ASD 后路手术后发生神经功能完整的 PJF 患者进行随访，随访时间超过 PJF 发生后 2 年或直至行翻修手术。将 PJF 分为韧带性失败（近端交界角[PJA]大于 20°）和骨性失败。根据翻修手术的实施情况，将患者分为翻修组和未翻修组。在单因素和多因素分析中，对患者、手术和影像学变量与翻修手术的关系进行分析。
PJF 发生时患者的平均年龄为 70.9 岁。其中 45 例为骨性失败，24 例为韧带性失败。对 23 例（33.3%）患者行翻修手术。多因素分析显示，骨性失败（比值比：10.465）和 PJA（比值比：1.131）是显著的危险因素。对于骨性失败患者，计算得出行翻修手术的 PJA 临界值为 22°。PJA 大于 22°且伴有骨性失败的患者（63.6%）的翻修率最高，其次是 PJA 小于 22°且伴有骨性失败的患者（26.1%），最后是伴有韧带性失败的患者（12.5%）（P=0.002）。
PJA 大于 22°的骨性失败增加了行翻修手术的可能性。因此，对于这些患者应考虑早期手术干预。
4 级
