Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA.
Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita City, Chiba, 286-0124, Japan.
Eur Spine J. 2021 May;30(5):1199-1207. doi: 10.1007/s00586-020-06669-0. Epub 2021 Jan 15.
Although proximal junctional kyphosis (PJK) is common after long spinal fusion, the outcomes of revision surgery for symptomatic PJK are unclear. Our aim was to assess the outcomes of revision surgery for symptomatic PJK in patients with adult spinal deformity and elucidate the incidence and risk factors for recurrent PJK (rePJK).
We evaluated standing radiographs and health-related quality of life (HRQOL) in patients who underwent revision surgery for symptomatic PJK with at least 2-year follow-up. Patients were assigned to the non-rePJK or rePJK group according to PJK recurrence.
Thirty-nine consecutive patients (mean age, 63 ± 11 years; 24 women) met the inclusion criteria. RePJK occurred in 12 patients (31%). There were significant differences in the following parameters between groups (non-rePJK vs. rePJK): initial proximal junctional sagittal Cobb angle (PJA) (26.6° vs. 35.6°), thoracic kyphosis (TK) (38.6° vs. 52.8°), and sagittal vertical axis (SVA) (9.3 vs. 15.9 cm), and pre- to postoperative SVA decrease (6.1 vs. 12.2 cm). Significant risk factors for rePJK were initial PJA > 40°, preoperative TK > 60°, preoperative SVA > 10.0 cm, correction of TK > 15°, and correction of SVA > 5.0 cm. HRQOL scores improved significantly; however, postoperative SRS-22r activity scores were significantly worse in the rePJK group vs the non-rePJK group.
The incidence of rePJK was 31%. Risk factors for rePJK were large initial PJA, high preoperative TK and SVA, and greater correction of TK and SVA. HRQOL did not differ significantly between patients with vs without rePJK, except immediate postoperative SRS-22r activity scores.
III.
尽管近端交界性后凸（PJK）在长节段脊柱融合后很常见，但有症状的 PJK 患者行翻修手术的疗效尚不清楚。本研究旨在评估有症状的 PJK 患者行翻修手术的疗效，并阐明其再发性 PJK（rePJK）的发生率和危险因素。
我们评估了行翻修手术治疗有症状的 PJK 且随访时间至少 2 年的患者的站立位 X 线片和健康相关生活质量（HRQOL）。根据 PJK 复发情况，将患者分为无 rePJK 组和 rePJK 组。
39 例连续患者（平均年龄 63 ± 11 岁；24 例女性）符合纳入标准。12 例（31%）患者发生 rePJK。两组间存在以下参数差异（无 rePJK 组 vs. rePJK 组）：初始近端交界区矢状位 Cobb 角（PJA）（26.6° vs. 35.6°）、胸腰椎后凸角（TK）（38.6° vs. 52.8°）和矢状位垂直轴（SVA）（9.3 vs. 15.9cm），术前至术后 SVA 减小值（6.1 vs. 12.2cm）。rePJK 的显著危险因素为初始 PJA＞40°、术前 TK＞60°、术前 SVA＞10.0cm、TK 矫正＞15°和 SVA 矫正＞5.0cm。HRQOL 评分显著改善，但 rePJK 组术后 SRS-22r 活动评分显著低于无 rePJK 组。
rePJK 的发生率为 31%。rePJK 的危险因素包括初始 PJA 较大、术前 TK 和 SVA 较高，以及 TK 和 SVA 矫正量较大。除术后即刻 SRS-22r 活动评分外，有 rePJK 与无 rePJK 患者的 HRQOL 评分无显著差异。
III 级
