Ha Kee-Yong, Kim Eung-Ha, Kim Young-Hoon, Jang Hae-Dong, Park Hyung-Youl, Cho Chang-Hee, Cho Ryu-Kyoung, Kim Sang-Il
1Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul.
2Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Gyeonggi-do.
J Neurosurg Spine. 2021 Jul 9;35(3):340-346. doi: 10.3171/2020.12.SPINE20604. Print 2021 Sep 1.
The most catastrophic symptom of proximal junctional failure (PJF) following long instrumented fusion surgery for adult spinal deformity (ASD) is neurological deficits. Although previous reports have shown that PJF usually developed during the early postoperative period, some patients showed late neurological deficits. The aim of this study was to report the incidence, characteristics, and surgical outcomes of PJF with late neurological deficits.
Patients surgically treated for ASD at a single institution were retrospectively reviewed. Among them, the patients requiring revision surgery for newly developed neurological deficits at least 6 months after the initial surgery were included. Patient demographic, radiographic, surgical, and clinical data were investigated. Neurological status was assessed using the Frankel grading system.
PJF with late neurological deficits developed in 18 of 385 patients (4.7%). The mean age at the onset of neurological deficits was 72.0 ± 6.0 years, and the median time from the initial surgery was 4.5 years. The most common pathology of PJF was adjacent disc degeneration and subsequent canal stenosis (11 patients). Five patients showed disc degeneration with aseptic bone destruction. Fractures at the upper instrumented vertebra (UIV), UIV + 1, and UIV + 2 occurred in 2, 3, and 2 patients, respectively. Ossification of the yellow ligament, which had not been found at the first surgery, was identified in 6 patients. Eight patients showed improvement of their neurological deficits and 10 patients showed no improvement by the final follow-up. Perioperative major complications occurred in 8 of 18 patients.
The incidence of PJF with late neurological deficits following ASD surgery was 4.7% in this cohort. The patients showed several morphological features. After revision surgery, perioperative complications were common and the prognosis for improved neurological status was not favorable.
成人脊柱畸形（ASD）长节段器械融合手术后近端交界性失败（PJF）最严重的症状是神经功能缺损。尽管既往报道显示PJF通常在术后早期发生，但部分患者出现了迟发性神经功能缺损。本研究旨在报告迟发性神经功能缺损的PJF的发生率、特征及手术结果。
对在单一机构接受ASD手术治疗的患者进行回顾性分析。其中，纳入初次手术后至少6个月因新出现的神经功能缺损而需要翻修手术的患者。调查患者的人口统计学、影像学、手术及临床资料。采用Frankel分级系统评估神经功能状态。
385例患者中有18例（4.7%）发生迟发性神经功能缺损的PJF。神经功能缺损出现时的平均年龄为72.0±6.0岁，距初次手术的中位时间为4.5年。PJF最常见的病理改变是相邻椎间盘退变及随后的椎管狭窄（11例患者）。5例患者表现为椎间盘退变伴无菌性骨质破坏。上固定椎（UIV）、UIV + 1和UIV + 2处骨折分别发生在2例、3例和2例患者中。6例患者在初次手术时未发现的黄韧带骨化在随访中被发现。末次随访时，8例患者神经功能缺损改善，10例患者无改善。18例患者中有8例发生围手术期严重并发症。
该队列中ASD手术后迟发性神经功能缺损的PJF发生率为4.7%。患者表现出多种形态学特征。翻修手术后，围手术期并发症常见，神经功能改善的预后不佳。
