Passias Peter G, Naessig Sara, Sagoo Navraj, Passfall Lara, Ahmad Waleed, Lafage Renaud, Lafage Virginie, Vira Shaleen, Schoenfeld Andrew J, Oh Cheongeun, Protopsaltis Themistocles, Kim Han Jo, Daniels Alan, Hart Robert, Burton Douglas, Klineberg Eric O, Bess Shay, Schwab Frank, Shaffrey Christopher, Ames Christopher P, Smith Justin S
Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY.
Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX.
Spine (Phila Pa 1976). 2023 Jan 1;48(1):49-55. doi: 10.1097/BRS.0000000000004372. Epub 2022 Jul 14.
A retrospective review of a multicenter comprehensive cervical deformity (CD) database.
To develop a novel risk index specific to each patient to aid in patient counseling and surgical planning to minimize postop distal junctional kyphosis (DJK) occurrence.
DJK is a radiographic finding identified after patients undergo instrumented spinal fusions which can result in sagittal spinal deformity, pain and disability, and potentially neurological compromise. DJK is considered multifactorial in nature and there is a lack of consensus on the true etiology of DJK.
CD patients with baseline (BL) and at least one-year postoperative radiographic follow-up were included. A patient-specific DJK score was created through use of unstandardized Beta weights of a multivariate regression model predicting DJK (end of fusion construct to the second distal vertebra change in this angle by <-10° from BL to postop).
A total of 110 CD patients included (61 yr, 66.4% females, 28.8 kg/m 2 ). In all, 31.8% of these patients developed DJK (16.1% three males, 11.4% six males, 62.9% one-year). At BL, DJK patients were more frail and underwent combined approach more (both P <0.05). Multivariate model regression analysis identified individualized scores through creation of a DJK equation: -0.55+0.009 (BL inclination)-0.078 (preinflection)+5.9×10 -5 (BL lowest instrumented vertebra angle) + 0.43 (combine approach)-0.002 (BL TS-CL)-0.002 (BL pelvic tilt)-0.031 (BL C2 - C7) + 0.02 (∆T4-T12)+ 0.63 (osteoporosis)-0.03 (anterior approach)-0.036 (frail)-0.032 (3 column osteotomy). This equation has a 77.8% accuracy of predicting DJK. A score ≥81 predicted DJK with an accuracy of 89.3%. The BL reference equation correlated with two year outcomes of Numeric Rating Scales of Back percentage ( P =0.003), reoperation ( P =0.04), and minimal clinically importance differences for 5-dimension EuroQol questionnaire ( P =0.04).
This study proposes a novel risk index of DJK development that focuses on potentially modifiable surgical factors as well as established patient-related and radiographic determinants. The reference model created demonstrated strong correlations with relevant two-year outcome measures, including axial pain-related symptoms, occurrence of related reoperations, and the achievement of minimal clinically importance differences for 5-dimension EuroQol questionnaire.
对多中心综合颈椎畸形（CD）数据库进行回顾性分析。
开发一种针对每位患者的新型风险指数，以辅助患者咨询和手术规划，尽量减少术后远端交界性后凸（DJK）的发生。
DJK是患者接受脊柱内固定融合术后出现的一种影像学表现，可导致脊柱矢状面畸形、疼痛和功能障碍，并可能造成神经功能损害。DJK本质上被认为是多因素的，对于其真正病因缺乏共识。
纳入具有基线（BL）数据且术后至少有一年影像学随访的CD患者。通过使用预测DJK的多变量回归模型的非标准化β权重（融合结构末端至第二个远端椎体的该角度从BL到术后变化<-10°）创建患者特异性DJK评分。
共纳入110例CD患者（年龄61岁，66.4%为女性，体重指数28.8kg/m²）。这些患者中，31.8%发生了DJK（16.1%为3名男性，11.4%为6名男性，62.9%发生在术后一年）。在BL时，DJK患者更虚弱，采用联合手术方式的更多（均P<0.05）。多变量模型回归分析通过创建DJK方程确定个体化评分：-0.55+0.009（BL倾斜度）-0.078（弯曲前）+5.9×10⁻⁵（BL最低固定椎体角度）+0.43（联合手术方式）-0.002（BL胸腰段矢状面 Cobb角）-0.002（BL骨盆倾斜度）-0.031（BL C2-C7）+0.02（∆T4-T12）+0.63（骨质疏松症）-0.03（前路手术）-0.036（虚弱）-0.032（三柱截骨术）。该方程预测DJK的准确率为77.8%。评分≥81预测DJK的准确率为89.3%。BL参考方程与两年后背部数字评分量表结果（P=0.003）、再次手术（P=0.04）以及5维度欧洲生活质量调查问卷最小临床重要差异（P=0.04）相关。
本研究提出了一种新型的DJK发生风险指数，该指数侧重于潜在可改变的手术因素以及已确定的患者相关和影像学决定因素。所创建的参考模型与相关的两年结局指标具有很强的相关性，包括与轴向疼痛相关的症状、相关再次手术的发生以及5维度欧洲生活质量调查问卷最小临床重要差异的实现。
