Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan, South Korea.
Spine (Phila Pa 1976). 2022 Dec 15;47(24):1737-1745. doi: 10.1097/BRS.0000000000004449. Epub 2022 Aug 2.
Retrospective study.
To validate the age-adjusted ideal sagittal alignment in terms of proximal junctional failure (PJF) and clinical outcomes.
It is reported that optimal sagittal correction with regard to the age-adjusted ideal sagittal alignment reduces the risk of PJF development. However, few studies have validated this concept. The age-considered optimal correction is likely to be undercorrection in terms of conventional surgical target, such as pelvic incidence (PI)-lumbar lordosis (LL) within ±9°. Therefore, the clinical impact of age-adjusted sagittal alignment should be evaluated along with radiographic effect.
Adult spinal deformity patients, aged 50 years and above, who underwent greater than or equal to four-level fusion to sacrum with a minimum of four years of follow-up data were included in this study. Radiographic risk factors for PJF (including age-adjusted ideal PI-LL) were evaluated with multivariate analyses. Three groups were created based on PI-LL offset between age-adjusted ideal PI-LL and actual actual PI-LL: undercorrection, ideal correction, and overcorrection. Clinical outcomes were compared among the three groups.
This study included 194 adult spinal deformity patients. The mean age was 68.5 years and there were 172 females (88.7%). PJF developed in 99 patients (51.0%) at a mean postoperative period of 14.9 months. Multivariate analysis for PJF revealed that only PI-LL offset group had statistical significance. The proportion of patients with PJF was greatest in the overcorrection group followed by the ideal correction and undercorrection groups. Overcorrected patients regard to the age-adjusted ideal alignment showed poorer clinical outcomes than the other patient groups.
Overcorrection relative to age-adjusted sagittal alignment increases the risk of PJF development and is associated with poor clinical outcomes. Older patients and those with small PI are likely to be overcorrected in terms of the age-adjusted PI-LL target. Therefore, the age-adjusted alignment should be considered more strictly in these patients.
回顾性研究。
验证近端交界失败（PJF）和临床结果方面的年龄调整理想矢状位排列。
据报道，与年龄调整理想矢状位排列相关的最佳矢状矫正可降低 PJF 发展的风险。然而，很少有研究验证这一概念。就传统手术目标（如骨盆入射角（PI）-腰椎前凸（LL）在±9°范围内）而言，考虑年龄的最佳矫正可能是矫正不足。因此，应结合影像学效果评估年龄调整矢状位排列的临床影响。
本研究纳入了年龄在 50 岁及以上、接受大于或等于 4 级融合至骶骨并至少有 4 年随访数据的成人脊柱畸形患者。采用多变量分析评估 PJF 的放射学危险因素（包括年龄调整理想的 PI-LL）。根据年龄调整理想的 PI-LL 与实际实际 PI-LL 之间的 PI-LL 偏移，将患者分为三组：矫正不足、理想矫正和矫正过度。比较三组之间的临床结果。
本研究共纳入 194 例成人脊柱畸形患者。患者平均年龄为 68.5 岁，其中 172 例为女性（88.7%）。术后平均 14.9 个月，99 例（51.0%）患者发生 PJF。多变量分析显示，仅 PI-LL 偏移组具有统计学意义。在过度矫正组中，PJF 患者的比例最高，其次是理想矫正组和矫正不足组。与其他患者组相比，按照年龄调整的理想排列过度矫正的患者临床结局较差。
与年龄调整矢状位排列相比，过度矫正会增加 PJF 发展的风险，并与较差的临床结果相关。在年龄调整的 PI-LL 目标方面，年龄较大的患者和 PI 较小的患者更有可能过度矫正。因此，在这些患者中应更严格地考虑年龄调整的排列。
