Murata Koichi, Fujibayashi Shunsuke, Otsuki Bungo, Shimizu Takayoshi, Matsuda Shuichi
Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Spine Surg Relat Res. 2021 Dec 27;6(4):395-401. doi: 10.22603/ssrr.2021-0157. eCollection 2022.
Several targets have been proposed to achieve satisfactory alignment and favorable outcomes in adult spinal deformity surgery. Stopping the upper instrumented vertebra (UIV) at the thoracolumbar junction levels, especially between T11 and L1, is considered a high-risk factor for the development of proximal junctional kyphosis (PJK). Nevertheless, it is unknown in which patients the results of surgery are satisfactory when L1 or L2 is set as UIV with lumbosacral fixation. This study aimed to identify the risk factors for PJK in patients with lumbosacral fixation with L1 or L2 as UIV.
From January 2011 to December 2019, 21 consecutive patients who underwent lumbopelvic fixation for adult spinal deformity were included. The patients were divided into two groups: the PJK group (n=7) and the nonPJK group (n=14). Patients who experienced PJK within half a year of surgery were included in the PJK group. Pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt (PT), thoracic kyphosis (TK), thoracic compensation (TK compensation), sagittal vertical axis (SVA), T10-L2 angle, and T1 pelvic angle (TPA) were measured before and after surgery.
No difference was found between the two groups in terms of age and sex at the time of surgery. The indices that were significantly different between the two groups were preoperative PT, PI minus LL, TK, TPA, TK compensation, and postoperative T10-L2 angle. No significant differences were found in postoperative LL, PI minus LL, PT, TK, TPA, or SVA.
Preoperative X-ray indices, including preoperative TPA, TK compensation, TK, PT, and PI-LL, determined the risk of PJK in fusions from the sacrum to L1 or L2. Appropriate patient selection is crucial for the success of this surgery.
在成人脊柱畸形手术中，已提出多个目标以实现满意的对线和良好的手术效果。在胸腰段交界处水平，尤其是T11和L1之间停止使用上固定椎（UIV），被认为是近端交界性后凸（PJK）发生的高风险因素。然而，当将L1或L2设定为UIV并进行腰骶固定时，哪些患者的手术结果令人满意尚不清楚。本研究旨在确定以L1或L2为UIV进行腰骶固定的患者发生PJK的风险因素。
纳入2011年1月至2019年12月期间连续21例行腰骶固定治疗成人脊柱畸形的患者。将患者分为两组：PJK组（n = 7）和非PJK组（n = 14）。术后半年内发生PJK的患者纳入PJK组。在手术前后测量骨盆入射角（PI）、腰椎前凸（LL）、骨盆倾斜度（PT）、胸椎后凸（TK）、胸椎代偿（TK代偿）、矢状垂直轴（SVA）、T10-L2角和T1骨盆角（TPA）。
两组患者手术时的年龄和性别无差异。两组之间显著不同的指标为术前PT、PI减去LL、TK、TPA、TK代偿和术后T10-L2角。术后LL、PI减去LL、PT、TK、TPA或SVA无显著差异。
术前X线指标，包括术前TPA、TK代偿、TK、PT和PI-LL，决定了从骶骨到L1或L2融合术中PJK的风险。合适的患者选择对该手术的成功至关重要。
