Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
Spine (Phila Pa 1976). 2023 Feb 15;48(4):223-231. doi: 10.1097/BRS.0000000000004517. Epub 2022 Nov 2.
Retrospective cohort study.
The purpose of the present study was to assess the impact of sarcopenia on the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following thoracolumbar spine fusion surgery using opportunistic evaluation of paraspinal fatty degeneration on preoperative magnetic resonance imaging.
While paraspinal sarcopenia has been shown to have detrimental consequences following posterior cervicothoracic fusions, the impact of paraspinal sarcopenia on PJK and PJF following thoracolumbar spine fusion surgery remains unknown.
We performed a retrospective review of patients who underwent posterior spine fusion surgery that extended caudally to the pelvis and terminated cranially between T10 and L2 between 2010 and 2017. The cohort was divided into three groups: (1) patients without PJK or PJF, (2) patients with PJK but no PJF, and (3) patients with PJF. Univariate and multivariate analyses were performed to determine risk factors for the development of proximal junctional complications.
We identified 150 patients for inclusion in this study. Mean Hounsfield Units at the upper instrumented vertebra (UIV) was 148.3±34.5 in the cohort of patients without PJK or PJF, which was substantially higher than values recorded in the PJK (117.8±41.9) and PJF (118.8±41.8) subgroups (P<0.001). Severe multifidus sarcopenia was identified at a much higher rate in the subgroups of patients who developed PJK (76.0%) and PJF (78.9%) than in the subgroup of patients who developed neither PJK nor PJF (34.0%; P<0.001). Multivariate analysis demonstrated both low HU at the UIV and moderate-severe multifidus sarcopenia to be risk factors for the development of PJK and PJF.
The results of this study suggest severe paraspinal sarcopenia and diminished bone density at the UIV impart an increased risk of developing PJK and PJF, while markers of systemic frailty such as modified Frailty Index and Charlson Comorbidity Index are not associated with an increased risk of these complications.
III.
回顾性队列研究。
本研究旨在评估在使用机会性评估术前磁共振成像上的脊柱旁脂肪变性的情况下，脊柱旁肌减少症对胸腰椎后路融合术后近端交界性后凸（PJK）和近端交界性失败（PJF）的发展的影响。
虽然脊柱旁肌减少症已经被证明对后路颈胸融合后有不利影响，但脊柱旁肌减少症对胸腰椎后路融合术后 PJK 和 PJF 的影响仍不清楚。
我们对 2010 年至 2017 年间接受后路脊柱融合术且延伸至骨盆的患者进行了回顾性研究，其颅端止于 T10 至 L2 之间。该队列分为三组：（1）无 PJK 或 PJF 的患者；（2）有 PJK 但无 PJF 的患者；（3）有 PJF 的患者。进行了单变量和多变量分析以确定近端交界并发症发展的危险因素。
我们确定了 150 名患者纳入本研究。无 PJK 或 PJF 患者组的上器械椎体（UIV）的平均 Hounsfield 单位为 148.3±34.5，明显高于 PJK（117.8±41.9）和 PJF（118.8±41.8）亚组（P<0.001）。在发生 PJK（76.0%）和 PJF（78.9%）的患者亚组中，严重多裂肌肌减少症的发生率明显高于既未发生 PJK 也未发生 PJF 的患者亚组（34.0%；P<0.001）。多变量分析表明，UIV 的低 HU 和中度至重度多裂肌肌减少症均是发生 PJK 和 PJF 的危险因素。
本研究结果表明，严重的脊柱旁肌减少症和 UIV 处的骨密度降低会增加发生 PJK 和 PJF 的风险，而改良的虚弱指数和 Charlson 合并症指数等全身脆弱性标志物与这些并发症的风险增加无关。
III。
