Park Se-Jun, Lee Chong-Suh, Park Jin-Sung, Jeon Chung-Youb, Ma Chang-Hyun
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.
Neurosurgery. 2023 Sep 1;93(3):706-716. doi: 10.1227/neu.0000000000002475. Epub 2023 Mar 31.
Four guidelines have been suggested for optimal correction in adult spinal deformity surgery: Scoliosis Research Society (SRS)-Schwab classification, age-adjusted sagittal alignment goals, Global Alignment and Proportion (GAP) score, and the Roussouly algorithm. Whether these goals provide benefit in both proximal junctional kyphosis (PJK) reduction and clinical outcome improvement remains unclear.
To validate 4 preoperative surgical planning tools in PJK development and clinical outcomes.
We retrospectively reviewed patients who underwent ≥5-segment fusion including the sacrum for adult spinal deformity with a follow-up of ≥2-year. PJK development and clinical outcomes were compared among the groups separately using 4 surgical guidelines: SRS-Schwab pelvic incidence (PI)-lumbar lordosis (LL) modifier (Group 0, +, ++), age-adjusted PI-LL goal (undercorrection, matched correction, and overcorrection), GAP score (proportioned, moderately disproportioned, and severely disproportioned groups), and the Roussouly algorithm (restored and nonrestored groups).
A total of 189 patients were included in this study. The mean age was 68.3 years, and there were 162 women (85.7%). There were no differences in the rate of PJK development and clinical outcomes among SRS-Schwab PI-LL modifier and GAP score groups. With the age-adjusted PI-LL goal, PJK developed significantly less frequently in the matched group compared with the under- and overcorrection groups. Clinical outcomes were significantly better in the matched group compared with the under- and overcorrection groups. With the Roussouly algorithm, PJK developed significantly less frequently in the restored group than in the nonrestored group. However, there were no differences in clinical outcomes between the 2 Roussouly groups.
Correction according to the age-adjusted PI-LL goal and the restored Roussouly type was associated with reduced PJK development. However, differences in clinical outcomes were only observed in the age-adjusted PI-LL groups.
对于成人脊柱畸形手术的最佳矫正，已提出四项指导原则：脊柱侧凸研究学会（SRS）-施瓦布分类、年龄调整矢状面排列目标、整体排列与比例（GAP）评分以及鲁苏利算法。这些目标是否能在减少近端交界性后凸（PJK）和改善临床结局方面带来益处仍不明确。
验证4种术前手术规划工具在PJK发生发展及临床结局方面的效果。
我们回顾性分析了接受包括骶骨在内的≥5节段融合术治疗成人脊柱畸形且随访时间≥2年的患者。分别使用4种手术指导原则比较各组的PJK发生发展情况及临床结局：SRS-施瓦布骨盆入射角（PI）-腰椎前凸（LL）修正值（0组、+组、++组）、年龄调整PI-LL目标（矫正不足、匹配矫正和过度矫正）、GAP评分（比例协调组、中度比例失调组和严重比例失调组）以及鲁苏利算法（恢复组和未恢复组）。
本研究共纳入189例患者。平均年龄为68.3岁，女性162例（85.7%）。SRS-施瓦布PI-LL修正值组和GAP评分组在PJK发生发展率及临床结局方面无差异。采用年龄调整PI-LL目标时，匹配矫正组的PJK发生率明显低于矫正不足组和过度矫正组。匹配矫正组的临床结局明显优于矫正不足组和过度矫正组。采用鲁苏利算法时，恢复组的PJK发生率明显低于未恢复组。然而，鲁苏利算法的两组在临床结局方面无差异。
根据年龄调整PI-LL目标和恢复后的鲁苏利类型进行矫正与PJK发生率降低相关。然而，仅在年龄调整PI-LL组中观察到临床结局的差异。
