1Vanderbilt University School of Medicine, Nashville, Tennessee.
2University of Mississippi Medical Center School of Medicine, Jackson, Mississippi.
J Neurosurg Spine. 2023 Apr 7;39(1):82-91. doi: 10.3171/2023.2.SPINE221101. Print 2023 Jul 1.
Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity (ASD) with a multifactorial etiology. Many risk factors are controversial, and their relative importance is not fully understood. The authors aimed to elucidate the association between bone mineral density (BMD) and PJK.
A systematic literature search was performed using PubMed and Web of Science keywords of "Proximal Junctional Kyphosis [MeSH] OR Proximal Junctional Failure [MeSH]" AND "Bone Mineral Density [MeSH] OR Hounsfield Units [MeSH] OR DEXA [MeSH]" set to the date range of January 2002 to July 2022. Studies required a minimum of 10 patients and 12 months of follow-up. Articles were included if they were in the English language and presented a primary retrospective cohort that included a comparison of patients with and without PJK, as well as a radiographic biomarker for BMD, such as Hounsfield units (HU) or T-score.
A total of 18 unique studies with 2185 patients who underwent ASD surgery were identified. Of these, 537 patients (24.6%) developed PJK. Eight studies provided T-scores that were amenable to comparison, which found that patients who developed PJK were found to have lower BMD T-scores by a mean of -0.69 (95% CI -0.88 to -0.50; I2 = 63.9%, p < 0.001). The HU at the UIV among patients with the PJK group (n = 101) compared with the non-PJK group (n = 156) was found to be significantly lower (mean difference -32.35, 95% CI -46.05 to -18.65; I2 = 28.7%, p < 0.001).
This meta-analysis suggests that low preoperative BMD as measured by T-score and a diagnosis of osteoporosis were associated with higher postoperative PJK. Additionally, lower HU on CT at the UIV were found to be significant risk factors for postoperative PJK as well. These findings suggest that more attention to preoperative BMD is a risk factor for PJK among ASD patients is warranted.
近端交界性后凸（PJK）是成人脊柱畸形（ASD）手术治疗的一种并发症，其病因具有多因素性。许多危险因素存在争议，其相对重要性尚不完全清楚。作者旨在阐明骨密度（BMD）与 PJK 之间的关系。
使用 PubMed 和 Web of Science 的关键词“Proximal Junctional Kyphosis [MeSH] OR Proximal Junctional Failure [MeSH]”和“Bone Mineral Density [MeSH] OR Hounsfield Units [MeSH] OR DEXA [MeSH]”进行系统文献检索，检索时间范围设定为 2002 年 1 月至 2022 年 7 月。研究需要至少有 10 名患者和 12 个月的随访。如果文章是英文的，并提出了一个包含 PJK 患者和无 PJK 患者比较的回顾性队列研究，以及一个骨密度的放射学生物标志物，如 Hounsfield 单位（HU）或 T 评分，则纳入文章。
共确定了 18 项独特的研究，其中包括 2185 名接受 ASD 手术的患者。其中，537 名患者（24.6%）发生了 PJK。8 项研究提供了可进行比较的 T 评分，结果发现，发生 PJK 的患者的 BMD T 评分平均低 0.69（95%CI -0.88 至 -0.50；I2 = 63.9%，p < 0.001）。与无 PJK 组（n = 156）相比，PJK 组（n = 101）UIV 的 HU 值明显较低（平均差异 -32.35，95%CI -46.05 至 -18.65；I2 = 28.7%，p < 0.001）。
这项荟萃分析表明，术前 T 评分测量的低骨密度和骨质疏松症诊断与较高的术后 PJK 有关。此外，UIV 上 CT 的较低 HU 值也被发现是术后 PJK 的显著危险因素。这些发现表明，对于 ASD 患者，术前 BMD 更应被视为 PJK 的一个危险因素。
