Ruffilli Alberto, Barile Francesca, Cerasoli Tosca, Manzetti Marco, Viroli Giovanni, Ialuna Marco, Traversari Matteo, Salamanna Francesca, Mazzotti Antonio, Fini Milena, Faldini Cesare
Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
J Craniovertebr Junction Spine. 2023 Jan-Mar;14(1):65-70. doi: 10.4103/jcvjs.jcvjs_140_22. Epub 2023 Mar 13.
This was a retrospective study.
Since a better understanding of modifiable risk factors for proximal junctional disease (PJD) may lead to improved postoperative outcomes and less need of revision surgery, the aim of the present study is to determine whether sarcopenia and osteopenia are independent risk factors for PJD in patients undergoing lumbar fusion.
PJD is one of the most frequent complications following posterior instrumented spinal fusion. It is characterized by a spectrum of pathologies ranging from proximal junctional kyphosis (PJK) to proximal junctional failure (PJF). The etiology of PJD is multifactorial and currently not fully understood. Patient-specific factors, such as age, body mass index, osteoporosis, sarcopenia, and the presence of other comorbidities, can represent potential risk factors.
A retrospective review of patients, aging 50-85 years, who underwent a short (≤3 levels) posterior lumbar fusion for degenerative diseases was performed. Through magnetic resonance imaging (MRI), central sarcopenia and osteopenia were evaluated, measuring the psoas-to-lumbar vertebral index (PLVI) and the M-score. A multivariate analysis was performed to determine the independent risk factors for PJD, PJK, and PJF.
A total of 308 patients (mean age at surgery 63.8 ± 6.2 years) were included. Ten patients (3.2%) developed a PJD and all required revision surgery. Multivariate regression identified PLVI ( = 0.02) and M-score ( = 0.04) as independent risk factors for both PJK ( = 0.02 and = 0.04, respectively) and PJF ( = 0.04 and = 0.01, respectively).
Sarcopenia and osteopenia, as measured by PLVI and M-score, proved to be independent risk factors for PJD in patients who undergo lumbar fusion for degenerative diseases.
The present study was approved by the Institutional Review Board, CE AVEC 208/2022/OSS/IOR.
这是一项回顾性研究。
由于更好地了解近端交界区疾病（PJD）的可改变风险因素可能会改善术后结果并减少翻修手术的需求，本研究的目的是确定肌肉减少症和骨质减少症是否是腰椎融合术患者发生PJD的独立风险因素。
PJD是后路器械辅助脊柱融合术后最常见的并发症之一。它的特征是一系列病理情况，从近端交界区后凸畸形（PJK）到近端交界区失败（PJF）。PJD的病因是多因素的，目前尚未完全了解。患者特定因素，如年龄、体重指数、骨质疏松症、肌肉减少症和其他合并症的存在，可能是潜在的风险因素。
对50 - 85岁因退行性疾病接受短节段（≤3节段）后路腰椎融合术的患者进行回顾性研究。通过磁共振成像（MRI）评估中心性肌肉减少症和骨质减少症，测量腰大肌与腰椎椎体指数（PLVI）和M评分。进行多因素分析以确定PJD、PJK和PJF的独立风险因素。
共纳入308例患者（手术时平均年龄63.8±6.2岁）。10例患者（3.2%）发生了PJD，均需要翻修手术。多因素回归分析确定PLVI（=0.02）和M评分（=0.04）分别是PJK（分别为=0.02和=0.04）和PJF（分别为=0.04和=0.01）的独立风险因素。
以PLVI和M评分衡量，肌肉减少症和骨质减少症被证明是因退行性疾病接受腰椎融合术患者发生PJD的独立风险因素。
本研究已获得机构审查委员会批准，批准号为CE AVEC 208/2022/OSS/IOR。
