Department of Orthopedic Surgery, Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan, Korea.
Clin Orthop Surg. 2023 Aug;15(4):606-615. doi: 10.4055/cios22329. Epub 2023 Jul 13.
Patient age has been associated with the development of proximal junctional failure (PJF). The characteristics of adult spinal deformity (ASD) are considered different between younger and older age groups. We hypothesized that the radiographic risk factors of PJF would be different according to age groups. This study aimed to evaluate different radiographic risk factors of PJF between two age groups undergoing thoracolumbar fusion for ASD.
ASD patients aged ≥ 60 years who underwent thoracolumbar fusion from the low thoracic level (T9-T12) to the sacrum were included. The minimum follow-up duration was 2 years. PJF was defined as proximal junctional angle (PJA) ≥ 20°, fixation failure, fracture, myelopathy, or necessity of revision surgery. Using various radiographic risk factors including age-adjusted ideal pelvic incidence (PI)-lumbar lordosis (LL), univariate and multivariate analyses were performed separately in two age groups: < 70 years and ≥ 70 years.
A total of 186 patients (90.3% women) with a mean age of 69 years were enrolled. The mean follow-up duration was 67.4 months. PJF developed in 97 patients (52.2%). There were fractures in 53 patients, PJA ≥ 20° in 26, fixation failure in 12, and myelopathy in 6. PJF developed more frequently in patients 70 years or older than in those younger than 70 years. In patients aged less than 70 years, preoperative LL, PI-LL, and a change in LL were significant risk factors in univariate analysis. Multivariate analysis showed only a change in LL was significant for PJF development (odds ratio [OR], 1.025; = 0.021). On the other hand, in patients 70 years or older, postoperative LL, postoperative PI-LL, and overcorrection relative to the conventional PI-LL target (within ± 10°) and age-adjusted ideal PI-LL target were significant risk factors. On multivariate analysis, only overcorrection of PI-LL relative to the age-adjusted ideal target was a single significant risk factor of PJF (OR, 5.250; = 0.024).
In patients younger than 70 years, a greater change in LL was associated with PJF development regardless of PI-related values. However, in older patients, overcorrection of PI-LL relative to the age-adjusted PI-LL target was a significant risk factor of PJF.
患者年龄与近端交界性失败（PJF）的发生有关。成人脊柱畸形（ASD）的特点被认为在年轻和老年人群中存在差异。我们假设，根据年龄组，PJF 的放射学危险因素也会不同。本研究旨在评估接受胸腰椎融合术治疗 ASD 的两个年龄组中 PJF 的不同放射学危险因素。
纳入年龄≥60 岁、从胸 9 至胸 12 （T9-T12）融合至骶骨的 ASD 患者。最低随访时间为 2 年。PJF 定义为近端交界角（PJA）≥20°、固定失败、骨折、脊髓病或需要翻修手术。使用各种放射学危险因素，包括年龄调整理想骨盆入射角（PI）-腰椎前凸（LL），分别对两个年龄组（<70 岁和≥70 岁）进行单变量和多变量分析。
共纳入 186 例（90.3%为女性）患者，平均年龄为 69 岁。平均随访时间为 67.4 个月。97 例（52.2%）患者发生 PJF。其中 53 例骨折，26 例 PJA≥20°，12 例固定失败，6 例脊髓病。70 岁或以上患者的 PJF 发生率高于 70 岁以下患者。在年龄<70 岁的患者中，术前 LL、PI-LL 和 LL 变化在单变量分析中是显著的危险因素。多变量分析显示仅 LL 变化与 PJF 的发生显著相关（比值比[OR]，1.025； = 0.021）。另一方面，在 70 岁或以上的患者中，术后 LL、术后 PI-LL 和相对于常规 PI-LL 目标（±10°以内）和年龄调整理想 PI-LL 目标的过度矫正为显著危险因素。多变量分析显示，仅相对于年龄调整理想目标的 PI-LL 过度矫正是 PJF 的单一显著危险因素（OR，5.250； = 0.024）。
在年龄<70 岁的患者中，无论 PI 相关值如何，LL 的较大变化与 PJF 的发生相关。然而，在老年患者中，相对于年龄调整理想 PI-LL 目标的 PI-LL 过度矫正是 PJF 的一个显著危险因素。
