Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Orthopaedic Surgery, Kyung-Hee University Hospital at Gangdong, Seoul, South Korea.
World Neurosurg. 2023 Dec;180:e288-e295. doi: 10.1016/j.wneu.2023.09.063. Epub 2023 Sep 23.
Junctional failures after long fusion stopping at L5 can present at both proximal and distal ends. The purpose of this study was to investigate incidences and risk factors of proximal junctional failure (PJF) and distal junctional failure (DJF) after long lumbar instrumented fusion stopping at L5 for adult spinal deformity.
Sixty-three patients who underwent long fusion surgery stopping at L5 with a minimum follow-up of 3 years were reviewed retrospectively. PJF and DJF were defined as newly developed back pain and/or radiculopathy with corresponding radiographic failures. The incidence and risk factors of each junctional failure were analyzed using a log-rank test and Cox proportional hazards model.
Twelve men and 51 women were included in our study. Their mean age was 68.5 ± 7.0 years and the mean follow-up period was 84.5 ± 45.3 months. PJF and DJF occurred in 17 (27%) and 16 patients (25.4%), respectively. PJF and DJF developed at median durations of 32.1 months and 13.3 months, respectively, showing no significant difference between the two. Three patients presented with both PJF and DJF. Risk factors for PJF included lower body mass index, higher preoperative lumbar lordosis, and higher postoperative sagittal vertical axis (SVA) (hazard ratio, 0.570, 1.055, and 1.040, respectively). For DJF, higher preoperative SVA was an independent risk factor (hazard ratio, 1.010).
After long fusion surgery stopping at L5, PJF and DJF occurred at similar rates. Lower body mass index, higher preoperative lumbar lordosis, and higher postoperative SVA were risk factors for PJF. Higher preoperative SVA was an independent risk factor for DJF.
长节段融合终止于 L5 后出现的交界区失败可发生在近端和远端。本研究旨在探讨成人脊柱畸形后路长节段融合终止于 L5 后近端交界区失败（PJF）和远端交界区失败（DJF）的发生率和危险因素。
回顾性分析了 63 例接受长节段融合手术（融合终点止于 L5）并至少随访 3 年的患者。PJF 和 DJF 定义为新发腰痛和/或根性痛，并伴有相应的影像学失败。采用对数秩检验和 Cox 比例风险模型分析各交界区失败的发生率和危险因素。
本研究共纳入 12 名男性和 51 名女性患者，平均年龄为 68.5±7.0 岁，平均随访时间为 84.5±45.3 个月。17 例（27%）和 16 例（25.4%）患者分别发生了 PJF 和 DJF。PJF 和 DJF 的中位发病时间分别为 32.1 个月和 13.3 个月，两组间无显著差异。3 例患者同时出现 PJF 和 DJF。PJF 的危险因素包括较低的体重指数、较高的术前腰椎前凸角和较高的术后矢状垂直轴（SVA）（风险比分别为 0.570、1.055 和 1.040）。对于 DJF，较高的术前 SVA 是独立的危险因素（风险比为 1.010）。
后路长节段融合终止于 L5 后，PJF 和 DJF 的发生率相似。较低的体重指数、较高的术前腰椎前凸角和较高的术后 SVA 是 PJF 的危险因素。较高的术前 SVA 是 DJF 的独立危险因素。
