Spine Surgery Department, King Faisal Specialist Hospital and Research Centre, P.O.Box 3354, 11211, Riyadh, Saudi Arabia.
Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France.
Eur Spine J. 2024 Jul;33(7):2832-2839. doi: 10.1007/s00586-024-08332-4. Epub 2024 Jun 6.
To assess, in a large population of Adult Spinal Deformity (ASD) patients, the true interest of varying the upper anchors as a protective measure against Proximal Junctional Kyphosis (PJK), by analyzing and comparing 2 groups of patients defined according to their proximal construct. Another objective of the study is to look for any other factors, radiological or clinical, that would affect the occurrence of the proximal failure.
Retrospective review of a prospective ASD database collected from 5 centers. Inclusion criteria were age of at least 18 years, presence of a spinal deformity with instrumentation from T12 or above to the pelvis, with minimum 2 years of follow-up. Demographic data, spinopelvic parameters, functional outcomes and complications were collected. Multiple logistic regression analysis was performed to identify the risk factors that would affect the occurrence of PJK.
254 patients were included. 166 in the group "screws proximally" (SP) and 88 in the group "hooks proximally" (HP). There was no difference between both groups for PJK (p = 0.967). The occurrence of PJK was rather associated with greater age and BMI, higher preoperative kyphosis, worst preoperative SRS22 and SF36 scores, greater postoperative Sagittal Vertical Axis (SVA), coronal malalignment and kyphosis.
The use of proximal hooks was not effective to prevent PJK after ASD surgery, when compared to proximal screws. Worse preoperative functional outcomes and worse postoperative sagittal and also coronal malalignment were the main drivers for the occurrence of PJK regardless the type of proximal implant.
在大量成人脊柱畸形（ASD）患者中评估，通过分析和比较两组根据近端结构定义的患者，改变上锚作为预防近端交界性后凸（PJK）的保护措施的真正意义。该研究的另一个目的是寻找任何其他可能影响近端失败发生的放射学或临床因素。
回顾性分析来自 5 个中心的前瞻性 ASD 数据库。纳入标准为年龄至少 18 岁，存在脊柱畸形，T12 或以上至骨盆处有器械固定，至少随访 2 年。收集人口统计学数据、脊柱骨盆参数、功能结果和并发症。进行多因素逻辑回归分析，以确定影响 PJK 发生的危险因素。
共纳入 254 例患者。166 例患者为“近端螺钉”（SP）组，88 例患者为“近端钩”（HP）组。两组之间 PJK 的发生率无差异（p=0.967）。PJK 的发生与年龄和 BMI 较大、术前后凸较大、术前 SRS22 和 SF36 评分较差、术后矢状垂直轴（SVA）、冠状面和矢状面失衡较大有关。
与近端螺钉相比，ASD 手术后使用近端钩并不能有效预防 PJK。无论近端植入物的类型如何，较差的术前功能结果以及术后矢状面和冠状面的失衡都是 PJK 发生的主要原因。
