Park Se-Jun, Park Jin-Sung, Kang Minwook, Jung Kyunghun, Lee Chong-Suh, Kang Dong-Ho
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan, South Korea.
Spine (Phila Pa 1976). 2025 Jan 1;50(1):10-18. doi: 10.1097/BRS.0000000000005114. Epub 2024 Aug 1.
Retrospective study.
To investigate the incidence and risk factors of mechanical failure (MF) following anterior column realignment (ACR) in patients with severe degenerative sagittal imbalance (DSI).
Considering the biomechanical properties of the procedure, ACR may increase the risk of MF, including proximal junctional kyphosis (PJK) and rod fracture (RF). However, this issue has been poorly documented in the literature.
We included patients aged ≥60 years with severe DSI radiographically defined by pelvic incidence (PI)-lumbar lordosis (LL) ≥20° undergoing ≥5-level fusion, including the sacrum. PJK was defined radiographically as a proximal junctional angle (PJA) >28° plus Δ PJA of >22°. RF was evaluated at ACR levels performed. Clinical and radiographic variables were compared with identify the risk factors for PJK and RF, then multivariate analysis was performed by combining PJK and RF into a single composite outcome of MF.
We included a total of 147 patients in the final study cohort. The mean age was 70.3 years, and there were 126 women (90.6%). The median fusion length was 8 levels. After surgery, PI-LL was corrected from 48.1° to 4.3°. MF developed in 49 patients (33.3%); PJK in 41 (27.9%), RF in 11 (7.5%), and both PJK and RF in 3 (2.0%) patients. Multivariate analyses revealed that osteoporosis (odds ratio [OR]=2.361, 95% confidence interval [CI]=1.270-5.590, P =0.048) and an increased number of ACR levels (OR=1.762, 95% CI=1.039-3.587, P =0.036) were significant risk factors for MF.
A considerable number of patients (33.3%) developed MF after deformity correction using ACR procedures. Therefore, appropriate surgical strategies are necessary to prevent MF in patients undergoing deformity correction using ACR, with special attention to the risk factors we identified here.
回顾性研究。
调查重度退行性矢状面失衡（DSI）患者前路椎体复位（ACR）后机械性故障（MF）的发生率及危险因素。
考虑到该手术的生物力学特性，ACR可能会增加MF的风险，包括近端交界性后凸（PJK）和棒材断裂（RF）。然而，这一问题在文献中记载较少。
我们纳入了年龄≥60岁、经影像学检查诊断为重度DSI（骨盆入射角[PI] -腰椎前凸[LL]≥20°）且接受包括骶骨在内的≥5节段融合手术的患者。PJK的影像学定义为近端交界角（PJA）>28°且ΔPJA>22°。在进行ACR的节段评估RF情况。比较临床和影像学变量以确定PJK和RF的危险因素，然后将PJK和RF合并为MF这一单一综合结局进行多因素分析。
最终研究队列共纳入147例患者。平均年龄为70.3岁，女性126例（90.6%）。融合节段中位数为8个节段。术后，PI - LL从48.1°矫正至4.3°。49例患者（33.3%）发生MF；41例（27.9%）发生PJK，11例（7.5%）发生RF，3例（2.0%）患者同时发生PJK和RF。多因素分析显示，骨质疏松（比值比[OR]=2.361，95%置信区间[CI]=1.270 - 5.590，P =0.048）和ACR节段数增加（OR=1.762，95% CI=1.039 - 3.587，P =0.036）是MF的显著危险因素。
相当一部分患者（33.3%）在采用ACR手术进行畸形矫正后发生MF。因此，对于接受ACR畸形矫正的患者，有必要采取适当的手术策略以预防MF，尤其要关注我们在此处确定的危险因素。
