Ghailane Soufiane, Bouloussa Houssam, Fernandes Marques Manuel, Castelain Jean-Etienne, Challier Vincent, Campana Matthieu, Jacquemin Clément, Vital Jean-Marc, Gille Olivier
Department of Spinal Surgery Unit, Hôpital Privé Francheville, 24000 Périgueux, France.
Department of Orthopaedic Surgery, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO 64108, USA.
J Clin Med. 2024 Aug 23;13(17):4981. doi: 10.3390/jcm13174981.
Distal junctional failure (DJF) is less commonly described than proximal junctional failure following posterior spinal fusion, and particularly adult spinal deformity (ASD) surgery. We describe a case series of patients with DJF, taking into account sagittal spinopelvic alignment, and suggest potential risk factors in light of the current literature. We performed a single-center, retrospective review of posterior spinal fusion patients with DJF who underwent subsequent revision surgery between June 2009 and January 2019. Demographics and surgical details were collected. Radiographical measurements included the following: preoperative and postoperative sagittal and coronal alignment for each index or revision surgery. The upper-instrumented vertebra (UIV), lower instrumented vertebra (LIV), and fusion length were recorded. Nineteen cases (64.7 ± 13.5 years, 12 women, seven men) were included. The mean follow-up was 4.7 ± 2.4 years. The number of instrumented levels was 6.79 ± 2.97. Among the patients, 84.2% (n = 16) presented at least one known DJF risk factor. LIV was frequently L5 (n = 10) or S1 (n = 2). Six patients had an initial circumferential fusion at the distal end. Initial DJFs were vertebral fracture distal to the fusion (n = 5), screw pull-out (n = 9), spinal stenosis (n = 4), instability (n = 4), and one early DJK. The distal mechanical complications after a first revision included screw pull-out (n = 4), screw fracture (n = 3), non-union (n = 2), and an iatrogenic spondylolisthesis. In this case series, insufficient sagittal balance restoration, female gender, osteoporosis, L5 or S1 LIV in long constructs were associated with DJF. Restoring spinal balance and circumferentially fusing the base of constructs represent key steps to maintain correction and prevent revisions.
与后路脊柱融合术后尤其是成人脊柱畸形（ASD）手术中的近端交界性失败相比，远端交界性失败（DJF）的描述较少。我们报告了一组DJF患者病例系列，考虑了矢状位脊柱骨盆对线情况，并根据当前文献提出了潜在风险因素。我们对2009年6月至2019年1月间因DJF接受二次翻修手术的后路脊柱融合患者进行了单中心回顾性研究。收集了人口统计学和手术细节。影像学测量包括：每次初次或翻修手术的术前和术后矢状位及冠状位对线情况。记录上固定椎（UIV）、下固定椎（LIV）和融合长度。纳入19例患者（年龄64.7±13.5岁，女性12例，男性7例）。平均随访时间为4.7±2.4年。固定节段数为6.79±2.97。在这些患者中，84.2%（n = 16）至少存在一种已知的DJF风险因素。LIV常为L5（n = 10）或S1（n = 2）。6例患者在远端最初进行了环形融合。初次DJF为融合远端的椎体骨折（n = 5）、螺钉拔出（n = 9）、椎管狭窄（n = 4）、不稳定（n = 4）和1例早期DJK。首次翻修后的远端机械并发症包括螺钉拔出（n = 4）、螺钉断裂（n = 3）、不愈合（n = 2）和医源性椎体滑脱。在本病例系列中，矢状位平衡恢复不足、女性、骨质疏松、长节段固定中L5或S1作为LIV与DJF相关。恢复脊柱平衡并对结构基底进行环形融合是维持矫正和防止翻修的关键步骤。
