Li Junyu, Ma Yinghong, Liu Baitao, Ma Junjie, Sun Zhuoran, Wang Yongqiang, Yu Miao, Li Weishi, Zeng Yan
Orthopedic Department, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China.
Spine Deform. 2025 Mar;13(2):469-480. doi: 10.1007/s43390-024-00983-z. Epub 2024 Nov 2.
This study aimed to identify the effect of some novel risk factors associated with L1 vertebrae and parameters closely related to the sagittal alignment for the occurrence of proximal junctional kyphosis (PJK) following surgery for patients with osteoporotic vertebral compression fractures (OVCF) kyphosis.
74 OVCF patients undergoing posterior corrective surgery between January 2008 and June 2021 with a minimum 2-year follow-up were included. These patients were divided into PJK and non-PJK groups. Spinopelvic parameters, including thoracolumbar slope (TLS) and the L1 plumb line (L1PL) were measured preoperatively, postoperatively, and at follow-up. Multivariate logistic analysis was performed on various risk factors and Global Alignment and Proportion (GAP) scores. Associations between novel parameters and PJK were analyzed using receiver operating characteristic (ROC) analysis.
PJK was identified in 28.4% of patients. The mean age and follow-up were 63.45 years and 38.17 months, respectively. There was no difference between the PJK and the non-PJK groups in baseline demographics, pre-operative and immediate post-operative pelvic incidence-lumbar lordosis mismatch. Multiple comparisons showed that the proportion of PJK in the severely disproportioned group(the group with the highest GAP scores) and that of the other two groups with lower GAP scores were statistically different (P < 0.001). Potential risk factors for PJK included preoperative thoracic kyphosis (TK) (P < 0.001), TLS (P = 0.016), postoperative TLS (P < 0.001), and L1PL (P < 0.001). Postoperative TLS and L1PL were respectively independent risk factors for PJK, with the cut-off values set at 8.6° and 10.4 mm to predict the occurrence of PJK.
TLS and L1PL can be used to predict the occurrence of PJK in patients undergoing surgery for OVCF and are crucial for preventing the progression of PJK. Achieving a proportionate GAP Score postoperatively seems to be a viable option as higher GAP scores were associated with higher rates of PJK.
本研究旨在确定一些与L1椎体相关的新风险因素以及与矢状位排列密切相关的参数对骨质疏松性椎体压缩骨折（OVCF）后凸畸形患者手术后近端交界性后凸（PJK）发生的影响。
纳入2008年1月至2021年6月期间接受后路矫正手术且随访至少2年的74例OVCF患者。这些患者被分为PJK组和非PJK组。在术前、术后及随访时测量脊柱骨盆参数，包括胸腰段倾斜度（TLS）和L1铅垂线（L1PL）。对各种风险因素和整体排列与比例（GAP）评分进行多因素逻辑分析。使用受试者工作特征（ROC）分析来分析新参数与PJK之间的关联。
28.4%的患者发生了PJK。平均年龄和随访时间分别为63.45岁和38.17个月。PJK组和非PJK组在基线人口统计学、术前及术后即刻骨盆入射角-腰椎前凸不匹配方面无差异。多重比较显示，严重不成比例组（GAP评分最高的组）中PJK的比例与其他两个GAP评分较低的组在统计学上有差异（P＜0.001）。PJK的潜在风险因素包括术前胸椎后凸（TK）（P＜0.001）、TLS（P = 0.016）、术后TLS（P＜0.001）和L1PL（P＜0.001）。术后TLS和L1PL分别是PJK的独立危险因素，预测PJK发生的截断值分别设定为8.6°和10.4 mm。
TLS和L1PL可用于预测OVCF手术患者PJK的发生，对预防PJK进展至关重要。术后获得合适的GAP评分似乎是一个可行的选择，因为较高的GAP评分与较高的PJK发生率相关。
