Monroig-Rivera Carlos, Okonta Ingrid, Bauer Jennifer M, Jain Amit, Miyanji Firoz, Parent Stefan, Newton Peter, Upasani V Salil, Cahill Patrick, Sucato Daniel, Sponseller Paul D, Samdani Amer, McLean D'Marfeivel, Brooks Jaysson T
Department of Orthopedics, Scottish Rite for Children, 2222 Welborn St, Dallas, TX, 75219, USA.
School of Medicine, University of Louisville, Louisville, KY, USA.
Spine Deform. 2025 Mar;13(2):595-601. doi: 10.1007/s43390-024-01002-x. Epub 2024 Nov 10.
Proximal junctional kyphosis is an infrequent complication in AIS; however, equipoise remains on the effects of ending a fusion proximally at the C7-T1 junction on the future development of PJK. The purpose of this study was to determine the rate of PJK in patients with AIS who had a UIV of T1 vs those with a UIV of T2 at 5 years of follow-up.
A query was performed of a prospective, multi-center AIS database of patients who received a PSF with at least 5 years of follow-up. Patients with a T1 UIV (n = 29) were compared to those with a T2 UIV (n = 58). PJK was defined as a proximal junctional angle (PJA) > 10 degrees.
There was no difference between the T1 and T2 UIV cohorts in preoperative T2-T12 kyphosis or pelvic incidence; however preoperatively, T1 UIV patients had a significantly decreased PJA at - 3° ± 4.5° as compared to T2 UIV patients 1.6° ± 6.5° (p = 0.0014). No patients with a T1 UIV experienced PJK at 5-years of follow-up, while 16% of patients with a T2 UIV experienced PJK (p = 0.025). No patients in the T2 UIV cohort required revision surgeries for their PJK. There was no difference found in total SRS22 scores, however at 5 years of follow-up, T2 UIV patients had better Pain domain scores (4.4 ± 0.6) vs T1 UIV patients (4.0 ± 0.6; p = 0.004).
While T1 is an uncommon UIV in AIS, at 5 years of follow-up, a T1 UIV did not result in PJK, nor did it result in a clinically significant change in patient-reported outcome scores.
近端交界性后凸是特发性脊柱侧凸（AIS）中一种不常见的并发症；然而，对于在C7-T1交界处近端终止融合对未来近端交界性后凸（PJK）发展的影响，目前仍存在平衡观点。本研究的目的是确定在5年随访期内，顶椎为T1的AIS患者与顶椎为T2的AIS患者的PJK发生率。
对一个前瞻性、多中心的AIS患者数据库进行查询，这些患者接受了后路脊柱融合术（PSF）且随访时间至少5年。将顶椎为T1的患者（n = 29）与顶椎为T2的患者（n = 58）进行比较。PJK定义为近端交界角（PJA）> 10度。
T1和T2顶椎组在术前T2-T12后凸或骨盆入射角方面无差异；然而在术前，顶椎为T1的患者的PJA显著降低，为-3°±4.5°，而顶椎为T2的患者为1.6°±6.5°（p = 0.0014）。在5年随访期内，顶椎为T1的患者无PJK发生，而顶椎为T2的患者中有16%发生了PJK（p = 0.025）。T2顶椎组中没有患者因PJK需要翻修手术。在SRS22总分方面未发现差异，然而在5年随访时，顶椎为T2的患者的疼痛领域评分（4.4±0.6）优于顶椎为T1的患者（4.0±0.6；p = 0.004）。
虽然T1是AIS中不常见的顶椎，但在5年随访期内，顶椎为T1并未导致PJK，也未导致患者报告的结局评分出现具有临床意义的变化。
