Spine Center, Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea.
Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
BMC Musculoskelet Disord. 2024 Nov 30;25(1):981. doi: 10.1186/s12891-024-08065-x.
This retrospective review study aimed to determine whether functional mobility test (FMT) results are related to the incidence of proximal junctional kyphosis (PJK) after surgical correction of adult spinal deformity (ASD).
A total of 157 patients who underwent reconstructive spinal surgery for ASD between July 2019 and December 2021 were included in this study. Three types of FMTs were performed preoperatively: timed-up-and-go (TUG) test, five times sit-to-stand (STS) test, and alternate step (AS) test. The primary outcome measure was the occurrence of PJK at 1 year after surgery. Oswestry disability index (ODI) and EuroQOL-5-dimension (EQ-5D) scores were surveyed as patient-reported outcome measures of the surgery.
The occurrence of PJK was observed in 41 of the 157 patients (26.1%) at 1 year after surgery. Among the three functional mobility tests, STS test results were significantly higher in the patients who developed PJK. The receiver operating characteristics curve drawn with the STS test had an area under the curve of 0.69 and the optimal cutoff value was suggested as 22 seconds. Multivariate logistic regression analysis identified the STS test along with age and preoperative ODI score as the significant predictors of PJK (p = 0.026, 0.005 and 0.001, respectively).
A longer test time on the STS test result was associated with a higher occurrence of postoperative PJK. A cutoff value of 22 s can be suggested. Preoperative surveillance of these patients and providing additional efforts and surgical procedures for the prevention of PJK are anticipated to improve the surgical outcome of ASD correction.
本回顾性研究旨在确定功能性移动测试（FMT）结果与成人脊柱畸形（ASD）手术后近端交界性后凸（PJK）的发生率是否相关。
本研究共纳入 157 例 2019 年 7 月至 2021 年 12 月接受 ASD 重建脊柱手术的患者。术前进行了三种类型的 FMT：计时起坐（TUG）测试、五次坐立测试（STS）和交替步测试（AS）。主要观察指标为术后 1 年 PJK 的发生情况。术后患者报告的手术结果采用 Oswestry 残疾指数（ODI）和 EuroQOL-5 维度（EQ-5D）评分进行评估。
术后 1 年时，157 例患者中有 41 例（26.1%）发生 PJK。在三种功能性移动测试中，发生 PJK 的患者 STS 测试结果明显较高。STS 测试绘制的受试者工作特征曲线下面积为 0.69，建议最佳截断值为 22 秒。多变量逻辑回归分析确定 STS 测试以及年龄和术前 ODI 评分是 PJK 的显著预测因素（p=0.026、0.005 和 0.001）。
STS 测试结果的测试时间较长与术后 PJK 的发生较高相关。可以建议 22 秒的截断值。预计对这些患者进行术前监测，并为预防 PJK 提供额外的努力和手术程序，将改善 ASD 矫正的手术结果。
