Patel Ruchit V, Chalif Joshua I, Yearley Alexander G, Jha Rohan, Chalif Eric J, Zaidi Hasan A
Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2025 Mar;195:123741. doi: 10.1016/j.wneu.2025.123741. Epub 2025 Feb 22.
Surgical intervention is a cornerstone of adult spinal deformity (ASD) management. However, there remain burdens from complications, including proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Posterior anatomic preservation at the uppermost instrumented vertebra has emerged as an accessible approach to potentially reduce PJK/PJF risk.
We assembled an institutional cohort of patients with ASD evaluated between 2017 and 2022 who had spinal fusion performed with a modified subperiosteal dissection at and immediately below the uppermost instrumented vertebra. Through a meta-analysis with a random-effects model, we compared our incidence of PJK/PJF against other prophylactic interventions.
Ninety patients were identified, (median age, 64 years; average follow-up, 19 months). Most had scoliosis and/or spinal stenosis with a median of 8 levels fused (40% revision cases). 6.7% and 3.3% of patients developed PJK and PJF, respectively, with the most common clinical correlate being a minor neurologic deficit such as numbness (37.8%). PJK/PJF and non-PJK/PJF patients had similar postoperative complication profiles. Radiographic parameters varied: the PJK/PJF cohort had greater preoperative pelvic incidence/pelvic tilt and postoperative pelvic incidence-lumbar lordosis mismatch as well as smaller operative correction of the thoracolumbar Cobb angle. In the literature, prophylactic interventions broadly reduced the incidence of PJK/PJF, with a pooled estimate of 19% compared with 36% in patients who did not receive any additional intervention.
Preservation of posterior anatomic structures likely has a role in reducing the rate of PJK/PJF. Linking radiographic parameters to PJK/PJF and studying techniques that keep posterior structures intact may be steps toward improving ASD correction outcomes.
手术干预是成人脊柱畸形（ASD）治疗的基石。然而，并发症带来的负担依然存在，包括近端交界性后凸（PJK）和近端交界性失败（PJF）。在最上方固定椎体进行后方解剖结构保留已成为一种可行的方法，有可能降低PJK/PJF的风险。
我们收集了2017年至2022年间接受评估的ASD患者的机构队列，这些患者在最上方固定椎体及其下方立即进行了改良骨膜下剥离的脊柱融合术。通过随机效应模型的荟萃分析，我们将我们的PJK/PJF发生率与其他预防性干预措施进行了比较。
共确定了90例患者（中位年龄64岁；平均随访19个月）。大多数患者患有脊柱侧弯和/或椎管狭窄，中位融合节段为8个（40%为翻修病例）。分别有6.7%和3.3%的患者发生了PJK和PJF，最常见的临床相关表现是轻微神经功能缺损，如麻木（37.8%）。发生PJK/PJF和未发生PJK/PJF的患者术后并发症情况相似。影像学参数各不相同：发生PJK/PJF的队列术前骨盆倾斜度/骨盆入射角更大，术后骨盆入射角-腰椎前凸不匹配，胸腰段Cobb角的手术矫正度更小。在文献中，预防性干预措施总体上降低了PJK/PJF的发生率，汇总估计为19%，而未接受任何额外干预的患者为36%。
保留后方解剖结构可能在降低PJK/PJF发生率方面发挥作用。将影像学参数与PJK/PJF联系起来，并研究保持后方结构完整的技术，可能是改善ASD矫正效果的步骤。
