Nnake Chidebelum, Givens Ritt, Weintraub Matthew, Taha Omar, Concepción-González Alondra, Malka Matan, Lu Kevin, Blanchard Simon, El-Hawary Ron, Vitale Michael G, Roye Benjamin D
Department of Pediatric Orth opaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, 3959 Broadway, CHONY 8N, New York, NY, 10032-3784, USA.
Department of Orthopedic Surgery, IWK Health, Dalhousie University, Halifax, Canada.
Spine Deform. 2025 Jun 27. doi: 10.1007/s43390-025-01135-7.
For early-onset scoliosis (EOS) patients with growth-friendly implants, posterior distraction is a known contributor to proximal junctional kyphosis (PJK). Rib-based proximal fixation is thought to potentially reduce the risk of PJK compared to spine-based anchors. However, the effect of revising proximal rib-based implants to rib vs. spine-based implants on PJK has not yet been investigated.
(1) Patients converted from rib-based to spine-based proximal anchors (RTS) have a higher risk of PJK two years post-revision compared to those revised to rib-based anchors (RTR). (2) Revising the upper instrumented vertebra (UIV) to a lower level increases the risk of PJK at two years post-revision compared to revising to a higher or same level.
In this retrospective cohort study of EOS patients with rib-based growing constructs undergoing revision surgery with a minimum 2-year follow-up, we assessed pre-revision, post-revision, and 2-year follow-up radiographs. We excluded patients lacking lateral radiographs and attachment data and conducted descriptive analyses.
280 subjects were included, with an average age of 7.2 years at revision; RTS patients were slightly older (8.6y vs 7.2y), and 51% female. At 2 years, 32% of all patients developed PJK. This risk was higher in RTS patients compared to RTR patients (42.8% vs 30.2%, p = 0.17). RTS patients had a greater pre-revision total spine height (p = 0.02), a more negative sagittal balance at 2 years (p = 0.01) and were predominantly male (p = 0.08) compared to RTR. Of the factors associated with a greater risk of PJK, proximal anchor conversion from rib-to-spine had the highest predictive value of PJK development (OR 2.23, p = 0.04). While statistically significant, there was no clinical difference in risk at 2 years of developing PJK among patients revised to a lower level compared to those revised to a higher or same level (32.1% vs 32.5% vs 30.9%, respectively; p = 0.05).
32% of all subjects developed PJK at a 2-year follow-up. The risk of PJK in RTS patients was 40% higher than in RTR patients. While this did not reach statistical significance to the 0.05 level, due to the associations of risk established by literature and replicated in this study, and the magnitude of this difference, we believe these results to be clinically significant. We intend to re-evaluate this population in the future as more data becomes available. With no demonstrated risk in revision levels, these results should guide providers in revision decision-making in growing rods.
对于使用生长友好型植入物的早发性脊柱侧凸（EOS）患者，后路撑开是近端交界性后凸（PJK）的一个已知促成因素。与基于脊柱的锚钉相比，基于肋骨的近端固定被认为可能降低PJK的风险。然而，将基于肋骨的近端植入物翻修为基于肋骨与基于脊柱的植入物对PJK的影响尚未得到研究。
（1）与翻修为基于肋骨的锚钉（RTR）的患者相比，从基于肋骨的近端锚钉转换为基于脊柱的锚钉（RTS）的患者在翻修后两年发生PJK的风险更高。（2）与翻修为更高或相同节段相比，将上固定椎（UIV）翻修为更低节段会增加翻修后两年发生PJK的风险。
在这项对接受翻修手术且至少随访2年的使用基于肋骨的生长型内固定装置的EOS患者的回顾性队列研究中，我们评估了翻修前、翻修后和2年随访时的X线片。我们排除了缺乏侧位X线片和固定数据的患者，并进行了描述性分析。
纳入280名受试者，翻修时平均年龄为7.2岁；RTS患者年龄稍大（8.6岁对7.2岁），女性占51%。在2年时，所有患者中有32%发生了PJK。与RTR患者相比，RTS患者的这种风险更高（42.8%对30.2%，p = 0.17）。与RTR患者相比，RTS患者翻修前的全脊柱高度更大（p = 0.02），2年时矢状面平衡更负（p = 0.01），且男性占主导（p = 0.08）。在与PJK风险增加相关的因素中，近端锚钉从肋骨转换为脊柱对PJK发生的预测价值最高（OR 2.23，p = 0.04）。虽然具有统计学意义，但与翻修为更高或相同节段的患者相比，翻修为更低节段的患者在2年时发生PJK的风险在临床上并无差异（分别为32.1%对32.5%对30.9%；p = 0.05）。
在2年随访时，所有受试者中有32%发生了PJK。RTS患者发生PJK的风险比RTR患者高40%。虽然这未达到0.05水平的统计学显著性，但由于文献中确立并在本研究中重现的风险关联以及这种差异的程度，我们认为这些结果具有临床意义。我们打算在未来有更多数据时重新评估这一人群。由于翻修节段未显示出风险，这些结果应指导医生在生长棒翻修决策中做出判断。
