Diebo Bassel G, Balmaceno-Criss Mariah, Daher Mohammad, Lafage Renaud, Singh Manjot, Ames Christopher P, Burton Douglas, Lewis Stephen, Klineberg Eric O, Eastlack Robert, Gupta Munish, Mundis Greg, Gum Jeffrey L, Hamilton D Kojo, Hostin Richard, Passias Peter G, Protopsaltis Themistocles, Kebaish Khaled, Shaffrey Christopher, Smith Justin S, Line Breton, Bess Shay, Kim Han Jo, Lenke Lawrence G, Schwab Frank, Lafage Virginie, Daniels Alan H
Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York.
Spine (Phila Pa 1976). 2025 Sep 3. doi: 10.1097/BRS.0000000000005484.
Retrospective analysis of prospective data.
Evaluate the impact of radiographic and morphologic configuration of the uppermost instrumented vertebrae (UIV) region on proximal junctional kyphosis (PJK) rates.
Literature is limited on evaluation of the preoperative landing zone (UIV-1 to UIV +2 levels) and its impact on development of PJK.
Adult ASD patients with native baseline thoracolumbar junction, postoperative UIV between T9-T12 and LIV extending to pelvis, and 2-year follow-up available were included. Landing zone was assessed on radiographs for Meyerding grade listhesis and posterior translation angle by 2 spine surgeons. Comparative analyses were performed on demographics, radiographic parameters, and PJK rates across patients with/without landing zone listhesis and above/below 15° UIV spinopelvic inclination (UIV SPi). Multivariable regression, accounting for listhesis, UIV SPi, PJK prophylaxis, age, osteoporosis, radiographic UIV quality (bridging osteophytes/degenerative disc disease) and change in PI-LL and SVA, was used to identify independent predictors of PJK.
Among 244 patients, mean age was 64.41 years, 73.0% were female, mean CCI was 1.97. In total, 30% had preoperative landing zone listhesis and 42% had posterior translation (41% with baseline posterior translation and 59% with iatrogenic translation). Listhesis patients had similar baseline and 2-year radiographic alignment but higher 2-year PJK rates (32.9% vs. 20.5%, P=0.04). UIV SPi>15° patients also had higher PJK (37.5% vs. 14.2%, P<0.01) and PJK reoperation (16.3% vs. 5.8%, P=0.01) rates. Patients with both listhesis and UIV SPi>15° had the highest PJK (45.5%, P=0.03) and PJK reoperation (21.1%, P=0.18) rates. Multivariable regression (R2=0.33) identified landing zone listhesis (coeff=1.0, P=0.01) and UIV SPi (coeff=-0.22, P<.001) to be predictive of PJK.
Preoperative listhesis and postoperative posterior translation are independent predictors of 2-year PJK. These findings highlight the importance of meticulous selection of the UIV landing zone, with particular emphasis on preoperative listhesis and spinopelvic inclination.
IV.
对前瞻性数据进行回顾性分析。
评估最上位固定椎体（UIV）区域的影像学和形态学结构对近端交界性后凸（PJK）发生率的影响。
关于术前着陆区（UIV - 1至UIV +2节段）及其对PJK发生影响的评估的文献有限。
纳入成年退变性脊柱侧凸（ASD）患者，其基线为天然胸腰段交界区，术后UIV在T9 - T12之间且腰椎固定节段（LIV）延伸至骨盆，并具有2年随访资料。由2名脊柱外科医生通过X线片评估Meyerding分级滑脱和后移角度来确定着陆区。对有/无着陆区滑脱以及UIV矢状面骨盆倾斜度（UIV SPi）高于/低于15°的患者的人口统计学、影像学参数和PJK发生率进行比较分析。采用多变量回归分析，纳入因素包括滑脱、UIV SPi、PJK预防措施、年龄、骨质疏松症、影像学UIV质量（桥接骨赘/退变性椎间盘疾病）以及骨盆入射角（PI）-腰椎前凸（LL）和矢状面垂直轴（SVA）的变化，以确定PJK的独立预测因素。
244例患者中，平均年龄为64.41岁，73.0%为女性，平均Charlson合并症指数（CCI）为1.97。总体而言，30%的患者术前着陆区存在滑脱，42%的患者存在后移（41%为基线后移，59%为医源性后移）。存在滑脱的患者基线和2年时的影像学对线情况相似，但2年时PJK发生率更高（32.9%对20.5%，P = 0.04）。UIV SPi>15°的患者PJK发生率（37.5%对14.2%，P<0.01）和PJK再次手术率（16.3%对5.8%，P = 0.01）也更高。同时存在滑脱和UIV SPi>15°的患者PJK发生率（45.5%，P = 0.03）和PJK再次手术率（21.1%，P = 0.18）最高。多变量回归分析（R2 = 0.33）确定着陆区滑脱（系数 = 1.0，P =
