柯布角
脊柱畸形
骨盆倾斜
入射(几何)
脊柱侧凸
脊柱融合术
作者
Peter G. Passias,Cole Bortz,Katherine E. Pierce,Nicholas Kummer,Renaud Lafage,Bassel G. Diebo,Breton Line,Virginie Lafage,Douglas C. Burton,Eric O. Klineberg,Han Jo Kim,Alan H. Daniels,Gregory M. Mundis,Themistocles S. Protopsaltis,Robert K. Eastlack,Daniel M. Sciubba,Shay Bess,Frank J. Schwab,Christopher I. Shaffrey,Justin S. Smith,Christopher P. Ames
出处
期刊:Spine
[Ovid Technologies (Wolters Kluwer)]
日期:2021-11-01
卷期号:46 (21): 1437-1447
被引量:2
标识
DOI:10.1097/brs.0000000000004033
摘要
STUDY DESIGN Retrospective cohort study of a prospective cervical deformity (CD) database. OBJECTIVE Identify factors associated with distal junctional kyphosis (DJK); assess differences across DJK types. SUMMARY OF BACKGROUND DATA DJK may develop as compensation for mal-correction of sagittal deformity in the thoracic curve. There is limited understanding of DJK drivers, especially for different DJK types. METHODS Included: patients with pre- and postoperative clinical/radiographic data. Excluded: patients with previous fusion to L5 or below. DJK was defined per surgeon note or DJK angle (kyphosis from LIV to LIV-2) 4.4°), symptomatic (reoperation or published disability thresholds of NDI ≥ 24 or mJOA≤14). Random forest identified factors associated with DJK. Means comparison tests assessed differences. RESULTS Included: 136 CD patients (61 ± 10 yr, 61%F). DJK rate was 30%. Postop offset from ideal LL-TK correlated with greater DJK angle (r = 0.428) and inclination of the distal end of the fusion construct (r = 0.244, both P < 0.02). Seven of the top 15 factors associated with DJK were radiographic, four surgical, and four clinical. Breakdown by type: severe (22%), progressive (24%), symptomatic (61%). Symptomatic had more posterior osteotomies than asymptomatic (P = 0.018). Severe had worse NDI and upper-cervical deformity (CL, C2 slope, C0-C2), as well as more posterior osteotomies than nonsevere (all P < 0.01). Progressive had greater malalignment both globally and in the cervical spine (all P < 0.03) than static. Each type had varying associated factors. CONCLUSION Offset from age-specific alignment is associated with greater DJK and more anterior distal construct inclination, suggesting DJK may develop due to inappropriate realignment. Preoperative clinical and radiographic factors are associated with symptomatic and progressive DJK, suggesting the need for preoperative risk stratification.Level of Evidence: 3.
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