An evidence based conceptual framework for the multifactorial understanding of proximal junctional kyphosis

IF 1.9 Q3 CLINICAL NEUROLOGY Brain & spine Pub Date : 2024-01-01 DOI:10.1016/j.bas.2024.102807
Pearce B. Haldeman , Samuel R. Ward , Joseph Osorio , Bahar Shahidi
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Abstract

Introduction

Adult spinal deformity (ASD) is a debilitating pathology that arises from a variety of etiologies. Spinal fusion surgery is the mainstay of treatment for those who do not achieve symptom relief with conservative interventions. Fusion surgery can be complicated by a secondary deformity termed proximal junctional kyphosis (PJK).

Research question

This scoping review evaluates the modern body of literature analyzing risk factors for PJK development and organizes these factors according to a multifactorial framework based on mechanical, tissue or demographic components.

Materials and methods

An extensive search of the literature was performed in PubMed and Embase back to the year 2010. Articles were assessed for quality. All risk factors that were evaluated and those that significantly predicted the development of PJK were compiled. The frequency that a risk factor was predictive compared to the number of times it was evaluated was calculated.

Results

150 articles were reviewed. 57.3% of papers were of low quality. 76% of risk factors analyzed were focusing on the mechanical contribution to development of PJK versus only 5% were focusing on the tissue-based contribution. Risk factors that were most frequently predictive compared to how often they were analyzed were Hounsfield Units of vertebrae, UIV disc degeneration, paraspinal muscle cross sectional area and fatty infiltration, ligament augmentation, instrument characteristics, postoperative hip and lower extremity radiographic metrics, and postoperative teriparatide supplementation.

Discussion and conclusion

This review finds a multifactorial framework accounting for mechanical, patient and tissue-based risk factors will improve the understanding of PJK development.

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以证据为基础的概念框架:对近交界脊柱侧凸的多因素理解
导言成人脊柱畸形(ASD)是一种使人衰弱的病理现象,由多种病因引起。对于保守治疗无法缓解症状的患者,脊柱融合手术是主要的治疗手段。融合手术可能会因继发性畸形而变得复杂,这种畸形被称为近端交界性脊柱后凸(PJK)。研究问题本范围综述评估了分析 PJK 发生风险因素的现代文献,并根据基于机械、组织或人口统计学成分的多因素框架对这些因素进行了整理。对文章的质量进行了评估。对所有经过评估的风险因素以及对 PJK 的发生有显著预测作用的因素进行了汇总。结果 150 篇文章接受了审查。57.3%的论文质量不高。所分析的风险因素中,76%侧重于PJK发生的机械因素,只有5%侧重于组织因素。与分析频率相比,最常预测的风险因素是椎体的 Hounsfield 单位、UIV 椎间盘变性、脊柱旁肌肉横截面积和脂肪浸润、韧带增强、器械特征、术后髋关节和下肢放射学指标以及术后补充特立帕肽。
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来源期刊
Brain & spine
Brain & spine Surgery
CiteScore
1.10
自引率
0.00%
发文量
0
审稿时长
71 days
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