Immediate Postoperative Change in the Upper Instrumented Screw-Vertebra Angle is a Predictor for Proximal Junctional Kyphosis and Failure.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY Spine Pub Date : 2025-03-01 Epub Date: 2024-05-23 DOI:10.1097/BRS.0000000000005048

Riza M Cetik, Steven D Glassman, John R Dimar, Charles H Crawford, Jeffrey L Gum, Jensen Smith, Nicole McGrath, Leah Y Carreon

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Abstract

Study design: Retrospective review.

Objectives: To determine if change in position of upper instrumented vertebral (UIV) screw between intraoperative prone and immediate postoperative standing radiographs is a predictor for proximal junctional kyphosis or failure (PJK/PJF).

Summary of background data: Cranially directed UIV screws on postoperative radiographs have been found to be associated with PJK. Change in the screw position between intraoperative and immediate postoperative radiographs has not been studied.

Materials and methods: Patients with posterior fusion greater than or equal to three levels and UIV at or distal to T8, and minimum two-year follow-up were identified from a single-center database. Primary outcomes were radiographic PJK/PJF or revision for PJK/PJF. Demographic, surgical, and radiographic variables, including intraoperative screw-vertebra (S-V) angle, change in S-V angle, direction of UIV screw (cranial-neutral-caudal), and rod-vertebra (R-V) angle were collected.

Results: Totally, 143 cases from 110 patients were included with a mean age of 62.9 years and a follow-up of 3.5 years. Fifty-four (38%) cases developed PJK/PJF, of whom 30 required a revision. Mean S-V angle was -0.9°±5.5° intraoperative and -2.8°±5.5° postoperative. The group with PJK/PJF had a mean S-V angle change of -2.5°±2.4 while the rest had a change of -1.0°±1.6 ( P =0.010). When the change in S-V angle was <5°, 33% developed PJK, this increased to 80% when it was ≥5° ( P =0.001). Revision for PJK/PJF increased from 16% to 60% when S-V angle changed ≥5° ( P =0.001). Regression analysis showed S-V angle change as a significant risk factor for PJK/PJF ( P =0.047, OR=1.58) and for revision due to PJK/PJF ( P =0.009, OR=2.21).

Conclusions: Change in the S-V angle from intraoperative prone to immediate postoperative standing radiograph is a strong predictor for PJK/PJF and for revision. For each degree of S-V angle change, odds of revision for PJK/PJF increases by x2.2. A change of 5° should alert the surgeon to the likely development of PJK/PJF requiring revision.

Level of evidence: Level II.

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术后上部器械螺钉与椎体夹角的即时变化是近端交界性脊柱后凸和失败的预测因素。

研究设计回顾性分析：目的：确定术中俯卧位和术后立即站立位X光片之间上部器械椎体（UIV）螺钉位置的变化是否是近端交界性后凸或失败（PJK/PJF）的预测因素：背景数据摘要：在术后X光片上发现颅向UIV螺钉与PJK有关。尚未对术中和术后即刻X光片上螺钉位置的变化进行研究：从一个中心的数据库中找出后路融合≥3级、UIV位于T8或其远端、随访至少2年的患者。主要结果为放射学上的PJK/PJF或因PJK/PJF而进行的翻修。收集了人口统计学、手术和放射学变量，包括术中螺钉-椎体（S-V）角度、S-V角度变化、UIV螺钉方向（头颅-中轴-尾椎）和杆-椎体（R-V）角度：结果：110 名患者的 143 个病例被纳入研究，平均年龄为 62.9 岁，随访时间为 3.5 年。54例（38%）出现了PJK/PJF，其中30例需要进行翻修。术中平均S-V角为-0.9°±5.5°，术后为-2.8°±5.5°。PJK/PJF组的平均S-V角变化为-2.5°±2.4，而其他组的变化为-1.0°±1.6（P=0.010）。当 S-V 角的变化为结论时：从术中俯卧位到术后立即站立位X光片上的S-V角变化是预测PJK/PJF和翻修的有力指标。S-V 角每变化一度，PJK/PJF 的翻修几率就会增加 2.2 倍。每变化 5°，外科医生就应警惕可能发展为需要翻修的 PJK/PJF。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.