Proximal Junctional Degeneration and Failure Modes: A Novel Classification and Clinical Implications.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY Spine Pub Date : 2024-11-01 Epub Date: 2024-05-29 DOI:10.1097/BRS.0000000000005053

Riza M Cetik, Steven D Glassman, John R Dimar, Mitchell J Campbell, Mladen Djurasovic, Charles H Crawford, Jeffrey L Gum, R Kirk Owens, Kathryn J McCarthy, Leah Y Carreon

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Abstract

Study design: Case-control study.

Objective: To introduce a classification system that will include the major types of degenerative changes and failures related to the proximal junction, and to determine the clinical course and characteristics for the different types of proximal junctional degeneration.

Background: Proximal junctional kyphosis and failures are well recognized after adult spinal fusion; however, a standardized classification is lacking.

Materials and methods: The proposed system identified 4 different patterns of proximal junctional degeneration: (1) Type 1 (multilevel symmetrical collapse), (2) Type 2 (single adjacent level collapse), (3) Type 3 (fracture), and (4) Type 4 (spondylolisthesis). A single-center database was reviewed from 2018 to 2021. Patients 18 years or older of age, who underwent posterior spinal fusion of ≥3 levels with an upper instrumented vertebral level between T8 and L2, and a follow-up of ≥2 years were included. Radiographic measurements, revision surgery, and time to revision were the primary outcomes.

Results: One hundred fifty patients were included with a mean age of 65.1 (±9.8) years and a mean follow-up of 3.2 (±1) years. Sixty-nine patients (46%) developed significant degenerative changes in the proximal junction and were classified accordingly. Twenty (13%) were type 1, 17 (11%) were type 2, 22 (15%) were type 3, and 10 (7%) were type 4. Type 3 had a significantly shorter time to revision with a mean of 0.9 (±0.9) years. Types 3 and 4 had greater preoperative sagittal vertical axis, and types 1 and 3 had greater final follow-up lumbar lordosis. Bone density measured by Hounsfield units showed lower measurements for type 3. Types 1 and 4 had lower rates of developing proximal junctional kyphosis. Type 1 had the lowest revision rate with 40% (types 2, 3, and 4 were 77%, 73%, and 80%, respectively, P = 0.045).

Conclusion: This novel classification system defines different modes of degeneration and failures at the proximal junction, and future studies with larger sample sizes are needed for validation.

Level of evidence: Level III.

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近端交界处退化和失效模式：新的分类和临床意义。

研究设计病例对照研究：引入一个分类系统，该系统将包括与近端交界处相关的退行性改变和失败的主要类型，并确定不同类型的近端交界处退变（PJD）的临床过程和特征：背景资料概要：成人脊柱融合术后，近端交界处脊柱后凸（PJK）和脊柱融合失败已得到广泛认可，但目前尚缺乏标准化的分类方法：所提出的系统确定了四种不同的 PJD 模式：1 型（多层次对称塌陷）、2 型（单相邻水平塌陷）、3 型（骨折）和 4 型（脊柱滑脱）。对 2018 年至 2021 年的单中心数据库进行了回顾。纳入的患者年龄≥18岁，接受后路脊柱融合术≥3级，上部器械椎体水平在T8-L2之间，随访时间≥2年。放射学测量、翻修手术和翻修时间是主要结果：150名患者的平均年龄为65.1（±9.8）岁，平均随访时间为3.2（±1）年。69名患者（46%）的近端交界处出现了明显的退行性病变，并进行了相应的分类。20例（13%）为1型，17例（11%）为2型，22例（15%）为3型，10例（7%）为4型。3型患者的翻修时间明显较短，平均为0.9 (±0.9) 年。3型和4型的术前矢状纵轴更大，1型和3型的最终复查腰椎前凸更大。用 Hounsfield 单位测量的骨密度显示，3 型的测量值较低。1 型和 4 型的 PJK 发生率较低。1型的翻修率最低，为40%（2、3和4型分别为77%、73%和80%，P=0.045）：结论：这一新颖的分类系统定义了近端交界处退变和失败的不同模式，未来需要更大样本量的研究进行验证：3.

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.