Distal Junctional Failure After Fusion Stopping at L5 in Patients With Adult Spinal Deformity: Incidence, Risk Factors, and Radiographic Criteria.

IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Neurospine Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI:10.14245/ns.2448122.061
Sung Ho Do, Sungsoo Bae, Dae Jean Jo, Ho Yong Choi
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Abstract

Objective: To identify risk factors and establish radiographic criteria for distal junctional failure (DJF) in patients with adult spinal deformity (ASD), who underwent fusion surgery stopping at L5.

Methods: This retrospective study was undertaken from January 2016 to December 2020. Patients with ASD who underwent fusion surgery (≥5 levels) stopping at L5 were analyzed. DJF was defined as symptomatic adjacent segment pathology at the lumbosacral junction necessitating consideration for revision surgery. Demographic data and radiographic measurements were compared between the DJF and non-DJF groups. Receiver operating characteristic curve analysis was performed to identify the radiographic cutoff value for DJF.

Results: Among 76 patients, 16 (21.1%) experienced DJF. DJF was associated with older age, antidepressant/anxiolytic medication, longer level of fusions, and worse preoperative sagittal alignment. Antidepressant/anxiolytic medication (odds ratio, 5.60) and preoperative pelvic incidence (PI)-lumbar lordosis (LL) mismatch>40° (odds ratio, 5.87) were independent risk factors for DJF. Without both factors, the incidence of DJF has been greatly reduced (9.1%). Two radiographic criteria were determined for DJF: last distal junctional angle (DJA)>-5° and Δ last DJA-post DJA>5°. When both criteria were met, the sensitivity and specificity of the DJF were 93.3% and 91.7%, respectively.

Conclusion: Use of antidepressant/anxiolytic medication and preoperative PI-LL mismatch >40° were independent risk factors for DJF. DJF could be diagnosed using postoperative changes in the DJA. If both criteria were met, DJF could be strongly suggested.

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成人脊柱畸形患者在 L5 期停止融合后的远端连接失败:发生率、风险因素和放射学标准。
目的在接受以L5为止点的融合手术的成人脊柱畸形(ASD)患者中识别远端连接失败(DJF)的风险因素并建立其影像学标准:这项回顾性研究于2016年1月至2020年12月进行。研究分析了接受融合手术(≥5级)、止于L5的ASD患者。DJF被定义为腰骶交界处有症状的邻近节段病变,需要考虑进行翻修手术。对 DJF 组和非 DJF 组的人口统计学数据和影像学测量结果进行了比较。对接收者操作特征曲线进行分析,以确定 DJF 的放射学临界值:76名患者中,16人(21.1%)出现了DJF。DJF与年龄较大、服用抗抑郁药/抗焦虑药、融合时间较长以及术前矢状对线较差有关。抗抑郁药/抗焦虑药(几率比为5.60)和术前骨盆前凸(PI)-腰椎前凸(LL)不匹配>40°(几率比为5.87)是DJF的独立风险因素。如果不考虑这两个因素,DJF 的发生率将大大降低(9.1%)。DJF 有两个影像学标准:最后一个远端交界角 (DJA)>-5° 和 Δ 最后一个 DJA 后 DJA>5°。当符合这两个标准时,DJF 的敏感性和特异性分别为 93.3% 和 91.7%:结论:使用抗抑郁/抗焦虑药物和术前PI-LL不匹配>40°是DJF的独立危险因素。根据术后 DJA 的变化可以诊断 DJF。如果同时满足这两个标准,则可强烈推荐使用 DJF。
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来源期刊
Neurospine
Neurospine Multiple-
CiteScore
5.80
自引率
18.80%
发文量
93
审稿时长
10 weeks
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