TY - JOUR
T1 - Assessment of Patient Outcomes and Proximal Junctional Failure Rate of Patients with Adult Spinal Deformity Undergoing Caudal Extension of Previous Spinal Fusion
AU - International Spine Study Group
AU - Daniels, Alan H.
AU - Reid, Daniel B.C.
AU - Durand, Wesley M.
AU - Line, Breton
AU - Passias, Peter
AU - Kim, Han Jo
AU - Protopsaltis, Themistocles
AU - LaFage, Virginie
AU - Smith, Justin S.
AU - Shaffrey, Christopher
AU - Gupta, Munish
AU - Klineberg, Eric
AU - Schwab, Frank
AU - Burton, Doug
AU - Bess, Shay
AU - Ames, Christopher
AU - Hart, Robert A.
N1 - Funding Information:
Conflict of interest statement: This study was funded by the International Spine Study Group Foundation . The authors also declare the following outside the present work: A. H. Daniels: consulting fees from Stryker, Orthofix, Spineart, and EOS; D. Reid: research support from Southern Spine and fellowship support from Orthofix ; P. Passias: consulting fees from Medicrea and SpineWave, speaking/teaching arrangements from Zimmer Biomet, scientific advisory board at Allosource, and grants from Cervical Spine Research Society ; H. J. Kim: board of directors at AOSpine, fellowship support from AOSpine, research support from CSRS and ISSGF , and royalties from K2M and Zimmer Biomet; T. Protopsaltis: consulting fees from Globus, Medicrea, Innovasis, K2M, and NuVasive; V. Lafage: stock ownership in Nemaris, Inc., consulting fees for Globus, speaking/teaching arrangements for DePuy Spine and K2M, and board of directors for Nemaris, Inc.; J. S. Smith: grants from DePuy Synthes , royalties from Zimmer Biomet, stock ownership in Alphatec, consulting fees from Zimmer Biomet, Nuvasive, Cerapedics, and AllSource, and fellowship support from AOSpine and NREF ; C. Shaffrey: royalties from Medtronic, Nuvasive, and Zimmer Biomet, stock ownership in Nuvasive, consulting fees for Medtronic, and fellowship support from NREF and AO; M. Gupta: royalties from DePuy and Innomed, stock ownership in J&J, P&G, perform Biologics, consulting for DePuy and Medtronic, trips/travel for Alphatec and Scoliosis Research Society, scientific advisory board for DePuy and Medtronic, and fellowship support from OMeGA and AOSpine; E. Klineberg: consulting fees from DePuy Synthes, Stryker, and Medicrea, speaking/teaching arrangements from AOSpine and K2M, and fellowship support from AOSpine; F. Schwab: royalties from MSD and K2M; stock ownership in Nemaris, Inc., consulting fees from Zimmer Biomet, Globus Medical, MSD, K2M, and Medicrea, speaking/teaching arrangements from Zimmer Biomet, MSD, Globus Medical, and K2M, and board of directors for Nemaris, Inc.; D. Burton: royalties from DePuy Spine, consulting for DePuy Spine, board of directors for ISSG, SRS, and University of Kansas Physicians, and research support from DePuy Spine , Bioventus , and Pfizer ; S. Bess: grants from K2, DePuy Spine , and Nuvasive , royalties from K2M, consulting for K2M, scientific advisory board for EOS and MISONIX, and grants from ISSGF ; C. Ames: royalties from Stryker, Zimmer Biomet, DePuy Synthes, Nuvasive, Next Orthosurgical, K2M, and Medicrea, consulting from DePuy Synthes, Medtronic, Medicrea and K2M, research support from Titan Spine , DePuy Synthes , and ISSG , and grants from SRS ; and R. Hart: royalties from Seaspine and DSS, consulting from Globus, and grants from ISSGF .
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/7
Y1 - 2020/7
N2 - Objective: This case series examined patients undergoing caudal extension of prior fusion without alteration of the prior upper instrumented vertebra (UIV) to assess patient outcomes and rates of proximal junctional kyphosis (PJK)/proximal junctional failure (PJF). Methods: Patients eligible for 2-year minimum follow-up undergoing caudal extension of prior fusion with unchanged UIVs were identified. These patients were evaluated for PJK/PJF, and patient reported outcomes were recorded. Results: In total, 40 patients were included. Mean follow-up duration was 2.2 ± 0.3 years. Patients in this cohort had poor preoperative sagittal alignment (pelvic incidence minus lumbar lordosis [PI-LL] 26.7°, T1 pelvic angle [TPA] 29.0°, sagittal vertical axis [SVA] 93.4 mm) and achieved substantial sagittal correction (ΔSVA −62.2 mm, ΔPI-LL −19.8°, ΔTPA −11.1°) after caudal extension surgery. At final follow-up, there was a 0% rate of PJF among patients undergoing caudal extension of previous fusion without creation of a new UIV, but 27.5% of patients experienced PJK. Patients experienced significant improvement in both the Oswestry Disability Index and Scoliosis Research Society-22r total score at 2 years postoperatively (P < 0.05). In total, 7.5% (n = 3) of patients underwent further revision, at an average of 1.1 ± 0.54 years after the surgery with unaltered UIV. All 3 of these patients underwent revision for rod fracture with no revisions for PJK/PJF. Conclusions: Patients undergoing caudal extension of previous fusions for sagittal alignment correction have high rates of clinical success, low revision surgery rates, and very low rates of PJF. Minimizing repetitive tissue trauma at the UIV may result in decreased PJF risk because the PJF rate in this cohort of patients with unaltered UIV is below historical PJF rates of patients undergoing sagittal balance correction.
AB - Objective: This case series examined patients undergoing caudal extension of prior fusion without alteration of the prior upper instrumented vertebra (UIV) to assess patient outcomes and rates of proximal junctional kyphosis (PJK)/proximal junctional failure (PJF). Methods: Patients eligible for 2-year minimum follow-up undergoing caudal extension of prior fusion with unchanged UIVs were identified. These patients were evaluated for PJK/PJF, and patient reported outcomes were recorded. Results: In total, 40 patients were included. Mean follow-up duration was 2.2 ± 0.3 years. Patients in this cohort had poor preoperative sagittal alignment (pelvic incidence minus lumbar lordosis [PI-LL] 26.7°, T1 pelvic angle [TPA] 29.0°, sagittal vertical axis [SVA] 93.4 mm) and achieved substantial sagittal correction (ΔSVA −62.2 mm, ΔPI-LL −19.8°, ΔTPA −11.1°) after caudal extension surgery. At final follow-up, there was a 0% rate of PJF among patients undergoing caudal extension of previous fusion without creation of a new UIV, but 27.5% of patients experienced PJK. Patients experienced significant improvement in both the Oswestry Disability Index and Scoliosis Research Society-22r total score at 2 years postoperatively (P < 0.05). In total, 7.5% (n = 3) of patients underwent further revision, at an average of 1.1 ± 0.54 years after the surgery with unaltered UIV. All 3 of these patients underwent revision for rod fracture with no revisions for PJK/PJF. Conclusions: Patients undergoing caudal extension of previous fusions for sagittal alignment correction have high rates of clinical success, low revision surgery rates, and very low rates of PJF. Minimizing repetitive tissue trauma at the UIV may result in decreased PJF risk because the PJF rate in this cohort of patients with unaltered UIV is below historical PJF rates of patients undergoing sagittal balance correction.
KW - Adult spinal deformity
KW - Proximal junctional failure
KW - Proximal junctional kyphosis
KW - Upper instrumented vertebra
UR - http://www.scopus.com/inward/record.url?scp=85084400134&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2020.04.024
DO - 10.1016/j.wneu.2020.04.024
M3 - Article
C2 - 32305603
AN - SCOPUS:85084400134
SN - 1878-8750
VL - 139
SP - e449-e454
JO - World Neurosurgery
JF - World Neurosurgery
ER -