TY - JOUR
T1 - Caudally directed upper-instrumented vertebra pedicle screws associated with minimized risk of proximal junctional failure in patients with long posterior spinal fusion for adult spinal deformity
AU - Harris, Andrew B.
AU - Kebaish, Floreana N.
AU - Puvanesarajah, Varun
AU - Raad, Micheal
AU - Wilkening, Matthew W.
AU - Jain, Amit
AU - Cohen, David B.
AU - Neuman, Brian J.
AU - Kebaish, Khaled M.
N1 - Publisher Copyright:
© 2021
PY - 2021/7
Y1 - 2021/7
N2 - BACKGROUND CONTEXT: It is unknown whether upper instrumented vertebra (UIV) pedicle screw trajectory and UIV screw-rod angle are associated with development of proximal junctional kyphosis (PJK) and/or proximal junctional failure (PJF). PURPOSE: To determine whether (1) the cranial-caudal trajectory of UIV pedicle screws and (2) UIV screw-vertebra angle are associated with PJK and/or PJF after long posterior spinal fusion in patients with adult spinal deformity (ASD). STUDY DESIGN/SETTING: Retrospective review. PATIENT SAMPLE: We included 96 patients with ASD who underwent fusion from T9–T12 to the pelvis (>5 vertebrae fused) between 2008 and 2015. OUTCOME MEASURES: Pedicle screw trajectory was measured as the UIV pedicle screw–vertebra angle (UIV-PVA), which is the mean of the two angles between the UIV superior endplate and both UIV pedicle screws. (Positive values indicate screws angled cranially; negative values indicate screws angled caudally.) We measured UIV rod-vertebra angle (UIV-RVA) between the rod at the point of screw attachment and the UIV superior endplate. METHODS: During ≥2-year follow-up, 38 patients developed PJK, and 28 developed PJF. Mean (± standard deviation) UIV-PVA was −0.9° ± 6.0°. Mean UIV-RVA was 87° ± 5.2°. We examined the development of PJK and PJF using a UIV-PVA/UIV-RVA cutoff of 3° identified by a receiver operating characteristic curve, while controlling for osteoporosis, age, sex, and preoperative thoracic kyphosis. RESULTS: Patients with UIV-PVA ≥3° had significantly greater odds of developing PJK (odds ratio 2.7; 95% confidence interval: 1.0–7.1) and PJF (odds ratio 3.6; 95% confidence interval: 1.3–10) compared with patients with UIV-PVA <3°. UIV-RVA was not significantly associated with development of PJK or PJF. CONCLUSIONS: In long thoracic fusion to the pelvis for ASD, UIV-PVA ≥3° was associated with 2.7-fold greater odds of PJK and 3.6-fold greater odds of PJF compared with UIV-PVA <3°. UIV-RVA was not associated with PJK or PJF.
AB - BACKGROUND CONTEXT: It is unknown whether upper instrumented vertebra (UIV) pedicle screw trajectory and UIV screw-rod angle are associated with development of proximal junctional kyphosis (PJK) and/or proximal junctional failure (PJF). PURPOSE: To determine whether (1) the cranial-caudal trajectory of UIV pedicle screws and (2) UIV screw-vertebra angle are associated with PJK and/or PJF after long posterior spinal fusion in patients with adult spinal deformity (ASD). STUDY DESIGN/SETTING: Retrospective review. PATIENT SAMPLE: We included 96 patients with ASD who underwent fusion from T9–T12 to the pelvis (>5 vertebrae fused) between 2008 and 2015. OUTCOME MEASURES: Pedicle screw trajectory was measured as the UIV pedicle screw–vertebra angle (UIV-PVA), which is the mean of the two angles between the UIV superior endplate and both UIV pedicle screws. (Positive values indicate screws angled cranially; negative values indicate screws angled caudally.) We measured UIV rod-vertebra angle (UIV-RVA) between the rod at the point of screw attachment and the UIV superior endplate. METHODS: During ≥2-year follow-up, 38 patients developed PJK, and 28 developed PJF. Mean (± standard deviation) UIV-PVA was −0.9° ± 6.0°. Mean UIV-RVA was 87° ± 5.2°. We examined the development of PJK and PJF using a UIV-PVA/UIV-RVA cutoff of 3° identified by a receiver operating characteristic curve, while controlling for osteoporosis, age, sex, and preoperative thoracic kyphosis. RESULTS: Patients with UIV-PVA ≥3° had significantly greater odds of developing PJK (odds ratio 2.7; 95% confidence interval: 1.0–7.1) and PJF (odds ratio 3.6; 95% confidence interval: 1.3–10) compared with patients with UIV-PVA <3°. UIV-RVA was not significantly associated with development of PJK or PJF. CONCLUSIONS: In long thoracic fusion to the pelvis for ASD, UIV-PVA ≥3° was associated with 2.7-fold greater odds of PJK and 3.6-fold greater odds of PJF compared with UIV-PVA <3°. UIV-RVA was not associated with PJK or PJF.
KW - Adult spinal deformity
KW - Complications
KW - Fusion
KW - Pedicle screw
KW - Pelvis
KW - Proximal junctional kyphosis
KW - Scoliosis
KW - Thoracic kyphosis
KW - Upper instrumented vertebra
KW - proximal junctional failure
UR - https://www.scopus.com/pages/publications/85105281781
U2 - 10.1016/j.spinee.2021.03.009
DO - 10.1016/j.spinee.2021.03.009
M3 - Article
C2 - 33722729
AN - SCOPUS:85105281781
SN - 1529-9430
VL - 21
SP - 1072
EP - 1079
JO - Spine Journal
JF - Spine Journal
IS - 7
ER -