TY - JOUR
T1 - Listhesis and Spinopelvic Inclination of Upper Instrumented Vertebra Region and the Implications on Proximal Junctional Kyphosis
AU - Diebo, Bassel G.
AU - Balmaceno-Criss, Mariah
AU - Daher, Mohammad
AU - Lafage, Renaud
AU - Singh, Manjot
AU - Ames, Christopher P.
AU - Burton, Douglas
AU - Lewis, Stephen
AU - Klineberg, Eric O.
AU - Eastlack, Robert
AU - Gupta, Munish
AU - Mundis, Greg
AU - Gum, Jeffrey L.
AU - Hamilton, D. Kojo
AU - Hostin, Richard
AU - Passias, Peter G.
AU - Protopsaltis, Themistocles
AU - Kebaish, Khaled
AU - Shaffrey, Christopher
AU - Smith, Justin S.
AU - Line, Breton
AU - Bess, Shay
AU - Kim, Han Jo
AU - Lenke, Lawrence G.
AU - Schwab, Frank
AU - Lafage, Virginie
AU - Daniels, Alan H.
N1 - Publisher Copyright:
© 2025 Wolters Kluwer Health, Inc. All rights reserved. Unauthorized reproduction of the article is prohibited.
PY - 2025
Y1 - 2025
N2 - Study Design. Retrospective analysis of prospective data. Objective. Evaluate the impact of radiographic and morphologic configuration of the uppermost instrumented vertebrae (UIV) region on proximal junctional kyphosis (PJK) rates. Background. Literature is limited on evaluation of the preoperative landing zone (UIV-1 to UIV +2 levels) and its impact on development of PJK. Methods. Adult ASD patients with native baseline thoracolumbar junction, postoperative UIV between T9-T12 and LIV extending to pelvis, and 2-year follow-up available were included. Landing zone was assessed on radiographs for Meyerding grade listhesis and posterior translation angle by 2 spine surgeons. Comparative analyses were performed on demographics, radiographic parameters, and PJK rates across patients with/without landing zone listhesis and above/below 15° UIV spinopelvic inclination (UIV SPi). Multivariable regression, accounting for listhesis, UIV SPi, PJK prophylaxis, age, osteoporosis, radiographic UIV quality (bridging osteophytes/degenerative disc disease) and change in PI-LL and SVA, was used to identify independent predictors of PJK. Results. Among 244 patients, mean age was 64.41 years, 73.0% were female, mean CCI was 1.97. In total, 30% had preoperative landing zone listhesis and 42% had posterior translation (41% with baseline posterior translation and 59% with iatrogenic translation). Listhesis patients had similar baseline and 2-year radiographic alignment but higher 2-year PJK rates (32.9% vs. 20.5%, P=0.04). UIV SPi>15° patients also had higher PJK (37.5% vs. 14.2%, P<0.01) and PJK reoperation (16.3% vs. 5.8%, P=0.01) rates. Patients with both listhesis and UIV SPi>15° had the highest PJK (45.5%, P=0.03) and PJK reoperation (21.1%, P=0.18) rates. Multivariable regression (R2=0.33) identified landing zone listhesis (coeff=1.0, P=0.01) and UIV SPi (coeff=-0.22, P<.001) to be predictive of PJK. Conclusions. Preoperative listhesis and postoperative posterior translation are independent predictors of 2-year PJK. These findings highlight the importance of meticulous selection of the UIV landing zone, with particular emphasis on preoperative listhesis and spinopelvic inclination. Level of Evidence. IV.
AB - Study Design. Retrospective analysis of prospective data. Objective. Evaluate the impact of radiographic and morphologic configuration of the uppermost instrumented vertebrae (UIV) region on proximal junctional kyphosis (PJK) rates. Background. Literature is limited on evaluation of the preoperative landing zone (UIV-1 to UIV +2 levels) and its impact on development of PJK. Methods. Adult ASD patients with native baseline thoracolumbar junction, postoperative UIV between T9-T12 and LIV extending to pelvis, and 2-year follow-up available were included. Landing zone was assessed on radiographs for Meyerding grade listhesis and posterior translation angle by 2 spine surgeons. Comparative analyses were performed on demographics, radiographic parameters, and PJK rates across patients with/without landing zone listhesis and above/below 15° UIV spinopelvic inclination (UIV SPi). Multivariable regression, accounting for listhesis, UIV SPi, PJK prophylaxis, age, osteoporosis, radiographic UIV quality (bridging osteophytes/degenerative disc disease) and change in PI-LL and SVA, was used to identify independent predictors of PJK. Results. Among 244 patients, mean age was 64.41 years, 73.0% were female, mean CCI was 1.97. In total, 30% had preoperative landing zone listhesis and 42% had posterior translation (41% with baseline posterior translation and 59% with iatrogenic translation). Listhesis patients had similar baseline and 2-year radiographic alignment but higher 2-year PJK rates (32.9% vs. 20.5%, P=0.04). UIV SPi>15° patients also had higher PJK (37.5% vs. 14.2%, P<0.01) and PJK reoperation (16.3% vs. 5.8%, P=0.01) rates. Patients with both listhesis and UIV SPi>15° had the highest PJK (45.5%, P=0.03) and PJK reoperation (21.1%, P=0.18) rates. Multivariable regression (R2=0.33) identified landing zone listhesis (coeff=1.0, P=0.01) and UIV SPi (coeff=-0.22, P<.001) to be predictive of PJK. Conclusions. Preoperative listhesis and postoperative posterior translation are independent predictors of 2-year PJK. These findings highlight the importance of meticulous selection of the UIV landing zone, with particular emphasis on preoperative listhesis and spinopelvic inclination. Level of Evidence. IV.
KW - Alignment
KW - Landing Zone
KW - Listhesis
KW - Proximal Junctional Kyphosis
KW - Spinopelvic Inclination
KW - Uppermost Instrumented Vertebrae
UR - https://www.scopus.com/pages/publications/105015476614
U2 - 10.1097/BRS.0000000000005484
DO - 10.1097/BRS.0000000000005484
M3 - Article
C2 - 40898909
AN - SCOPUS:105015476614
SN - 0362-2436
JO - Spine
JF - Spine
M1 - 05484
ER -