TY - JOUR
T1 - The Benefit of Addressing Malalignment in Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery
AU - Passias, Peter G.
AU - Krol, Oscar
AU - Williamson, Tyler K.
AU - Lafage, Virginie
AU - Lafage, Renaud
AU - Smith, Justin S.
AU - Line, Breton
AU - Vira, Shaleen
AU - Lipa, Shaina
AU - Daniels, Alan
AU - Diebo, Bassel
AU - Schoenfeld, Andrew
AU - Gum, Jeffrey
AU - Kebaish, Khaled
AU - Park, Paul
AU - Mundis, Gregory
AU - Hostin, Richard
AU - Gupta, Munish C.
AU - Eastlack, Robert
AU - Anand, Neel
AU - Ames, Christopher
AU - Hart, Robert
AU - Burton, Douglas
AU - Schwab, Frank J.
AU - Shaffrey, Christopher
AU - Klineberg, Eric
AU - Bess, Shay
N1 - Publisher Copyright:
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2023/11/15
Y1 - 2023/11/15
N2 - Study Design. Retrospective cohort study. Objective. Understand the benefit of addressing malalignment in revision surgery for proximal junctional kyphosis (PJK). Summary of Background Data. PJK is a common cause of revision surgery for adult spinal deformity patients. During a revision, surgeons may elect to perform a proximal extension of the fusion, or also correct the source of the lumbopelvic mismatch. Materials and Methods. Recurrent PJK following revision surgery was the primary outcome. Revision surgical strategy was the primary predictor (proximal extension of fusion alone compared with combined sagittal correction and proximal extension). Multivariable logistic regression determined rates of recurrent PJK between the two surgical groups with lumbopelvic surgical correction assessed through improving ideal alignment in one or more alignment criteria [Global Alignment and Proportionality (GAP), Roussouly-type, and Sagittal Age-Adjusted Score (SAAS)]. Results. A total of 151 patients underwent revision surgery for PJK. PJK occurred at a rate of 43.0%, and PJF at 12.6%. Patients proportioned in GAP postrevision had lower rates of recurrent PJK [23% vs. 42%; odds ratio (OR): 0.3, 95% confidence interval (CI): 0.1-0.8, P=0.024]. Following adjusted analysis, patients who were ideally aligned in one of three criteria (Matching in SAAS and/or Roussouly matched and/or achieved GAP proportionality) had lower rates of recurrent PJK (36% vs. 53%; OR: 0.4, 95% CI: 0.1-0.9, P=0.035) and recurrent PJF (OR: 0.1, 95% CI: 0.02-0.7, P=0.015). Patients ideally aligned in two of three criteria avoid any development of PJF (0% vs. 16%, P<0.001). Conclusions. Following revision surgery for PJK, patients with persistent poor sagittal alignment showed increased rates of recurrent PJK compared with patients who had abnormal lumbopelvic alignment corrected during the revision. These findings suggest addressing the root cause of surgical failure in addition to proximal extension of the fusion may be beneficial.
AB - Study Design. Retrospective cohort study. Objective. Understand the benefit of addressing malalignment in revision surgery for proximal junctional kyphosis (PJK). Summary of Background Data. PJK is a common cause of revision surgery for adult spinal deformity patients. During a revision, surgeons may elect to perform a proximal extension of the fusion, or also correct the source of the lumbopelvic mismatch. Materials and Methods. Recurrent PJK following revision surgery was the primary outcome. Revision surgical strategy was the primary predictor (proximal extension of fusion alone compared with combined sagittal correction and proximal extension). Multivariable logistic regression determined rates of recurrent PJK between the two surgical groups with lumbopelvic surgical correction assessed through improving ideal alignment in one or more alignment criteria [Global Alignment and Proportionality (GAP), Roussouly-type, and Sagittal Age-Adjusted Score (SAAS)]. Results. A total of 151 patients underwent revision surgery for PJK. PJK occurred at a rate of 43.0%, and PJF at 12.6%. Patients proportioned in GAP postrevision had lower rates of recurrent PJK [23% vs. 42%; odds ratio (OR): 0.3, 95% confidence interval (CI): 0.1-0.8, P=0.024]. Following adjusted analysis, patients who were ideally aligned in one of three criteria (Matching in SAAS and/or Roussouly matched and/or achieved GAP proportionality) had lower rates of recurrent PJK (36% vs. 53%; OR: 0.4, 95% CI: 0.1-0.9, P=0.035) and recurrent PJF (OR: 0.1, 95% CI: 0.02-0.7, P=0.015). Patients ideally aligned in two of three criteria avoid any development of PJF (0% vs. 16%, P<0.001). Conclusions. Following revision surgery for PJK, patients with persistent poor sagittal alignment showed increased rates of recurrent PJK compared with patients who had abnormal lumbopelvic alignment corrected during the revision. These findings suggest addressing the root cause of surgical failure in addition to proximal extension of the fusion may be beneficial.
KW - PJF
KW - PJK
KW - adult spinal deformity
KW - lumopelvic correction
KW - proximal extension
KW - proximal junctional failure
KW - proximal junctional kyphosis
KW - recurrent PJK
KW - revision
KW - sagittal correction
UR - https://www.scopus.com/pages/publications/85161791812
U2 - 10.1097/BRS.0000000000004476
DO - 10.1097/BRS.0000000000004476
M3 - Article
C2 - 36083599
AN - SCOPUS:85161791812
SN - 0362-2436
VL - 48
SP - 1581
EP - 1587
JO - Spine
JF - Spine
IS - 22
ER -