TY - JOUR
T1 - Thoracolumbar junction orientation
T2 - A novel guide for sagittal correction and proximal junctional kyphosis prediction in adult spinal deformity patients
AU - Moon, Hong Joo
AU - Bridwell, Keith H.
AU - Theologis, Alekos A.
AU - Kelly, Micheal P.
AU - Lertudomphonwanit, Thamrong
AU - Lenke, Lawrence G.
AU - Gupta, Munish C.
N1 - Publisher Copyright:
Copyright © 2020 by the Congress of Neurological Surgeons
PY - 2021/1/1
Y1 - 2021/1/1
N2 - BACKGROUND: Novel radiographic sagittal parameters of the thoracolumbar junction orientation (TLJO, thoracolumbar slope [TLS] and thoracolumbar tilt [TLT]) have been introduced and correlated with lumbopelvic parameters and thoracic kyphosis. OBJECTIVE: To determine a predictive model for reciprocal thoracic kyphosis and proximal junctional kyphosis (PJK) based on the TLJO. METHODS: A total of 127 patients who had fusion from sacrum to T10-L2 from 2004 to 2014 were reviewed. TK (T5-T12), PI, SS, PT, LL, and proximal junctional angle (PJA) were measured preoperatively, 6 wk postoperatively, and at final follow-up. TLJO was measured by TLS and TLT. Changes between time points were determined (preop-6 wk = ΔParameterPre6wk and preop-final follow/up = ΔParameterPreFinal). Scoliosis Research Society (SRS) and Oswestry Disability Index (ODI) questionnaires were evaluated at final follow-up. Patients were divided into 2 groups based on the presence of PJK (ΔPJAPreFinal >15◦). Independent t-tests and receiver operating characteristic (ROC) curves were used to investigate the significance of differences and cut-off values. Pearson correlations and linear regressions were used to analyze the entire cohort to determine the relationship between the changes in parameters. RESULTS: Compared to patients without PJK (n = 100), those with PJK (n = 27) had significantly lower SRS scores and significantly greater ΔTKPreFinal, ΔLLPre6wk, and ΔTLSPre6wk. To maintain in the nonPJK group, ROC curves demonstrated a cut-off value of −9.4◦ for ΔTLSPre6wk. PJK was significantly correlated with ΔTKPreFinal and ΔTLSPre6wk. The linear correlation revealed that ΔTLSPre6wk < −25.3◦ is the risk factor of PJK > 15◦. CONCLUSION: As change of TLS reflects lumbopelvic realignment and influences reciprocal TK, reducing the change of TLS may be a sagittal realignment guideline to reduce the risk of PJK.
AB - BACKGROUND: Novel radiographic sagittal parameters of the thoracolumbar junction orientation (TLJO, thoracolumbar slope [TLS] and thoracolumbar tilt [TLT]) have been introduced and correlated with lumbopelvic parameters and thoracic kyphosis. OBJECTIVE: To determine a predictive model for reciprocal thoracic kyphosis and proximal junctional kyphosis (PJK) based on the TLJO. METHODS: A total of 127 patients who had fusion from sacrum to T10-L2 from 2004 to 2014 were reviewed. TK (T5-T12), PI, SS, PT, LL, and proximal junctional angle (PJA) were measured preoperatively, 6 wk postoperatively, and at final follow-up. TLJO was measured by TLS and TLT. Changes between time points were determined (preop-6 wk = ΔParameterPre6wk and preop-final follow/up = ΔParameterPreFinal). Scoliosis Research Society (SRS) and Oswestry Disability Index (ODI) questionnaires were evaluated at final follow-up. Patients were divided into 2 groups based on the presence of PJK (ΔPJAPreFinal >15◦). Independent t-tests and receiver operating characteristic (ROC) curves were used to investigate the significance of differences and cut-off values. Pearson correlations and linear regressions were used to analyze the entire cohort to determine the relationship between the changes in parameters. RESULTS: Compared to patients without PJK (n = 100), those with PJK (n = 27) had significantly lower SRS scores and significantly greater ΔTKPreFinal, ΔLLPre6wk, and ΔTLSPre6wk. To maintain in the nonPJK group, ROC curves demonstrated a cut-off value of −9.4◦ for ΔTLSPre6wk. PJK was significantly correlated with ΔTKPreFinal and ΔTLSPre6wk. The linear correlation revealed that ΔTLSPre6wk < −25.3◦ is the risk factor of PJK > 15◦. CONCLUSION: As change of TLS reflects lumbopelvic realignment and influences reciprocal TK, reducing the change of TLS may be a sagittal realignment guideline to reduce the risk of PJK.
KW - Lumbar degenerative kyphosis
KW - Proximal junctional kyphosis
KW - Reciprocal change
KW - Sagittal alignment
KW - Thoracolumbar slope
KW - Thracolumbar junction orientation
UR - https://www.scopus.com/pages/publications/85098531717
U2 - 10.1093/neuros/nyaa311
DO - 10.1093/neuros/nyaa311
M3 - Article
C2 - 32761200
AN - SCOPUS:85098531717
SN - 0148-396X
VL - 88
SP - 55
EP - 62
JO - Neurosurgery
JF - Neurosurgery
IS - 1
ER -