• Andrew B Harris, Floreana N Kebaish, Varun Puvanesarajah, Micheal Raad, Matthew W Wilkening, Amit Jain, David B Cohen, Brian J Neuman, and Khaled M Kebaish.
• Department of Orthopedic Surgery, The Johns Hopkins University, 601 N. Caroline St, JHOC 5223, Baltimore, MD, USA.
• Spine J. 2021 Jul 1; 21 (7): 1072-1079.

Background ContextIt 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).PurposeTo 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/SettingRetrospective review.Patient SampleWe included 96 patients with ASD who underwent fusion from T9-T12 to the pelvis (>5 vertebrae fused) between 2008 and 2015.Outcome MeasuresPedicle 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.MethodsDuring ≥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.ResultsPatients 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.ConclusionsIn 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.Level Of EvidenceIII.Copyright © 2021. Published by Elsevier Inc.

23 keywords...

hide…