• World Neurosurg · Dec 2023

    Junctional Failures at Both Ends After Long Fusion Arthrodesis Stopping at L5: Incidences and Risk Factors.

    • Young-Hoon Kim, Kee-Yong Ha, Hyung-Youl Park, Myung-Sup Ko, Young-Il Ko, Kyung-Jun Sin, and Sang-Il Kim.
    • Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
    • World Neurosurg. 2023 Dec 1; 180: e288e295e288-e295.

    ObjectiveJunctional failures after long fusion stopping at L5 can present at both proximal and distal ends. The purpose of this study was to investigate incidences and risk factors of proximal junctional failure (PJF) and distal junctional failure (DJF) after long lumbar instrumented fusion stopping at L5 for adult spinal deformity.MethodsSixty-three patients who underwent long fusion surgery stopping at L5 with a minimum follow-up of 3 years were reviewed retrospectively. PJF and DJF were defined as newly developed back pain and/or radiculopathy with corresponding radiographic failures. The incidence and risk factors of each junctional failure were analyzed using a log-rank test and Cox proportional hazards model.ResultsTwelve men and 51 women were included in our study. Their mean age was 68.5 ± 7.0 years and the mean follow-up period was 84.5 ± 45.3 months. PJF and DJF occurred in 17 (27%) and 16 patients (25.4%), respectively. PJF and DJF developed at median durations of 32.1 months and 13.3 months, respectively, showing no significant difference between the two. Three patients presented with both PJF and DJF. Risk factors for PJF included lower body mass index, higher preoperative lumbar lordosis, and higher postoperative sagittal vertical axis (SVA) (hazard ratio, 0.570, 1.055, and 1.040, respectively). For DJF, higher preoperative SVA was an independent risk factor (hazard ratio, 1.010).ConclusionsAfter long fusion surgery stopping at L5, PJF and DJF occurred at similar rates. Lower body mass index, higher preoperative lumbar lordosis, and higher postoperative SVA were risk factors for PJF. Higher preoperative SVA was an independent risk factor for DJF.Copyright © 2023 Elsevier Inc. All rights reserved.

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