• World Neurosurg · Aug 2024

    Independent risk factors of proximal junctional kyphosis with vertebral fracture after spinal long fusion: Survivorship analysis of adult spinal deformity surgery patients.

    • Junya Katayanagi, Hiroki Konuma, Tsukasa Yanase, Hiroyuki Inose, Tomoyuki Tanaka, Takahiro Iida, Shingo Morishita, and Tetsuya Jinno.
    • Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan. Electronic address: junya@dokkyomed.ac.jp.
    • World Neurosurg. 2024 Aug 1; 188: e597e605e597-e605.

    ObjectiveThis study aimed to identify risk factors for postoperative proximal junctional kyphosis (PJK) with vertebral fracture in adult spinal deformity (ASD) patients. We performed a survival analysis considering various factors, including osteoporosis.MethodsThis single-center retrospective study included 101 ASD patients (mean age: 67.2 years, mean follow-up: 8.1 years). We included patients aged ≥50 years with abnormal radiographic variables undergoing corrective long spinal fusion. The main outcome measure was PJK with vertebral fracture, analyzed based on patient data, radiographic measurements, sagittal parameters, bone mineral density, and osteoporosis medication.ResultsPJK occurred in 37.6% of patients, with vertebral fracture type 2 accounting for 65% of these cases. Kaplan-Meier analysis indicated a median PJK-free survival time of 60.7 months. Existing vertebral fracture (grade 1 or higher or grade 2 or higher) was a significant risk factor for PJK with vertebral fracture, with hazard ratios of 4.58 and 5.61, respectively. The onset time of PJK with vertebral fracture was 1.5 months postoperatively, with 44% of these cases occurring within 1 month and 64% within 2 months.ConclusionsPJK with vertebral fracture affected 25% of ASD patients, emphasizing the importance of osteoporosis evaluation. Existing vertebral fracture emerged as a significant independent risk factor, surpassing bone mineral density. This study provides valuable insights for spine surgeons, highlighting the need to provide osteoporosis treatment and emphasize potential postoperative complications during discussions with patients.Copyright © 2024 Elsevier Inc. All rights reserved.

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