• Zeyad Daher, Luke L Jouppi, Bryan G Anderson, Clifford Pierre, Donald David Davis, Neel Patel, Julius Gerstmeyer, Gautam Rao, Daniel Norvell, Giorgio Cracchiolo, Amir Abdul-Jabbar, Rod Oskouian, and Jens R Chapman.
• Seattle Science Foundation, Seattle, WA.
• World Neurosurg. 2024 Dec 20: 123598123598.

IntroductionDistal junctional kyphosis (DJK) and distal junctional failure (DJF) are known complications of adult multilevel spinal fusion surgery. Previous literature has extensively investigated proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), but DJK and DJF are relatively under-studied. This study investigates the association between bone mineral density (BMD) and DJK/DJF via a Systematic Review (SR) and Meta-Analysis (MA).MethodsA literature search was conducted across PubMed, Cochrane, Web of Science, Embase, and Scopus to find studies reporting DJK, DJF, and BMD. A 12-month minimum follow-up and radiographic biomarker for BMD (Hounsfield units {HU} or a T-score) individually reported for each patient type were required for inclusion. Studies that did not report individualized biomarkers but provided averaged estimates of the effect of BMD on DJK/DJF development were used for SR.ResultsOur search yielded 12 unique studies with 1,094 patients, of which five studies with a total of 519 patients were suitable for comparison by MA. Patients who developed DJK/DJF had significantly lower HUs (113.17 ± 33.86) than patients who did not develop DJK/DJF (142.51 ± 41.39). No significant difference was found with regards to DEXA measurements, age, or BMI between patients who did and did not develop DJK/DJF.ConclusionsPatients who developed DJK/DJF had significantly lower CT-measured HU as compared to those without DJK/DJF. Our findings highlight the potential importance of BMD evaluation with CT prior to multilevel spine fusion surgery, though further research would be helpful to evaluate the significance of DEXA-based BMD measurements on DJK/DJF development.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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