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European Spine Journal

, Volume 28, Issue 9, pp 2216–2222 | Cite as

Residence could influence the surgical outcome after corrective surgery in adult spinal deformity: comparison study between urban and rural area in Korea

  • Un-Yong Choi
  • Ji-In Kang
  • Jeong-Yoon Park
  • Sung-Uk Kuh
  • Dong-Kyu Chin
  • Keun-Su Kim
  • Yong-Eun Cho
  • Kyung-Hyun KimEmail author
Original Article

Abstract

Purpose

Numerous factors affect the surgical outcomes in patients with adult spinal deformity (ASD). However, no study has examined the relationship between residence and physical factors and surgical outcomes in patients with ASD. Here, we analysed the impact of residence and physical factors on the post-operative outcomes of patients with ASD residing in urban (U) and rural (R) environments.

Methods

We retrospectively reviewed data from patients who had undergone ASD surgery with sacropelvic fixation at a single institution between June 2011 and May 2017 with a minimum 1 year follow-up. We divided the patients into two groups (U and R). Preoperative demographic data were reviewed, and radiographic parameters were measured preoperatively, immediately postoperatively, at 1, 3, and 6 months, and at the final follow-up. The L4 axial paraspinal muscles were measured preoperatively using magnetic resonance imaging.

Results

There were 25 and 34 patients in the U and R groups, respectively. Both groups had similar preoperative demographic and radiological parameters. There were no differences between the groups in post-operative radiographic parameters, clinical outcomes, and complications, but proximal junctional kyphosis (PJK) was significantly higher in the R group. Additionally, muscle mass in the multifidus and erector spinae was lower in the R than in the U group.

Conclusions

Patient residence influenced PJK in patients with ASD. Mass reduction in the trunk extensor muscle is an important and existing risk factor for PJK. Surgeons should be aware of this information for preoperative counselling, informed consent, and post-operative education of patients with ASD.

Graphic abstract

These slides can be retrieved from Electronic Supplementary Material.

Keywords

Adult spinal deformity Proximal junctional kyphosis Urban living Rural living Trunk extensor muscle 

Notes

Funding

This work was supported by the World Class 300 Project (R&D) (S2482672) of the MOTIE, MSS (Korea).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6042_MOESM1_ESM.pptx (149 kb)
Supplementary material 1 (PPTX 148 kb)

References

  1. 1.
    Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, DeWald C, Mehdian H, Shaffrey C, Tribus C, Lafage V (2012) Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 37(12):1077–1082.  https://doi.org/10.1097/brs.0b013e31823e15e2 CrossRefGoogle Scholar
  2. 2.
    Bess S, Schwab F, Lafage V, Shaffrey CI, Ames CP (2013) Classifications for adult spinal deformity and use of the scoliosis research society-schwab adult spinal deformity classification. Neurosurg Clin N Am 24(2):185–193.  https://doi.org/10.1016/j.nec.2012.12.008 CrossRefPubMedGoogle Scholar
  3. 3.
    Kim YJ, Lenke LG, Bridwell KH, Kim J, Cho SK, Cheh G, Yoon J (2007) Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases. Spine (Phila Pa 1976) 32(24):2731–2738.  https://doi.org/10.1097/brs.0b013e31815a7ead CrossRefGoogle Scholar
  4. 4.
    Kim YJ, Bridwell KH, Lenke LG, Glattes CR, Rhim S, Cheh G (2008) Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up. Spine (Phila Pa 1976) 33(20):2179–2184.  https://doi.org/10.1097/brs.0b013e31817c0428 CrossRefGoogle Scholar
  5. 5.
    Denis F, Sun EC, Winter RB (2009) Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spine (Phila Pa 1976) 34(20):E729–E734.  https://doi.org/10.1097/brs.0b013e3181ae2ab2 CrossRefGoogle Scholar
  6. 6.
    Hyun SJ, Rhim SC (2010) Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data. J Korean Neurosurg Soc 47(2):95–101.  https://doi.org/10.3340/jkns.2010.47.2.95 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Yagi M, Akilah KB, Boachie-Adjei O (2011) Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Spine (Phila Pa 1976) 36(1):E60–E68.  https://doi.org/10.1097/brs.0b013e3181eeaee2 CrossRefGoogle Scholar
  8. 8.
    Ha Y, Maruo K, Racine L, Schairer WW, Hu SS, Deviren V, Burch S, Tay B, Chou D, Mummaneni PV, Ames CP, Berven SH (2013) Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae. J Neurosurg Spine 19(3):360–369.  https://doi.org/10.3171/2013.5.SPINE12737 CrossRefPubMedGoogle Scholar
  9. 9.
    Liu FY, Wang T, Yang SD, Wang H, Yang DL, Ding WY (2016) Incidence and risk factors for proximal junctional kyphosis: a meta-analysis. Eur Spine J 25(8):2376–2383.  https://doi.org/10.1007/s00586-016-4534-0 CrossRefPubMedGoogle Scholar
  10. 10.
    Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis Clinical, radiological and epidemiological studies. Spine (Phila Pa 1976) 13(11):1317–1326CrossRefGoogle Scholar
  11. 11.
    Wang C, Xu W, He S, Gu S, Zhao Y, Zhang J, Zhu X, Li M (2010) Differences in postoperative quality of life between adolescent patients with idiopathic scoliosis residing in urban and rural environments. Spine (Phila Pa 1976) 35(6):652–656.  https://doi.org/10.1097/brs.0b013e3181b9fe3e CrossRefGoogle Scholar
  12. 12.
    Misterska E, Glowacki M, Panek S, Ignys-O’Byrne A, Glowacki J, Ignys I, Krauss H, Piatek J (2012) Effects of living environment on the postoperative scoliosis research society-24 results in females with adolescent idiopathic scoliosis. Med Sci Monit 18(8):CR523–CR531CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Cho SK, Shin JI, Kim YJ (2014) Proximal junctional kyphosis following adult spinal deformity surgery. Eur Spine J 23(12):2726–2736.  https://doi.org/10.1007/s00586-014-3531-4 CrossRefPubMedGoogle Scholar
  14. 14.
    Ranson CA, Burnett AF, Kerslake R, Batt ME, O’Sullivan PB (2006) An investigation into the use of MR imaging to determine the functional cross sectional area of lumbar paraspinal muscles. Eur Spine J 15(6):764–773.  https://doi.org/10.1007/s00586-005-0909-3 CrossRefPubMedGoogle Scholar
  15. 15.
    Lee HJ, Lim WH, Park JW, Kwon BS, Ryu KH, Lee JH, Park YG (2012) The relationship between cross sectional area and strength of back muscles in patients with chronic low back pain. Ann Rehabil Med 36(2):173–181.  https://doi.org/10.5535/arm.2012.36.2.173 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Chen YY, Pao JL, Liaw CK, Hsu WL, Yang RS (2014) Image changes of paraspinal muscles and clinical correlations in patients with unilateral lumbar spinal stenosis. Eur Spine J 23(5):999–1006.  https://doi.org/10.1007/s00586-013-3148-z CrossRefPubMedGoogle Scholar
  17. 17.
    Kim JY, Ryu DS, Paik HK, Ahn SS, Kang MS, Kim KH, Park JY, Chin DK, Kim KS, Cho YE, Kuh SU (2016) Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion. Spine J 16(7):867–875.  https://doi.org/10.1016/j.spinee.2016.03.010 CrossRefPubMedGoogle Scholar
  18. 18.
    Kostuik JP, Bentivoglio J (1981) The incidence of low-back pain in adult scoliosis. Spine 6(3):268–273CrossRefPubMedGoogle Scholar
  19. 19.
    Carter OD, Haynes SG (1987) Prevalence rates for scoliosis in US adults: results from the first national health and nutrition examination survey. Int J Epidemiol 16(4):537–544CrossRefPubMedGoogle Scholar
  20. 20.
    Liu G, Tan JH, Ee G, Chan YH, Low SL, Wong HK (2016) Morphology and prevalence study of lumbar scoliosis in 7,075 multiracial asian adults. J Bone Joint Surg Am 98(15):1307–1312.  https://doi.org/10.2106/JBJS.15.00710 CrossRefPubMedGoogle Scholar
  21. 21.
    Kim JS, Phan K, Cheung ZB, Lee N, Vargas L, Arvind V, Merrill RK, Gidumal S, Di Capua J, Overley S, Dowdell J, Cho SK (2019) Surgical, radiographic, and patient-related risk factors for proximal junctional kyphosis: a meta-analysis. Global Spine J 9(1):32–40.  https://doi.org/10.1177/2192568218761362 CrossRefPubMedGoogle Scholar
  22. 22.
    Kahanovitz N, Weiser S (1989) The psychological impact of idiopathic scoliosis on the adolescent female. A preliminary multi-center study. Spine (Phila Pa 1976) 14(5):483–485CrossRefGoogle Scholar
  23. 23.
    Watanabe K, Michikawa T, Yonezawa I, Takaso M, Minami S, Soshi S, Tsuji T, Okada E, Abe K, Takahashi M, Asakura K, Nishiwaki Y, Matsumoto M (2017) Physical activities and lifestyle factors related to adolescent idiopathic scoliosis. J Bone Joint Surg Am 99(4):284–294.  https://doi.org/10.2106/JBJS.16.00459 CrossRefPubMedGoogle Scholar
  24. 24.
    Ames CP, Scheer JK, Lafage V, Smith JS, Bess S, Berven SH, Mundis GM, Sethi RK, Deinlein DA, Coe JD, Hey LA, Daubs MD (2016) Adult spinal deformity: epidemiology, health impact, evaluation, and management. Spine Deform 4(4):310–322.  https://doi.org/10.1016/j.jspd.2015.12.009 CrossRefPubMedGoogle Scholar
  25. 25.
    Lee CH, Chung CK, Jang JS, Kim SM, Chin DK, Lee JK (2017) Lumbar degenerative kyphosis is not byword for degenerative sagittal imbalance: time to replace a misconception. J Korean Neurosurg Soc 60(2):125–129.  https://doi.org/10.3340/jkns.2016.0607.001 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Lee SH, Kim KT, Suk KS, Lee JH, Seo EM, Huh DS (2011) Sagittal decompensation after corrective osteotomy for lumbar degenerative kyphosis: classification and risk factors. Spine (Phila Pa 1976) 36(8):E538–E544.  https://doi.org/10.1097/brs.0b013e3181f45a17 CrossRefGoogle Scholar
  27. 27.
    Kobayashi T, Chiba H, Jimbo S, Senoo I, Shimizu M, Atsuta Y, Ito H, Sugisawa H, Sugawara T, Habaguchi T (2016) Clinical, physical, and radiographic analyses of lumbar degenerative kyphosis and spondylolisthesis among community-based cohort. Eur Spine J 25(8):2384–2389.  https://doi.org/10.1007/s00586-016-4615-0 CrossRefPubMedGoogle Scholar
  28. 28.
    Le Huec JC, Richards J, Tsoupras A, Price R, Leglise A, Faundez AA (2018) The mechanism in junctional failure of thoraco-lumbar fusions. Part I: biomechanical analysis of mechanisms responsible of vertebral overstress and description of the cervical inclination angle (CIA). Eur Spine J 27:129–138.  https://doi.org/10.1007/s00586-017-5425-8 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, CHA Bundang Medical CenterCHA University School of MedicineSeongnam-SiRepublic of Korea
  2. 2.Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord InstituteYonsei University College of MedicineSeoulSouth Korea

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