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



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.


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.


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.


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.


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



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)


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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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