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Effect of sagittal shape on proximal junctional kyphosis following thoracopelvic corrective fusion for adult spinal deformity: postoperative inflection vertebra cranial to T12 is a significant risk factor

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Abstract

Study design

This was a retrospective analysis of a prospectively collected consecutive case series of patients with adult spinal deformity (ASD).

Objective

This study aimed to investigate the impact of the geometrical sagittal shape of the corrected spine on the development of proximal junctional kyphosis (PJK).

Summary of background data

Several studies have documented risk factors for PJK in ASD surgery. Geometrical assessment is vital for evaluating sagittal spinal deformity. It is essential to assess the postoperative geometrical shape of the spine and the location of the correction in the spine to decrease postoperative junctional stress and PJK.

Methods

Consecutive patients with ASD who underwent corrective fusion with long constructs to the pelvis were included. Patients with neuromuscular disease, congenital and adolescent scoliosis, infection, and spinal tumor were excluded. We investigated the spinopelvic and geometrical parameters of the whole spine. The locations of the thoracic and lumbar apical vertebrae and the inflection vertebrae (IV), where the curvature of the associated adjacent vertebral bodies changes from kyphosis to lordosis, were investigated. The subjects were divided into PJK included patients who underwent revision surgery for junctional failure or with a change in proximal junctional angle ≥ 20°, and non-PJK groups.

Results

A total of 139 patients (mean age, 69.6 years; range 18–82 years) were included. There were 47 and 92 patients in the PJK and non-PJK groups, respectively. The IV were located significantly cranial and posterior, the lumbar apex were located significantly posterior in the PJK group at the immediate postoperative time points. The significant risk factors for PJK on binary logistic regression were cranial IV and posterior lumbar apical vertebrae. The incidence of PJK in patients with IV at T12 or cranial tends PJK significantly higher (69%) than at L1 or caudal (26%).

Conclusions

Geometrical spinal shape should be taken into account to reduce the rate of postoperative mechanical complications.

Level of evidence

Level of evidence III.

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References

  1. Pellise F, Vila-Casademunt A, Ferrer M et al (2015) Impact on health-related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 24:3–11. https://doi.org/10.1007/s00586-014-3542-1

    Article  PubMed  Google Scholar 

  2. Soroceanu A, Diebo BG, Burton D et al (2015) Radiographical and implant-related complications in adult spinal deformity surgery: incidence, patient risk factors, and impact on health-related quality of life. Spine 40:1414–1421. https://doi.org/10.1097/BRS.0000000000001020

    Article  PubMed  Google Scholar 

  3. 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 25:2376–2383. https://doi.org/10.1007/s00586-016-4534-0

    Article  PubMed  Google Scholar 

  4. Maruo K, Ha Y, Inoue S et al (2013) Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity. Spine (Phila Pa 1976) 38:E1469–E1476. https://doi.org/10.1097/brs.0b013e3182a51d43

    Article  Google Scholar 

  5. Yagi M, Akilah KB, Boachie-Adjei O (2018) Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Spine (Phila Pa 1976) 36:E60–E68. https://doi.org/10.1097/brs.0b013e3181eeaee2

    Article  Google Scholar 

  6. Yan P, Bao H, Qiu Y et al (2017) Mismatch between proximal rod contouring and proximal junctional angle: a predisposed risk factor for proximal junctional kyphosis in degenerative scoliosis. Spine (Phila Pa 1976) 42:E280–E287. https://doi.org/10.1097/brs.0000000000001883

    Article  Google Scholar 

  7. Scheer JK, Fakurnejad S, Lau D et al (2015) Results of the 2014 SRS Survey on PJK/PJF: a report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development. Spine (Phila Pa 1976) 40:829–840. https://doi.org/10.1097/brs.0000000000000897

    Article  Google Scholar 

  8. Bridwell KH, Lenke LG, Cho SK et al (2013) Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle. Neurosurgery 72:899–906. https://doi.org/10.1227/NEU.0b013e31828bacd8

    Article  PubMed  Google Scholar 

  9. Roussouly P, Gollogly S, Berthonnaud E et al (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30:346–353. https://doi.org/10.1097/01.brs.0000152379.54463.65

    Article  Google Scholar 

  10. Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16:1459–1467. https://doi.org/10.1007/s00586-006-0294-6

    Article  PubMed  PubMed Central  Google Scholar 

  11. Itoi E (1991) Roentgenographic analysis of posture in spinal osteoporosis. Spine (Phila Pa 1976) 16:750–756. https://doi.org/10.1097/00007632-199107000-00011

    Article  CAS  Google Scholar 

  12. Takemitsu Y, Harada Y, Iwahara T et al (1988) Lumbar degenerative kyphosis. Clin Radiol Epidemiol Stud Spine (Phila Pa 1976) 13:1317–1326

    Article  CAS  Google Scholar 

  13. Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 20:1351–1358

    Article  CAS  Google Scholar 

  14. Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 14:717–721. https://doi.org/10.1097/00007632-198907000-00012

    Article  CAS  PubMed  Google Scholar 

  15. Yamato Y, Sato Y, Togawa D et al (2019) Differences in the geometrical spinal shape in the sagittal plane according to age and magnitude of pelvic incidence in healthy elderly individuals. J Orthop Sci. https://doi.org/10.1016/j.jos.2019.07.005

    Article  PubMed  Google Scholar 

  16. Cho KJ, Suk SI, Park SR, Kim JH, Jung JH (2013) Selection of proximal fusion level for adult degenerative lumbar scoliosis. Eur Spine J 22:394–401. https://doi.org/10.1007/s00586-012-2527-1

    Article  PubMed  Google Scholar 

  17. Kim HJ, Boachie-Adjei O, Shaffrey CI et al (2014) Upper thoracic versus lower thoracic upper instrumented vertebrae endpoints have similar outcomes and complications in adult scoliosis. Spine (Phila Pa 1976) 39:E795–E799. https://doi.org/10.1097/brs.0000000000000339

    Article  Google Scholar 

  18. Kobayashi T, Atsuta Y, Matsuno T, Takeda N (2004) A longitudinal study of congruent sagittal spinal alignment in an adult cohort. Spine (Phila Pa 1976) 29:671–676. https://doi.org/10.1097/01.brs.0000115127.51758.a2

    Article  Google Scholar 

  19. Barrey C, Roussouly P, Le Huec JC, D’Acunzi G (2013) Perrin G (2013) Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22(Suppl 6):S834–S841. https://doi.org/10.1007/s00586-013-3030-z

    Article  PubMed  Google Scholar 

  20. Barrey C, Roussouly P, Perrin G, Le Huec JC (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? European Spine J 20(Suppl 5):626–633. https://doi.org/10.1007/s00586-011-1930-3

    Article  Google Scholar 

  21. Roussouly P, Pinheiro-Franco JL (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20(Suppl 5):609–618. https://doi.org/10.1007/s00586-011-1928-x

    Article  PubMed  PubMed Central  Google Scholar 

  22. Yilgor C, Sogunmez N, Boissiere L et al (2017) Global Alignment and Proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am 99:1661–1672. https://doi.org/10.2106/JBJS.16.01594

    Article  PubMed  Google Scholar 

  23. Yilgor C, Sogunmez N, Yavuz Y et al (2017) Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence-based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis. Neurosurg Focus 43:E5. https://doi.org/10.3171/2017.8.FOCUS17498

    Article  PubMed  Google Scholar 

  24. Ghobrial GM, Eichberg DG, Kolcun DG et al (2017) Prophylactic vertebral cement augmentation at the uppermost instrumented vertebra and rostral adjacent vertebra for the prevention of proximal junctional kyphosis and failure following long-segment fusion for adult spinal deformity. Spine J 17:1499–1505. https://doi.org/10.1016/j.spinee.2017.05.015

    Article  PubMed  Google Scholar 

  25. Bess S, Harris JE, Turner AW et al (2017) The effect of posterior polyester tethers on the biomechanics of proximal junctional kyphosis: a finite element analysis. J Neurosurg Spine 26:125–133. https://doi.org/10.3171/2016.6.SPINE151477

    Article  PubMed  Google Scholar 

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Funding

Medtronic Sofamor Danek Inc.; Japan Medical Dynamic Marketing Inc.; and Meitoku Medical Institution. The manuscript submitted does not contain information about medical device(s)/drug(s).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka, Japan

    Sreenath Jakinapally, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Tatsuya Yasuda, Hiroki Ushirozako, Tomohiro Yamada, Koichirou Ide, Yuh Watanabe & Yukihiro Matsuyama

  2. Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1-20-1, Handayama Higashi-ku, Hamamatsu, Shizuoka, Japan

    Yu Yamato & Shin Oe

  3. Department of Orthopaedic Surgery, Kindai Nara Hospital, 1248-1, Otodacho, Ikoma, Japan

    Daisuke Togawa

Authors
  1. Sreenath Jakinapally
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  2. Yu Yamato
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  14. Yukihiro Matsuyama
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Contributions

Sreenath Jakinapally: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work; final approval of the version to be published; agrees to be accountable for all aspects of the work. Yu Yamato: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work and revising it critically; final approval of the version to be published; agrees to be accountable for all aspects of the work. Tomohiko Hasegawa: substantial contributions to the acquisition, analysis, or interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Daisuke Togawa: substantial contributions to the conception or design of the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Go Yoshida: substantial contributions to the acquisition, analysis, or interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Tomohiro Banno: substantial contributions to the acquisition, or interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Hideyuki Arima: substantial contributions to the acquisition, or interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Shin Oe: substantial contributions to the acquisition, or interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Tatsuya Yasuda: substantial contributions to the acquisition, or interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Hiroki Ushirozako: substantial contributions to the acquisition, or interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Tomohiro Yamada: substantial contributions to the acquisition, analysis, or interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Kouichirou Ide: substantial contributions to the acquisition, analysis, or interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Yuh Watanabe: substantial contributions to the acquisition, analysis, or interpretation of data for the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work. Yukihiro Matsuyama: substantial contributions to the conception or design of the work. Revising it critically for important intellectual content. Final approval of the version to be published. Agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Yu Yamato.

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Conflict of interest

Yu Yamato and Shin Oe work at a donation-endowed laboratory in the Division of Geriatric Musculoskeletal Health.

Ethical considerations

This study was approved by the institutional review board of our university hospital. Informed consent was waived due to the retrospective nature of the study.

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Jakinapally, S., Yamato, Y., Hasegawa, T. et al. Effect of sagittal shape on proximal junctional kyphosis following thoracopelvic corrective fusion for adult spinal deformity: postoperative inflection vertebra cranial to T12 is a significant risk factor. Spine Deform 8, 1313–1323 (2020). https://doi.org/10.1007/s43390-020-00162-w

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