Jamal McClendon1, Timothy R Smith2, Patrick A Sugrue3, Sara E Thompson3, Brian A O'Shaughnessy4, Tyler R Koski3. 1. Division of Pediatric Neurosurgery, Phoenix Children's Hospital, Phoenix, Arizona, USA. Electronic address: jmcclendon@phoenixchildrens.com. 2. Department of Neurological Surgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts, USA. 3. Department of Neurological Surgery, Northwestern Memorial Hospital, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA. 4. Howell Allen Clinic, Nashville, Tennessee, USA.
Abstract
OBJECTIVE: To evaluate spinal implant density and proximal junctional kyphosis (PJK) in adult spinal deformity (ASD). METHODS: Consecutive patients with ASD receiving ≥5 level fusions were retrospectively analyzed between 2007 and 2010. INCLUSION CRITERIA: ASD, elective fusions, minimum 2-year follow-up. EXCLUSION CRITERIA: age <18 years, neuromuscular or congenital scoliosis, cervical or cervicothoracic fusions, nonelective conditions (infection, tumor, trauma). Instrumented fusions were classified by the Scoliosis Research Society-Schwab ASD classification. Statistical analysis consisted of descriptives (measures of central tendency, dispersion, frequencies), independent Student t tests, χ2, analysis of variance, and logistic regression to determine association of implant density [(number of screws + number of hooks)/surgical levels of fusion] and PJK. Mean and median follow-up was 2.8 and 2.7 years, respectively. RESULTS: Eighty-three patients (17 male, 66 female) with a mean age of 59.7 years (standard deviation, 10.3) were analyzed. Mean body mass index (BMI) was 29.5 kg/m2 (range, 18-56 kg/m2) with mean preoperative Oswestry Disability Index of 48.67 (range, 6-86) and mean preoperative sagittal vertical axis of 8.42. The mean levels fused were 9.95 where 54 surgeries had interbody fusion. PJK prevalence was 21.7%, and pseudoarthrosis was 19.3%. Mean postoperative Oswestry Disability Index was 27.4 (range, 0-74). Independent Student t tests showed that PJK was not significant for age, gender, BMI, rod type, mean postoperative sagittal vertical axis, or Scoliosis Research Society-Schwab ASD classification; but iliac fixation approached significance (P = 0.077). Implant density and postoperative lumbar lordosis (LL) were predictors for PJK (P = 0.018 and 0.045, respectively). Controlling for age, BMI, and gender, postoperative LL (not implant density) continued to show significance in multivariate logistic regression model. CONCLUSIONS: PJK, although influenced by a multitude of factors, may be statistically related to implant density and LL.
OBJECTIVE: To evaluate spinal implant density and proximal junctional kyphosis (PJK) in adult spinal deformity (ASD). METHODS: Consecutive patients with ASD receiving ≥5 level fusions were retrospectively analyzed between 2007 and 2010. INCLUSION CRITERIA: ASD, elective fusions, minimum 2-year follow-up. EXCLUSION CRITERIA: age <18 years, neuromuscular or congenital scoliosis, cervical or cervicothoracic fusions, nonelective conditions (infection, tumor, trauma). Instrumented fusions were classified by the Scoliosis Research Society-Schwab ASD classification. Statistical analysis consisted of descriptives (measures of central tendency, dispersion, frequencies), independent Student t tests, χ2, analysis of variance, and logistic regression to determine association of implant density [(number of screws + number of hooks)/surgical levels of fusion] and PJK. Mean and median follow-up was 2.8 and 2.7 years, respectively. RESULTS: Eighty-three patients (17 male, 66 female) with a mean age of 59.7 years (standard deviation, 10.3) were analyzed. Mean body mass index (BMI) was 29.5 kg/m2 (range, 18-56 kg/m2) with mean preoperative Oswestry Disability Index of 48.67 (range, 6-86) and mean preoperative sagittal vertical axis of 8.42. The mean levels fused were 9.95 where 54 surgeries had interbody fusion. PJK prevalence was 21.7%, and pseudoarthrosis was 19.3%. Mean postoperative Oswestry Disability Index was 27.4 (range, 0-74). Independent Student t tests showed that PJK was not significant for age, gender, BMI, rod type, mean postoperative sagittal vertical axis, or Scoliosis Research Society-Schwab ASD classification; but iliac fixation approached significance (P = 0.077). Implant density and postoperative lumbar lordosis (LL) were predictors for PJK (P = 0.018 and 0.045, respectively). Controlling for age, BMI, and gender, postoperative LL (not implant density) continued to show significance in multivariate logistic regression model. CONCLUSIONS: PJK, although influenced by a multitude of factors, may be statistically related to implant density and LL.
Authors: Bernardo de Andrada Pereira; Jennifer N Lehrman; Anna G U Sawa; Piyanat Wangsawatwong; Jakub Godzik; David S Xu; Jay D Turner; Brian P Kelly; Juan S Uribe Journal: Neurospine Date: 2022-09-30
Authors: Jun S Kim; Kevin Phan; Zoe B Cheung; Nam Lee; Luilly Vargas; Varun Arvind; Robert K Merrill; Sunder Gidumal; John Di Capua; Samuel Overley; James Dowdell; Samuel K Cho Journal: Global Spine J Date: 2018-06-25
Authors: Peter Gust Passias; Haddy Alas; Katherine E Pierce; Matthew Galetta; Oscar Krol; Lara Passfall; Nicholas Kummer; Sara Naessig; Waleed Ahmad; Bassel G Diebo; Renaud Lafage; Virginie Lafage Journal: J Craniovertebr Junction Spine Date: 2021-09-08