Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine
Patients with proximal junctional kyphosis (PJK) or failure (PJF) may demonstrate disparate outcomes and recovery when fused to the upper (UT) versus lower (LT) thoracic spine. Few studies have distinguished the reoperation and recovery abilities of patients with PJK or PJF when fused to the upper (...
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| Veröffentlicht in: | Journal of clinical medicine 2024-12, Vol.13 (24), p.7722 |
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| creator | Onafowokan, Oluwatobi O Lafage, Renaud Tretiakov, Peter Smith, Justin S Line, Breton G Diebo, Bassel G Daniels, Alan H Gum, Jeffrey L Protopsaltis, Themistocles S Hamilton, David Kojo Buell, Thomas Soroceanu, Alex Scheer, Justin Eastlack, Robert K Mullin, Jeffrey P Mundis, Gregory Hosogane, Naobumi Yagi, Mitsuru Anand, Neel Okonkwo, David O Wang, Michael Y Klineberg, Eric O Kebaish, Khaled M Lewis, Stephen Hostin, Richard Gupta, Munish Chandra Lenke, Lawrence G Kim, Han Jo Ames, Christopher P Shaffrey, Christopher I Bess, Shay Schwab, Frank J Lafage, Virginie Burton, Douglas Passias, Peter G |
| description | Patients with proximal junctional kyphosis (PJK) or failure (PJF) may demonstrate disparate outcomes and recovery when fused to the upper (UT) versus lower (LT) thoracic spine. Few studies have distinguished the reoperation and recovery abilities of patients with PJK or PJF when fused to the upper (UT) versus lower (LT) thoracic spine.
Adult spine deformity patients ≥ 18 yrs with preoperative and 5-year (5Y) data fused to the sacrum/pelvis were included. The rates of PJK, PJK revision, and radiographic PJF were compared between patients with upper instrumented vertebra (UIV) in the upper thoracic spine (UT; T1-T7) and lower thoracic spine (LT; T8-L1). Mean differences were assessed via analyses of covariance, factoring in any differences between cohorts at baseline and any use of PJF prophylaxis. Backstep logistic regressions assessed predictors of achieving Smith et al.'s Best Clinical Outcomes (BCOs) and complications, controlling for similar covariates.
A total of 232 ASD patients were included (64.2 ± 10.2 years, 78% female); 36.3% were UT and 63.7% were LT. Postoperatively, the rates of PJK for UT were lower than LT at 1Y (34.6 vs. 50.4%,
= 0.024), 2Y (29.5 vs. 49.6% (
= 0.003), and 5Y (48.7 vs. 62.8%,
= 0.048), with comparable rates of PJF. In total, 4.0% of UT patients underwent subsequent reoperation, compared to 13.0% of LT patients (
= 0.025). A total of 6.0% of patients had recurrent PJK, and 3.9% had recurrent PJF (both
> 0.05). After reoperation, UT patients reported higher rates of improvement in the minimum clinically important difference for ODI by 2Y (
= 0.007) and last follow-up (
< 0.001). While adjusted regression revealed that, for UT patients, the minimization of construct extension was predictive of achieving BCOs by last follow-up (model
< 0.001), no such relationship was identified in LT patients.
Patients initially fused to the lower thoracic spine demonstrate an increased incidence of PJK and lower rates of disability improvement, but are at a lessened risk of neurologic complications if reoperation is required. |
| doi_str_mv | 10.3390/jcm13247722 |
| format | Article |
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Adult spine deformity patients ≥ 18 yrs with preoperative and 5-year (5Y) data fused to the sacrum/pelvis were included. The rates of PJK, PJK revision, and radiographic PJF were compared between patients with upper instrumented vertebra (UIV) in the upper thoracic spine (UT; T1-T7) and lower thoracic spine (LT; T8-L1). Mean differences were assessed via analyses of covariance, factoring in any differences between cohorts at baseline and any use of PJF prophylaxis. Backstep logistic regressions assessed predictors of achieving Smith et al.'s Best Clinical Outcomes (BCOs) and complications, controlling for similar covariates.
A total of 232 ASD patients were included (64.2 ± 10.2 years, 78% female); 36.3% were UT and 63.7% were LT. Postoperatively, the rates of PJK for UT were lower than LT at 1Y (34.6 vs. 50.4%,
= 0.024), 2Y (29.5 vs. 49.6% (
= 0.003), and 5Y (48.7 vs. 62.8%,
= 0.048), with comparable rates of PJF. In total, 4.0% of UT patients underwent subsequent reoperation, compared to 13.0% of LT patients (
= 0.025). A total of 6.0% of patients had recurrent PJK, and 3.9% had recurrent PJF (both
> 0.05). After reoperation, UT patients reported higher rates of improvement in the minimum clinically important difference for ODI by 2Y (
= 0.007) and last follow-up (
< 0.001). While adjusted regression revealed that, for UT patients, the minimization of construct extension was predictive of achieving BCOs by last follow-up (model
< 0.001), no such relationship was identified in LT patients.
Patients initially fused to the lower thoracic spine demonstrate an increased incidence of PJK and lower rates of disability improvement, but are at a lessened risk of neurologic complications if reoperation is required.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm13247722</identifier><identifier>PMID: 39768645</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Abnormalities ; Classification ; Clinical outcomes ; Comorbidity ; Comparative analysis ; Complications ; Data collection ; Disease prevention ; Frailty ; Patients ; Review boards ; Scoliosis ; Spine ; Surgery ; Treatment outcome ; Vertebrae</subject><ispartof>Journal of clinical medicine, 2024-12, Vol.13 (24), p.7722</ispartof><rights>COPYRIGHT 2024 MDPI AG</rights><rights>2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c309t-35fc746df4b842b87e0c371ab4a98eef7102e6cff40edef6aa01a7421ec36def3</cites><orcidid>0000-0002-4820-1835 ; 0000-0003-0395-1066 ; 0000-0001-9597-4139 ; 0000-0002-9697-8999 ; 0000-0002-7488-3227 ; 0000-0002-0119-7111 ; 0000-0002-1479-4070 ; 0000-0002-2070-4043 ; 0000-0002-0580-5129 ; 0000-0003-0471-9437 ; 0000-0002-2324-3780 ; 0000-0002-4711-4377</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39768645$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Onafowokan, Oluwatobi O</creatorcontrib><creatorcontrib>Lafage, Renaud</creatorcontrib><creatorcontrib>Tretiakov, Peter</creatorcontrib><creatorcontrib>Smith, Justin S</creatorcontrib><creatorcontrib>Line, Breton G</creatorcontrib><creatorcontrib>Diebo, Bassel G</creatorcontrib><creatorcontrib>Daniels, Alan H</creatorcontrib><creatorcontrib>Gum, Jeffrey L</creatorcontrib><creatorcontrib>Protopsaltis, Themistocles S</creatorcontrib><creatorcontrib>Hamilton, David Kojo</creatorcontrib><creatorcontrib>Buell, Thomas</creatorcontrib><creatorcontrib>Soroceanu, Alex</creatorcontrib><creatorcontrib>Scheer, Justin</creatorcontrib><creatorcontrib>Eastlack, Robert K</creatorcontrib><creatorcontrib>Mullin, Jeffrey P</creatorcontrib><creatorcontrib>Mundis, Gregory</creatorcontrib><creatorcontrib>Hosogane, Naobumi</creatorcontrib><creatorcontrib>Yagi, Mitsuru</creatorcontrib><creatorcontrib>Anand, Neel</creatorcontrib><creatorcontrib>Okonkwo, David O</creatorcontrib><creatorcontrib>Wang, Michael Y</creatorcontrib><creatorcontrib>Klineberg, Eric O</creatorcontrib><creatorcontrib>Kebaish, Khaled M</creatorcontrib><creatorcontrib>Lewis, Stephen</creatorcontrib><creatorcontrib>Hostin, Richard</creatorcontrib><creatorcontrib>Gupta, Munish Chandra</creatorcontrib><creatorcontrib>Lenke, Lawrence G</creatorcontrib><creatorcontrib>Kim, Han Jo</creatorcontrib><creatorcontrib>Ames, Christopher P</creatorcontrib><creatorcontrib>Shaffrey, Christopher I</creatorcontrib><creatorcontrib>Bess, Shay</creatorcontrib><creatorcontrib>Schwab, Frank J</creatorcontrib><creatorcontrib>Lafage, Virginie</creatorcontrib><creatorcontrib>Burton, Douglas</creatorcontrib><creatorcontrib>Passias, Peter G</creatorcontrib><creatorcontrib>International Spine Study Group</creatorcontrib><title>Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine</title><title>Journal of clinical medicine</title><addtitle>J Clin Med</addtitle><description>Patients with proximal junctional kyphosis (PJK) or failure (PJF) may demonstrate disparate outcomes and recovery when fused to the upper (UT) versus lower (LT) thoracic spine. Few studies have distinguished the reoperation and recovery abilities of patients with PJK or PJF when fused to the upper (UT) versus lower (LT) thoracic spine.
Adult spine deformity patients ≥ 18 yrs with preoperative and 5-year (5Y) data fused to the sacrum/pelvis were included. The rates of PJK, PJK revision, and radiographic PJF were compared between patients with upper instrumented vertebra (UIV) in the upper thoracic spine (UT; T1-T7) and lower thoracic spine (LT; T8-L1). Mean differences were assessed via analyses of covariance, factoring in any differences between cohorts at baseline and any use of PJF prophylaxis. Backstep logistic regressions assessed predictors of achieving Smith et al.'s Best Clinical Outcomes (BCOs) and complications, controlling for similar covariates.
A total of 232 ASD patients were included (64.2 ± 10.2 years, 78% female); 36.3% were UT and 63.7% were LT. Postoperatively, the rates of PJK for UT were lower than LT at 1Y (34.6 vs. 50.4%,
= 0.024), 2Y (29.5 vs. 49.6% (
= 0.003), and 5Y (48.7 vs. 62.8%,
= 0.048), with comparable rates of PJF. In total, 4.0% of UT patients underwent subsequent reoperation, compared to 13.0% of LT patients (
= 0.025). A total of 6.0% of patients had recurrent PJK, and 3.9% had recurrent PJF (both
> 0.05). After reoperation, UT patients reported higher rates of improvement in the minimum clinically important difference for ODI by 2Y (
= 0.007) and last follow-up (
< 0.001). While adjusted regression revealed that, for UT patients, the minimization of construct extension was predictive of achieving BCOs by last follow-up (model
< 0.001), no such relationship was identified in LT patients.
Patients initially fused to the lower thoracic spine demonstrate an increased incidence of PJK and lower rates of disability improvement, but are at a lessened risk of neurologic complications if reoperation is required.</description><subject>Abnormalities</subject><subject>Classification</subject><subject>Clinical outcomes</subject><subject>Comorbidity</subject><subject>Comparative analysis</subject><subject>Complications</subject><subject>Data collection</subject><subject>Disease prevention</subject><subject>Frailty</subject><subject>Patients</subject><subject>Review boards</subject><subject>Scoliosis</subject><subject>Spine</subject><subject>Surgery</subject><subject>Treatment 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Virginie</au><au>Burton, Douglas</au><au>Passias, Peter G</au><aucorp>International Spine Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine</atitle><jtitle>Journal of clinical medicine</jtitle><addtitle>J Clin Med</addtitle><date>2024-12-18</date><risdate>2024</risdate><volume>13</volume><issue>24</issue><spage>7722</spage><pages>7722-</pages><issn>2077-0383</issn><eissn>2077-0383</eissn><abstract>Patients with proximal junctional kyphosis (PJK) or failure (PJF) may demonstrate disparate outcomes and recovery when fused to the upper (UT) versus lower (LT) thoracic spine. Few studies have distinguished the reoperation and recovery abilities of patients with PJK or PJF when fused to the upper (UT) versus lower (LT) thoracic spine.
Adult spine deformity patients ≥ 18 yrs with preoperative and 5-year (5Y) data fused to the sacrum/pelvis were included. The rates of PJK, PJK revision, and radiographic PJF were compared between patients with upper instrumented vertebra (UIV) in the upper thoracic spine (UT; T1-T7) and lower thoracic spine (LT; T8-L1). Mean differences were assessed via analyses of covariance, factoring in any differences between cohorts at baseline and any use of PJF prophylaxis. Backstep logistic regressions assessed predictors of achieving Smith et al.'s Best Clinical Outcomes (BCOs) and complications, controlling for similar covariates.
A total of 232 ASD patients were included (64.2 ± 10.2 years, 78% female); 36.3% were UT and 63.7% were LT. Postoperatively, the rates of PJK for UT were lower than LT at 1Y (34.6 vs. 50.4%,
= 0.024), 2Y (29.5 vs. 49.6% (
= 0.003), and 5Y (48.7 vs. 62.8%,
= 0.048), with comparable rates of PJF. In total, 4.0% of UT patients underwent subsequent reoperation, compared to 13.0% of LT patients (
= 0.025). A total of 6.0% of patients had recurrent PJK, and 3.9% had recurrent PJF (both
> 0.05). After reoperation, UT patients reported higher rates of improvement in the minimum clinically important difference for ODI by 2Y (
= 0.007) and last follow-up (
< 0.001). While adjusted regression revealed that, for UT patients, the minimization of construct extension was predictive of achieving BCOs by last follow-up (model
< 0.001), no such relationship was identified in LT patients.
Patients initially fused to the lower thoracic spine demonstrate an increased incidence of PJK and lower rates of disability improvement, but are at a lessened risk of neurologic complications if reoperation is required.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>39768645</pmid><doi>10.3390/jcm13247722</doi><orcidid>https://orcid.org/0000-0002-4820-1835</orcidid><orcidid>https://orcid.org/0000-0003-0395-1066</orcidid><orcidid>https://orcid.org/0000-0001-9597-4139</orcidid><orcidid>https://orcid.org/0000-0002-9697-8999</orcidid><orcidid>https://orcid.org/0000-0002-7488-3227</orcidid><orcidid>https://orcid.org/0000-0002-0119-7111</orcidid><orcidid>https://orcid.org/0000-0002-1479-4070</orcidid><orcidid>https://orcid.org/0000-0002-2070-4043</orcidid><orcidid>https://orcid.org/0000-0002-0580-5129</orcidid><orcidid>https://orcid.org/0000-0003-0471-9437</orcidid><orcidid>https://orcid.org/0000-0002-2324-3780</orcidid><orcidid>https://orcid.org/0000-0002-4711-4377</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2077-0383 |
| ispartof | Journal of clinical medicine, 2024-12, Vol.13 (24), p.7722 |
| issn | 2077-0383 2077-0383 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3153869110 |
| source | MDPI - Multidisciplinary Digital Publishing Institute; EZB-FREE-00999 freely available EZB journals; PubMed Central; PubMed Central Open Access |
| subjects | Abnormalities Classification Clinical outcomes Comorbidity Comparative analysis Complications Data collection Disease prevention Frailty Patients Review boards Scoliosis Spine Surgery Treatment outcome Vertebrae |
| title | Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine |
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