ZHANG Xinuo,HAI Yong,Guan Li.Risk factors for proximal kyphosis after long segmental posterior lumbar interbody fusion of adult degenerative scoliosis[J].Chinese Journal of Spine and Spinal Cord,2019,(6):514-523.
Risk factors for proximal kyphosis after long segmental posterior lumbar interbody fusion of adult degenerative scoliosis
Received:November 18, 2018  Revised:May 02, 2019
English Keywords:Adult degenerative scoliosis  Posterior lumbar interbody fusion  Proximal junctional kyphosis  Risk factor
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Author NameAffiliation
ZHANG Xinuo Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, 100020, China 
HAI Yong 首都医科大学附属北京朝阳医院骨科 100020 北京市 
Guan Li 首都医科大学附属北京朝阳医院骨科 100020 北京市 
孙祥耀  
刘玉增  
刘 铁  
王云生  
韩超凡  
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English Abstract:
  【Abstract】 Objectives: To analyze the incidence of PJK and related risk factors after posterior lumbar interbody fusion(PLIF) in adult degenerative scoliosis. Methods: A retrospective analysis was performed on 144 patients with adult degenerative lumbar scoliosis treated with long segmental PLIF from June 2013 to January 2016. There were PJK group with 43 cases and non-PJK group with 101 cases. Collected patient basic data and clinical function scores included age, gender, follow-up time, BMI, preoperative anemia, diabetes, hypertension history, smoking status, heart disease complications, previous surgical history, hospital stay, preoperative Oswestry disability index(ODI), last follow-up ODI, preoperative JOA score, last follow-up JOA score, preoperative VAS score, last follow-up VAS score and last follow-up lumbar stiffness disability index(LSDI) score. Surgery related parameters included intraoperative bleeding, surgical time, fusion segments, decompression segments, fusion to sacrum, posterior ligament complex(PLC), osteotomy, screw loosening, broken rod, cerebrospinal fluid leakage, pseudarthrosis, reoperation, preoperative Cobb angle, last follow-up Cobb angle, preoperative pelvic incidence minus lumbar lordosis mismatch(PI-LL), last follow-up PI-LL, preoperative sagittal vertical axis(SVA) and last follow-up SVA. The immediate imaging parameters of the two groups included pelvic tilt(PT), PI, sacral slope(SS), LL, PI-LL, thoracic kyphosis(TK), lumbar lordosis minus thoracic kyphosis mismatch(LL-TK), real lumbar lordosis(RLL), real thoracic kyphosis(RTK), real lumbar lordosisminus really thoracic kyphosis mismatch(RLL-RTK), upper instrumented vertebra slope(UIVs), UIV tilt angle(UIVi), SVA and C7 perpendicular distance to UIV upper end plate anterior point divided by posterior distance to UIV upper end plate anterior point(UIVa/b). The Pearson correlation test(r) was used to assess different correlations among PI, PT, SS, LL, TK, LL-TK, RLL-RTK, SVA, UIVs, UIVi and UIVa/b immediately after surgery. Results: There were significant differences in gender, BMI, diabetes, smoking, ODI and LSDI score between the two groups(P<0.05). In the operation-related parameters, intraoperative blood lost, fusion segments decompression segments, S1 fusion, PLC, reoperation, preoperative PI-LL, last follow-up PI-LL and last follow-up SVA were statistically different. PT, PI-LL and UIVa/b values immediately after surgery were significantly higher in the non-PJK group(P<0.05); but SS, LL, LL-TK, RLL, RLL-RTK, UIVs and UIVi immediately after surgery were significantly higher in PJK group(P<0.05). The multivariate Logistic regression model showed perioperative independent risk factors for PJK after long-segment PLIF in adult spinal deformity surgery including: BMI(OR 1.6, P=0.000), smoking(OR 3.1, P=0.016), and UIV slope(OR=2.0, P=0.015) and PI-LL (OR=1.2, P=0.015). There was a high correlation between SVA and UIVa/b, UIV slope and UIV tilt(r=-0.93; P<0.001), (r=-0.66; P<0.001) and (r=-0.68; P<0.001). There was a high correlation between UIVa/b and UIV slope and UIV tilt(r=-0.63; P<0.001) and(r=-0.68; P<0.001). Conclusions: In this study, the independent risk factors for PJK after posterior lumbar interbody fusion with adult degenerative scoliosis were analyzed by multivariate logistic regression, smoking, UIV slope and PI-LL. UIVa/b can reflect the SVA situation and UIV tilt, which can be used as a predictor of PJK.
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