Should the C7-T1 Junction Be Feared? The Effect of a T1 Upper Instrumented Vertebra on Development of Proximal Junctional Kyphosis

被引:0
作者
Monroig-Rivera, Carlos [1 ]
Okonta, Ingrid [2 ]
Bauer, Jennifer M. [3 ]
Jain, Amit [4 ]
Miyanji, Firoz [5 ]
Parent, Stefan [6 ]
Newton, Peter [7 ]
Upasani, V. Salil [7 ]
Cahill, Patrick [8 ]
Sucato, Daniel [1 ]
Sponseller, Paul D. [4 ]
Samdani, Amer [9 ]
McLean, D'Marfeivel [10 ]
Brooks, Jaysson T. [1 ]
机构
[1] Scottish Rite Children, Dept Orthoped, 2222 Welborn St, Dallas, TX 75219 USA
[2] Univ Louisville, Sch Med, Louisville, KY USA
[3] Univ Washington, Seattle Childrens Hosp, Dept Orthoped & Sports Med, Seattle, WA 98195 USA
[4] Johns Hopkins Univ, Sch Med, Dept Orthopaed Surg, Baltimore, MD USA
[5] Univ British Columbia, Dept Orthopaed, Vancouver, BC, Canada
[6] Univ Montreal, Dept Surg, Montreal, PQ, Canada
[7] Rady Childrens Hosp, Div Orthoped & Scoliosis, San Diego, CA USA
[8] Childrens Hosp Philadelphia, Div Orthopaed, Philadelphia, PA USA
[9] Shriners Childrens Philadelphia, Dept Pediat Orthoped Surg, Philadelphia, PA USA
[10] Loma Linda Univ, Sch Med, Loma Linda, CA USA
关键词
Proximal junctional kyphosis; Adolescent idiopathic scoliosis; Posterior spinal fusion; Patient-reported outcome; Upper instrumented vertebra; ADOLESCENT IDIOPATHIC SCOLIOSIS; SPINAL INSTRUMENTATION; FUSION;
D O I
10.1007/s43390-024-01002-x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose Proximal junctional kyphosis is an infrequent complication in AIS; however, equipoise remains on the effects of ending a fusion proximally at the C7-T1 junction on the future development of PJK. The purpose of this study was to determine the rate of PJK in patients with AIS who had a UIV of T1 vs those with a UIV of T2 at 5 years of follow-up. Methods A query was performed of a prospective, multi-center AIS database of patients who received a PSF with at least 5 years of follow-up. Patients with a T1 UIV (n = 29) were compared to those with a T2 UIV (n = 58). PJK was defined as a proximal junctional angle (PJA) > 10 degrees. Results There was no difference between the T1 and T2 UIV cohorts in preoperative T2-T12 kyphosis or pelvic incidence; however preoperatively, T1 UIV patients had a significantly decreased PJA at - 3 degrees +/- 4.5 degrees as compared to T2 UIV patients 1.6 degrees +/- 6.5 degrees (p = 0.0014). No patients with a T1 UIV experienced PJK at 5-years of follow-up, while 16% of patients with a T2 UIV experienced PJK (p = 0.025). No patients in the T2 UIV cohort required revision surgeries for their PJK. There was no difference found in total SRS22 scores, however at 5 years of follow-up, T2 UIV patients had better Pain domain scores (4.4 +/- 0.6) vs T1 UIV patients (4.0 +/- 0.6; p = 0.004). Conclusion While T1 is an uncommon UIV in AIS, at 5 years of follow-up, a T1 UIV did not result in PJK, nor did it result in a clinically significant change in patient-reported outcome scores.
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页码:595 / 601
页数:7
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