The effect of prophylactic vertebroplasty on the incidence of proximal junctional kyphosis and proximal junctional failure following posterior spinal fusion in adult spinal deformity: a 5-year follow-up study

被引:85
作者
Raman, Tina [1 ]
Miller, Emily [1 ]
Martin, Christopher T. [1 ]
Kebaish, Khaled M. [1 ]
机构
[1] Johns Hopkins Univ, Dept Orthopaed Surg, 601 N Caroline St, Baltimore, MD 21287 USA
关键词
Adult spinal deformity; Adult spinal deformity complications; Long posterior thoracolumbar fusion; Prophylactic vertebroplasty; Proximal junctional failure; Proximal junctional kyphosis; Vertebroplasty; PEDICLE SCREW CONSTRUCTS; RISK-FACTORS; FRACTURE RISK; LUMBAR; INSTRUMENTATION; COMPLICATIONS; L5; AUGMENTATION; KYPHOPLASTY; OUTCOMES;
D O I
10.1016/j.spinee.2017.05.017
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND CONTEXT: The incidence of proximal junctional kyphosis (PJK) ranges from 5% to 46% following adult spinal deformity surgery. Approximately 66% to 76% of PJK occurs within 3 months of surgery. A subset of these patients, reportedly 26% to 47%, develop proximal junctional failure (PJF) within 6 months postoperatively. To date, there are no studies evaluating the impact of prophylactic vertebroplasty on PJK and PJF incidence at long-term follow-up. PURPOSE: The purpose of this study is to evaluate the long-term radiographic and clinical outcomes, and incidence of PJK and PJF, after prophylactic vertebroplasty for long-segment thoracolumbar posterior spinal fusion (PSF). STUDY DESIGN: This is a prospective cohort study. PATIENT SAMPLE: Thirty-nine patients, of whom 87% were female, who underwent two-level prophylactic vertebroplasty at the upper instrumented and supra-adjacent vertebrae at the time of index PSF were included in this study. OUTCOME MEASURES: Clinical outcomes were assessed using the Scoliosis Research Society-22 (SRS-22), and Short-Form (SF) 36 questionnaires, and the Oswestry Disability Index (ODI). Radiographic parameters including PJK angle, and coronal and sagittal alignment, were calculated, along with relevant perioperative complications and revision rates. METHODS: Of the 41 patients who received two-level prophylactic vertebroplasty at the upper instrumented and supra-adjacent vertebrae at the time of index PSF, and comprised a cohort with previously published 2-year follow-up data, 39 (95%) completed 5-year follow-up (average: 67.6 months). Proximal junctional kyphosis was defined as a change in the PJK angle >= 10 degrees between the immediate postoperative and final follow-up radiograph. Proximal junctional failure was defined as acute proximal junctional fracture, fixation failure, or kyphosis requiring extension of fusion within the first 6 months postoperatively. RESULTS: Thirty-nine patients with a mean age of 65.6 (41-87) years were included in this study. Of the 39 patients, 28.2% developed PJK (11: 7.7% at 2 years, 20.5% between 2 and 5 years), and 5.1% developed acute PJF. Two of the 11 PJK patients required revision for progressive worsening of the PJK. There were no proximal junctional fractures. There was no significant difference in preoperative, immediate postoperative, and final follow-up measurements of thoracic kyphosis, lumbar lordosis, and coronal or sagittal alignment between patients who developed PJK, PJF, or neither (p>.05). There was no significant difference in ODI, SRS-22, or SF-36 scores between those with and without PJK or PJF (p>.05). CONCLUSIONS: This long-term follow-up demonstrates that prophylactic vertebroplasty may minimize the risk for junctional failure in the early postoperative period. However, it does not appear to decrease the incidence of PJK at 5 years. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:1489 / 1498
页数:10
相关论文
共 44 条
[1]  
Annis Prokopis, 2014, Evid Based Spine Care J, V5, P160, DOI 10.1055/s-0034-1386755
[2]   Prophylactic vertebroplasty can decrease the fracture risk of adjacent vertebrae: An in vitro cadaveric study [J].
Aquarius, Rene ;
Homminga, Jasper ;
Hosman, Allard Jan Frederik ;
Verdonschot, Nico ;
Tanck, Esther .
MEDICAL ENGINEERING & PHYSICS, 2014, 36 (07) :944-948
[3]   Biomechanical Risk Factors for Proximal Junctional Kyphosis A Detailed Numerical Analysis of Surgical Instrumentation Variables [J].
Cammarata, Marco ;
Aubin, Carl-Eric ;
Wang, Xiaoyu ;
Mac-Thiong, Jean-Marc .
SPINE, 2014, 39 (08) :E500-E507
[4]   Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis [J].
Cho, Kyu-Jung ;
Suk, Se-Il ;
Park, Seung-Rim ;
Kim, Jin-Hyok ;
Kim, Sung-Soo ;
Choi, Won-Kee ;
Lee, Kang-Yoon ;
Lee, Seung-Ryol .
SPINE, 2007, 32 (20) :2232-2237
[5]   Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65 - Surgical considerations and treatment option in patients with poor bone quality [J].
DeWald, Christopher J. ;
Stanley, Thomas .
SPINE, 2006, 31 (19) :S144-S151
[6]   Vertebroplasty and Vertebral Augmentation Techniques [J].
Eckel, Timothy S. ;
Olan, Wayne .
TECHNIQUES IN VASCULAR AND INTERVENTIONAL RADIOLOGY, 2009, 12 (01) :44-50
[7]  
Feltes Carlos, 2005, Neurosurg Focus, V18, pe5
[8]  
FERNANDEZBAILLO N, 2012, SCOLIOSIS SPINAL DIS, V7
[9]   New technologies in spine - Kyphoplasty and vertebrosplasty for the treatment of painful osteoporotic compression fractures [J].
Garfin, SR ;
Yuan, HA ;
Reiley, MA .
SPINE, 2001, 26 (14) :1511-1515
[10]   The impact of perioperative complications on clinical outcome in adult deformity surgery [J].
Glassman, Steven D. ;
Hamill, Christopher L. ;
Bridwell, Keith H. ;
Schwab, Frank J. ;
Dimar, John R. ;
Lowe, Thomas G. .
SPINE, 2007, 32 (24) :2764-2770