Details

Autor(en) / Beteiligte

• Byun, Chan Woong
• Cho, Jae Hwan
• Lee, Choon Sung
• Lee, Dong-Ho
• Hwang, Chang Ju

Titel

Effect of overcorrection on proximal junctional kyphosis in adult spinal deformity: analysis by age-adjusted ideal sagittal alignment

Ist Teil von

• The spine journal, 2022-04, Vol.22 (4), p.635-645

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2022

Quelle

MEDLINE

Beschreibungen/Notizen

• •Overcorrected patients had a significantly higher PJK rate in the age-adjusted analysis (48.3%, 26.5%, and 13.3% for groups O, I, and U, respectively; p=.041).•The degree of postoperative LL correction relative to the PI is a risk factor for the development of PJK (11.4° for PJK vs. 0.2° for non-PJK, p=.033).•Inferior clinical outcomes (back VAS and ODI) were found in patients with PJK.•To reduce the risk of PJK, surgeon's should take age-adjusted parameters into account and exercise caution not to overcorrect patients with low PI. The effect of the degree of lumbar lordosis (LL) correction on proximal junctional kyphosis (PJK) has not been analyzed in context of the age-adjusted sagittal alignment goal. To determine the effect of sagittal correction on the incidence of PJK after an age-adjusted analysis in patients with adult spinal deformity (ASD). Retrospective comparative study. Seventy-eight ASD patients who underwent deformity correction. Visual analog scale (VAS), Oswestry Disability Index (ODI), and imaging. This study included 78 ASD patients who underwent deformity correction and were followed-up more than 2 years. Patients were grouped according to the degree of LL correction relative to pelvic incidence (PI) by adjusting for age using the following formula: (age-adjusted ideal PI - LL) - (postoperative PI - LL). These were group U (undercorrection; <−10˚, N=15), group I (ideal correction; −10˚–10˚, N=34), and group O (over correction, >10˚, N=29). Various clinical and radiological parameters were compared among groups. The risk factors for PJK were also evaluated. The overall incidence of PJK was 32.1% (25/78), with significantly higher PJK rate in group O (48.3%) compared with groups U (13.3%) and I (26.5%) (p=.041). The degree of postoperative LL correction relative to the PI by adjusting for age was a risk factor for the development of PJK (11.4° for PJK vs. 0.2° for non-PJK, p=.033). In addition, 2-year postoperative VAS (7.0 vs. 3.4, p<.001) and ODI (28.9 vs. 24.8, p=.040) scores were significantly higher in the PJK group than in the non-PJK group. A small PI (PI < 45°) was associated with a tendency of overcorrection (73.3%, P < 0.001) and thereby with the high incidence of PJK (53.3%, p=.005). Overcorrection of LL relative to PI considering age-adjusted ideal sagittal alignment tends to increase the incidence of PJK. The incidence of PJK is expected to be high in patients with low PI (<45°) because of the tendency of overcorrection. To reduce the risk of PJK, surgeons should take age-adjusted parameters into account and exercise caution not to overcorrect patients with low PI, since this can result in suboptimal clinical outcomes.