Caudally directed upper-instrumented vertebra pedicle screws associated with minimized risk of proximal junctional failure in patients with long posterior spinal fusion for adult spinal deformity |
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| Authors: | Andrew B. Harris Floreana N. Kebaish Varun Puvanesarajah Micheal Raad Matthew W. Wilkening Amit Jain David B. Cohen Brian J. Neuman Khaled M. Kebaish |
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| Affiliation: | 1. Brigham and Women''s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Boston, MA 02115, USA;2. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 550 N. Broadway, Ste 301, Baltimore, MD 21029, USA;3. Department of Anesthesiology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA;4. Laboratory of Bacterial Pathogenesis and Immunology, The Rockefeller University, New York, New York;5. Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA;6. Persica Pharmaceuticals Ltd, 7 Denne Hill Business Centre, Womenswold, Canterbury, Kent, CT4 6HD, UK;1. Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid- Wulumuqi Rd, Shanghai 200040 China;2. Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY 10212, USA;3. Department of Orthopedics, The Fifth People''s Hospital, Fudan University, Shanghai 200240 China;1. Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;2. Roseman University of Health Sciences, College of Dental Medicine, South Jordan, UT 84095, USA;3. Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA;1. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu Seoul, 05505, Republic of Korea;2. Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, 14 Siksadong, Ilsandonggu Goyangsi, Gyeonggidoo, 411-773, Republic of Korea;3. Department of Orthopedic Surgery, Kangwon National University Hospital, 156, Baengnyeong-ro Chuncheon-si, Gangwon-do, 24341, Republic of Korea;4. Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea |
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| Abstract: | BACKGROUND CONTEXTIt is unknown whether upper instrumented vertebra (UIV) pedicle screw trajectory and UIV screw-rod angle are associated with development of proximal junctional kyphosis (PJK) and/or proximal junctional failure (PJF).PURPOSETo determine whether (1) the cranial-caudal trajectory of UIV pedicle screws and (2) UIV screw-vertebra angle are associated with PJK and/or PJF after long posterior spinal fusion in patients with adult spinal deformity (ASD).STUDY DESIGN/SETTINGRetrospective review.PATIENT SAMPLEWe included 96 patients with ASD who underwent fusion from T9–T12 to the pelvis (>5 vertebrae fused) between 2008 and 2015.OUTCOME MEASURESPedicle screw trajectory was measured as the UIV pedicle screw–vertebra angle (UIV-PVA), which is the mean of the two angles between the UIV superior endplate and both UIV pedicle screws. (Positive values indicate screws angled cranially; negative values indicate screws angled caudally.) We measured UIV rod-vertebra angle (UIV-RVA) between the rod at the point of screw attachment and the UIV superior endplate.METHODSDuring ≥2-year follow-up, 38 patients developed PJK, and 28 developed PJF. Mean (± standard deviation) UIV-PVA was ?0.9° ± 6.0°. Mean UIV-RVA was 87° ± 5.2°. We examined the development of PJK and PJF using a UIV-PVA/UIV-RVA cutoff of 3° identified by a receiver operating characteristic curve, while controlling for osteoporosis, age, sex, and preoperative thoracic kyphosis.RESULTSPatients with UIV-PVA ≥3° had significantly greater odds of developing PJK (odds ratio 2.7; 95% confidence interval: 1.0–7.1) and PJF (odds ratio 3.6; 95% confidence interval: 1.3–10) compared with patients with UIV-PVA <3°. UIV-RVA was not significantly associated with development of PJK or PJF.CONCLUSIONSIn long thoracic fusion to the pelvis for ASD, UIV-PVA ≥3° was associated with 2.7-fold greater odds of PJK and 3.6-fold greater odds of PJF compared with UIV-PVA <3°. UIV-RVA was not associated with PJK or PJF.LEVEL OF EVIDENCEIII |
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