Analysis of Risk Factors Associated with Proximal Junctional Kyphosis Following Long Instrumented Fusion from L1 to Sacrum: Age Itself Does Not Independently Increase the Risk.

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  • Additional Information
    • Source:
      Publisher: MDPI Country of Publication: Switzerland NLM ID: 9425208 Publication Model: Electronic Cited Medium: Internet ISSN: 1648-9144 (Electronic) Linking ISSN: 1010660X NLM ISO Abbreviation: Medicina (Kaunas) Subsets: MEDLINE
    • Publication Information:
      Publication: 2018- : Basel, Switzerland : MDPI
      Original Publication: Kaunas : Lietuvos gydytojų sąjunga
    • Subject Terms:
      Spinal Fusion*/adverse effects ; Spinal Fusion*/methods ; Kyphosis*/etiology ; Sacrum*/diagnostic imaging ; Lumbar Vertebrae*; Humans ; Male ; Female ; Aged ; Risk Factors ; Retrospective Studies ; Middle Aged ; Postoperative Complications/etiology ; Age Factors ; Logistic Models
    • Abstract:
      Background and Objectives: This study is a retrospective analysis aimed at understanding the incidence and risk factors of proximal junctional kyphosis (PJK) following long-instrumented spinal fusion from L1 to the sacrum in patients with mild to moderate sagittal imbalance. Materials and Methods: It recruited consecutive patients undergoing instrumented fusion from L1 to the sacrum for degenerative lumbar disease between June 2006 and November 2019 in a single institution. The patients' preoperative clinical data, muscle status at T12-L1 on magnetic resonance images, and sagittal spinopelvic parameters were analyzed. Univariate analysis was used to compare clinical and radiographic data between PJK and non-PJK patients. Logistic regression analysis was used to investigate the independent risk factors for PJK. Results: A total of 56 patients were included in this study. The mean age at surgery was 67.3 years and mean follow-up period was 37.3 months. In total, 10 were male and 46 were female. PJK developed in 23 (41.1%) out of 56; of these patients, 20 (87.0%) developed PJK within 1 year postoperatively. In the univariate analysis between PJK and non-PJK patients, the PJK group showed more frequent osteoporosis, lower body mass index, smaller cross-sectional area (CSA) and more fat infiltration (FI) in erector spinae muscle at T12-L1 and larger preoperative TLK and PT with statistical significance ( p < 0.05). In the logistic regression analysis, severe (>50%) FI in erector spinae muscle (OR = 43.60, CI 4.10-463.06, R 2 N = 0.730, p = 0.002) and osteoporosis (OR = 20.49, CI 1.58-264.99, R 2 N = 0.730, p = 0.021) were statistically significant. Conclusions: Preexisting severe (>50%) fat infiltration in the erector spinae muscle and osteoporosis were independent risk factors associated with PJK following instrumented fusion from L1 to the sacrum, but age was not a risk factor.
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    • Contributed Indexing:
      Keywords: L1 vertebra; instrumented fusion; proximal junctional kyphosis; risk factor; thoracolumbar junction
    • Publication Date:
      Date Created: 20240928 Date Completed: 20240928 Latest Revision: 20240930
    • Publication Date:
      20240930
    • Accession Number:
      PMC11434054
    • Accession Number:
      10.3390/medicina60091441
    • Accession Number:
      39336481