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Junctional failure after long instrumented fusion involving thoracolumbar spine in degenerative spinal disorder
摘要
Introduction: Degenerative spinal stenosis in elderly patients causes neurogenic compression and loss of normal sagittal alignment. Restoration of sagittal balance with long-segment posterior fusion surgery is usually indicated. However, junctional kyphosis is a common complication following this surgery that negatively affects restoration of function. Purpose: To analyze the incidence and risk factors associated with junctional failure in patients receiving long-segment posterior fusion surgery for thoracolumbar degenerative spinal disease. Methods: A prospective cohort study was conducted for 84 patients who underwent the spine surgery from August 2014 to May 2017 at our hospital. These patients were examined and followed up for a minimum of 1 year. Functional parameters and sagittal parameters were collected and compared. Subsequently, these parameters were applied to logistic regression analysis to determine risk factors for junctional failure. Results: Junctional failure was observed in 36.9% of the participants, 15.5% of whom had proximal junctional failure (PJF) and 21.4% of whom had distal junctional failure (DJF). The function parameters of the without-junctional-failure group were significantly more favorable than those of the with-junctional-failure group (3.5 ± 1.9 vs. 4.7 ± 1.8, p = 0.006; 19.9 ± 8.6 vs. 26.3 ± 6.0, p = 0.001; and 6.3 ± 5.8 vs. 10.8 ± 5.0, p = 0.001). Larger sagittal vertical axis (SVA) and greater changes in the difference between lumbar lordosis (LL) (1.51, 95% confidence interval [CI] = 1.50-1.53), pelvic incidence (PI) (1.56, 95% CI = 1.50-1.62), and SVA (1.52, 95% CI = 1.50-1.53) at 3 months post operation were significantly correlated with postoperative junctional failure.
延伸閱讀
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