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Published on: September 16, 2022
Who Will Undergo Revision Surgery After Proximal Junctional Fracture Development in Adult Spinal Deformity
Se-Jun Park1, Jin-Sung Park1, Dong-Ho Kang1
1Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
Study Design:
Retrospective study.
Objectives:
To investigate the risk factors for revision surgery after proximal junctional fracture (PJFx) development in adult spinal deformity (ASD) surgery.
Summary Of Background:
Not all cases with PJFx require revision surgery, particularly in patients without acute neurological deficit. Therefore, identifying the risk factors for revision surgery after PJFx occurrence is necessary to establish proper management strategies.
Methods:
Of 509 patients who underwent ≥5-level fusion surgery to pelvis, those who developed PJFx without acute neurological deficit were included in this study. Patients were divided into a revision group (R group) and a nonrevision group (NR group) according to the performance of the revision surgery. Various clinical and radiographic variables were compared between these 2 groups to identify the factors for revision surgery.
Results:
A total of 102 patients composed the final study cohort. There were 93 women (91.2%) with a mean age of 72.1 years. On average, 7.9 levels were fused. PJFx was found at a mean of 8.8 months after surgery, and revision surgery was performed for 39 patients (38.2%) at a mean of 8.5 months after PJFx identification. Multivariate analysis revealed that overcorrection relative to the age-adjusted pelvic incidence (PI)-lumbar lordosis (LL) after index surgery [odds ratio (OR)=4.038, 95% CI=1.638-9.958, P =0.002] and high initial proximal junctional angle (PJA) (OR=1.149, 95% CI=1.072-1.230, P <0.001) were significant risk factors for revision surgery after PJFx development. The PJA cutoff value was calculated as 24 degrees.
Conclusion:
Overcorrection relative to the age-adjusted PI-LL at the index surgery and an initial PJA of ≥24 degrees at the time of PJFx increased likelihood for revision surgery for PJFx. Therefore, an early revision surgery should be considered for high-risk patients, while a close observation can be allowed for low-risk patients.
