Related Experiment Video
Updated: Sep 9, 2025
Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
Published on: September 16, 2022
Listhesis and Spinopelvic Inclination of Upper Instrumented Vertebra Region and the Implications on Proximal
Bassel G Diebo1, Mariah Balmaceno-Criss1, Mohammad Daher1
1Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
Study Design:
Retrospective analysis of prospective data.
Objective:
Evaluate the impact of radiographic and morphologic configuration of the uppermost instrumented vertebrae (UIV) region on proximal junctional kyphosis (PJK) rates.
Background:
Literature is limited on evaluation of the preoperative landing zone (UIV-1 to UIV +2 levels) and its impact on development of PJK.
Materials And Methods:
Adult ASD patients with native baseline thoracolumbar junction, postoperative UIV between T9 and T12 and LIV extending to pelvis, and two-year follow-up available were included. Landing zone was assessed on radiographs for Meyerding grade listhesis and posterior translation angle by 2 spine surgeons. Comparative analyses were performed on demographics, radiographic parameters, and PJK rates across patients with/without landing zone listhesis and above/below 15° UIV spinopelvic inclination (UIV SPi). Multivariable regression, accounting for listhesis, UIV SPi, PJK prophylaxis, age, osteoporosis, radiographic UIV quality (bridging osteophytes/degenerative disc disease), and change in PI-LL and SVA, was used to identify independent predictors of PJK.
Results:
Among 244 patients, mean age was 64.41 years, 73.0% were females, mean CCI was 1.97. In total, 30% had preoperative landing zone listhesis and 42% had posterior translation (41% with baseline posterior translation and 59% with iatrogenic translation). Listhesis patients had similar baseline and two-year radiographic alignment but higher two-year PJK rates (32.9% vs . 20.5%, P = 0.04). UIV SPi >15° patients also had higher PJK (37.5% vs . 14.2%, P < 0.01) and PJK reoperation (16.3% vs . 5.8%, P = 0.01) rates. Patients with both listhesis and UIV SPi >15° had the highest PJK (45.5%, P = 0.03) and PJK reoperation (21.1%, P = 0.18) rates. Multivariable regression (R 2 = 0.33) identified landing zone listhesis (coeff = 1.0, P = 0.01) and UIV SPi (coeff = -0.22, P < 0.001) to be predictive of PJK.
Conclusions:
Preoperative listhesis and postoperative posterior translation are independent predictors of two-year PJK. These findings highlight the importance of meticulous selection of the UIV landing zone, with particular emphasis on preoperative listhesis and spinopelvic inclination.
Level Of Evidence:
Level IV.
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