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Spine (Phila Pa 1976). 2018 Apr 1;43(7):485-491. doi: 10.1097/BRS.0000000000002355.

Low Bone-Mineral Density Is a Significant Risk for Proximal Junctional Failure After Surgical Correction of Adult Spinal Deformity: A Propensity Score-Matched Analysis.

Author information

1
Department of Orthopedic Surgery, Keio University School of Medicine.
2
Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center.
3
Keio Spine Research Group, Tokyo.
4
Department of Orthopedic Surgery, International University of Health and Welfare, Ōtawara, Tochigi, Japan.

Abstract

STUDY DESIGN:

A propensity-matched comparison of risk factors for proximal junctional failure (PJF), which is a symptomatic proximal junctional kyphosis developing after corrective surgery for adult spinal deformity (ASD).

OBJECTIVE:

To elucidate the role of bone strength for developing PJF.

SUMMARY OF BACKGROUND DATA:

PJF, a devastating complication of corrective surgery for ASD, often recurs even after revision surgery. Most studies of risk factors for PJF are retrospective and have a selection bias in surgical strategy, making it difficult to identify modifiable PJF risk factors.

METHODS:

We conducted propensity-matched comparisons of 113 surgically treated ASD patients who were followed for at least 2 years, to elucidate whether low bone-mineral density (BMD) was a true risk factor for PJF in a uniform population from a multicenter database. Patients were grouped as having mildly low to normal BMD (M group; T-score≧ - 1.5) or significantly low BMD (S group; T-score <  -1.5), and were propensity-matched for age, upper and lower instrumented vertebrae, history of spine surgery, and Schwab-Scoliosis Research Society (SRS) ASD classification. PJF was defined as a ≥20° increase from the baseline proximal junction angle with a concomitant deterioration of at least one SRS-Schwab sagittal modifier grade, or any type of proximal junctional kyphosis requiring revision.

RESULTS:

PJF developed in 22 of 113 patients (19%). There were 48 propensity-matched patients in the M and S groups (24 in each) with similar parameters for age, body mass index, number of vertebrae involved, C7SVA, pelvic incidence  - LL, and SRS-Schwab type. In this propensity-matched population, the incidence of PJF was significantly higher in the S group (33% vs. 8%, P < 0.01, odds ratio 6.4, 95% CI: 1.2-32.3).

CONCLUSION:

Low BMD was a significant risk factor for PJF in this propensity-matched cohort (odds ratio 6.4). Surgeons should consider prophylactic treatments when correcting ASD in patients with low BMD.

LEVEL OF EVIDENCE:

3.

PMID:
28767638
DOI:
10.1097/BRS.0000000000002355
[Indexed for MEDLINE]

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