Location of correction within the lumbar spine impacts acute adjacent-segment kyphosis

International Spine Study Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVEThe surgical correction of adult spinal deformity (ASD) often involves modifying lumbar lordosis (LL) to restore ideal sagittal alignment. However, corrections that include large changes in LL increase the risk for development of proximal junctional kyphosis (PJK). Little is known about the impact of cranial versus caudal correction in the lumbar spine on the occurrence of PJK. The goal of this study was to investigate the impact of the location of the correction on acute PJK development.METHODSThis study was a retrospective review of a prospective multicenter database. Surgically treated ASD patients with early follow-up evaluations (6 weeks) and fusions of the full lumbosacral spine were included. Radiographic parameters analyzed included the classic spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], PI-LL, and sagittal vertical axis [SVA]) and segmental correction. Using Glattes' criteria, patients were stratified into PJK and noPJK groups and propensity matched by age and regional lumbar correction (ΔPI-LL). Radiographic parameters and segmental correction were compared between PJK and noPJK patients using independent t-tests.RESULTSAfter propensity matching, 312 of 483 patients were included in the analysis (mean age 64 years, 76% women, 40% with PJK). There were no significant differences between PJK and noPJK patients at baseline or postoperatively, or between changes in alignment, with the exception of thoracic kyphosis (TK) and ΔTK. PJK patients had a decrease in segmental lordosis at L4-L5-S1 (-0.6° vs 1.6°, p = 0.025), and larger increases in segmental correction at cranial levels L1-L2-L3 (9.9° vs 7.1°), T12-L1-L2 (7.3° vs 5.4°), and T11-T12-L1 (2.9° vs 0.7°) (all p < 0.05).CONCLUSIONSAlthough achievement of an optimal sagittal alignment is the goal of realignment surgery, dramatic lumbar corrections appear to increase the risk of PJK. This study was the first to demonstrate that patients who developed PJK underwent kyphotic changes in the L4-S1 segments while restoring LL at more cranial levels (T12-L3). These findings suggest that restoring lordosis at lower lumbar levels may result in a decreased risk of developing PJK.

Original languageEnglish (US)
Pages (from-to)69-77
Number of pages9
JournalJournal of neurosurgery. Spine
Volume30
Issue number1
DOIs
StatePublished - Oct 26 2018

Fingerprint

Kyphosis
Spine
Lordosis
Incidence
Thorax

Keywords

  • adult spinal deformity
  • ASD = adult spinal deformity
  • FH = femoral head
  • HRQOL = health-related quality of life
  • LIV = lower instrumented vertebra
  • LL = lumbar lordosis
  • lumbar correction
  • lumbar fusion
  • overcorrection
  • PI = pelvic incidence
  • PJK = proximal junctional kyphosis
  • proximal junctional kyphosis
  • PT = pelvic tilt
  • segmental change
  • SVA = sagittal vertical axis
  • TK = thoracic kyphosis
  • TPA = T1−pelvic angle
  • UIV = upper instrumented vertebra

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Location of correction within the lumbar spine impacts acute adjacent-segment kyphosis. / International Spine Study Group.

In: Journal of neurosurgery. Spine, Vol. 30, No. 1, 26.10.2018, p. 69-77.

Research output: Contribution to journalArticle

@article{15d292cfd94d4d088ed3089ee3b40ca2,
title = "Location of correction within the lumbar spine impacts acute adjacent-segment kyphosis",
abstract = "OBJECTIVEThe surgical correction of adult spinal deformity (ASD) often involves modifying lumbar lordosis (LL) to restore ideal sagittal alignment. However, corrections that include large changes in LL increase the risk for development of proximal junctional kyphosis (PJK). Little is known about the impact of cranial versus caudal correction in the lumbar spine on the occurrence of PJK. The goal of this study was to investigate the impact of the location of the correction on acute PJK development.METHODSThis study was a retrospective review of a prospective multicenter database. Surgically treated ASD patients with early follow-up evaluations (6 weeks) and fusions of the full lumbosacral spine were included. Radiographic parameters analyzed included the classic spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], PI-LL, and sagittal vertical axis [SVA]) and segmental correction. Using Glattes' criteria, patients were stratified into PJK and noPJK groups and propensity matched by age and regional lumbar correction (ΔPI-LL). Radiographic parameters and segmental correction were compared between PJK and noPJK patients using independent t-tests.RESULTSAfter propensity matching, 312 of 483 patients were included in the analysis (mean age 64 years, 76{\%} women, 40{\%} with PJK). There were no significant differences between PJK and noPJK patients at baseline or postoperatively, or between changes in alignment, with the exception of thoracic kyphosis (TK) and ΔTK. PJK patients had a decrease in segmental lordosis at L4-L5-S1 (-0.6° vs 1.6°, p = 0.025), and larger increases in segmental correction at cranial levels L1-L2-L3 (9.9° vs 7.1°), T12-L1-L2 (7.3° vs 5.4°), and T11-T12-L1 (2.9° vs 0.7°) (all p < 0.05).CONCLUSIONSAlthough achievement of an optimal sagittal alignment is the goal of realignment surgery, dramatic lumbar corrections appear to increase the risk of PJK. This study was the first to demonstrate that patients who developed PJK underwent kyphotic changes in the L4-S1 segments while restoring LL at more cranial levels (T12-L3). These findings suggest that restoring lordosis at lower lumbar levels may result in a decreased risk of developing PJK.",
keywords = "adult spinal deformity, ASD = adult spinal deformity, FH = femoral head, HRQOL = health-related quality of life, LIV = lower instrumented vertebra, LL = lumbar lordosis, lumbar correction, lumbar fusion, overcorrection, PI = pelvic incidence, PJK = proximal junctional kyphosis, proximal junctional kyphosis, PT = pelvic tilt, segmental change, SVA = sagittal vertical axis, TK = thoracic kyphosis, TPA = T1−pelvic angle, UIV = upper instrumented vertebra",
author = "{International Spine Study Group} and Renaud Lafage and Ibrahim Obeid and Barthelemy Liabaud and Shay Bess and Douglas Burton and Smith, {Justin S.} and Cyrus Jalai and Richard Hostin and Shaffrey, {Christopher I.} and Christopher Ames and Kim, {Han Jo} and Klineberg, {Eric Otto} and Frank Schwab and Virginie Lafage",
year = "2018",
month = "10",
day = "26",
doi = "10.3171/2018.6.SPINE161468",
language = "English (US)",
volume = "30",
pages = "69--77",
journal = "Journal of neurosurgery. Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
number = "1",

}

TY - JOUR

T1 - Location of correction within the lumbar spine impacts acute adjacent-segment kyphosis

AU - International Spine Study Group

AU - Lafage, Renaud

AU - Obeid, Ibrahim

AU - Liabaud, Barthelemy

AU - Bess, Shay

AU - Burton, Douglas

AU - Smith, Justin S.

AU - Jalai, Cyrus

AU - Hostin, Richard

AU - Shaffrey, Christopher I.

AU - Ames, Christopher

AU - Kim, Han Jo

AU - Klineberg, Eric Otto

AU - Schwab, Frank

AU - Lafage, Virginie

PY - 2018/10/26

Y1 - 2018/10/26

N2 - OBJECTIVEThe surgical correction of adult spinal deformity (ASD) often involves modifying lumbar lordosis (LL) to restore ideal sagittal alignment. However, corrections that include large changes in LL increase the risk for development of proximal junctional kyphosis (PJK). Little is known about the impact of cranial versus caudal correction in the lumbar spine on the occurrence of PJK. The goal of this study was to investigate the impact of the location of the correction on acute PJK development.METHODSThis study was a retrospective review of a prospective multicenter database. Surgically treated ASD patients with early follow-up evaluations (6 weeks) and fusions of the full lumbosacral spine were included. Radiographic parameters analyzed included the classic spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], PI-LL, and sagittal vertical axis [SVA]) and segmental correction. Using Glattes' criteria, patients were stratified into PJK and noPJK groups and propensity matched by age and regional lumbar correction (ΔPI-LL). Radiographic parameters and segmental correction were compared between PJK and noPJK patients using independent t-tests.RESULTSAfter propensity matching, 312 of 483 patients were included in the analysis (mean age 64 years, 76% women, 40% with PJK). There were no significant differences between PJK and noPJK patients at baseline or postoperatively, or between changes in alignment, with the exception of thoracic kyphosis (TK) and ΔTK. PJK patients had a decrease in segmental lordosis at L4-L5-S1 (-0.6° vs 1.6°, p = 0.025), and larger increases in segmental correction at cranial levels L1-L2-L3 (9.9° vs 7.1°), T12-L1-L2 (7.3° vs 5.4°), and T11-T12-L1 (2.9° vs 0.7°) (all p < 0.05).CONCLUSIONSAlthough achievement of an optimal sagittal alignment is the goal of realignment surgery, dramatic lumbar corrections appear to increase the risk of PJK. This study was the first to demonstrate that patients who developed PJK underwent kyphotic changes in the L4-S1 segments while restoring LL at more cranial levels (T12-L3). These findings suggest that restoring lordosis at lower lumbar levels may result in a decreased risk of developing PJK.

AB - OBJECTIVEThe surgical correction of adult spinal deformity (ASD) often involves modifying lumbar lordosis (LL) to restore ideal sagittal alignment. However, corrections that include large changes in LL increase the risk for development of proximal junctional kyphosis (PJK). Little is known about the impact of cranial versus caudal correction in the lumbar spine on the occurrence of PJK. The goal of this study was to investigate the impact of the location of the correction on acute PJK development.METHODSThis study was a retrospective review of a prospective multicenter database. Surgically treated ASD patients with early follow-up evaluations (6 weeks) and fusions of the full lumbosacral spine were included. Radiographic parameters analyzed included the classic spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], PI-LL, and sagittal vertical axis [SVA]) and segmental correction. Using Glattes' criteria, patients were stratified into PJK and noPJK groups and propensity matched by age and regional lumbar correction (ΔPI-LL). Radiographic parameters and segmental correction were compared between PJK and noPJK patients using independent t-tests.RESULTSAfter propensity matching, 312 of 483 patients were included in the analysis (mean age 64 years, 76% women, 40% with PJK). There were no significant differences between PJK and noPJK patients at baseline or postoperatively, or between changes in alignment, with the exception of thoracic kyphosis (TK) and ΔTK. PJK patients had a decrease in segmental lordosis at L4-L5-S1 (-0.6° vs 1.6°, p = 0.025), and larger increases in segmental correction at cranial levels L1-L2-L3 (9.9° vs 7.1°), T12-L1-L2 (7.3° vs 5.4°), and T11-T12-L1 (2.9° vs 0.7°) (all p < 0.05).CONCLUSIONSAlthough achievement of an optimal sagittal alignment is the goal of realignment surgery, dramatic lumbar corrections appear to increase the risk of PJK. This study was the first to demonstrate that patients who developed PJK underwent kyphotic changes in the L4-S1 segments while restoring LL at more cranial levels (T12-L3). These findings suggest that restoring lordosis at lower lumbar levels may result in a decreased risk of developing PJK.

KW - adult spinal deformity

KW - ASD = adult spinal deformity

KW - FH = femoral head

KW - HRQOL = health-related quality of life

KW - LIV = lower instrumented vertebra

KW - LL = lumbar lordosis

KW - lumbar correction

KW - lumbar fusion

KW - overcorrection

KW - PI = pelvic incidence

KW - PJK = proximal junctional kyphosis

KW - proximal junctional kyphosis

KW - PT = pelvic tilt

KW - segmental change

KW - SVA = sagittal vertical axis

KW - TK = thoracic kyphosis

KW - TPA = T1−pelvic angle

KW - UIV = upper instrumented vertebra

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U2 - 10.3171/2018.6.SPINE161468

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