Distal junctional failure after corrective surgery without pelvic fixation for thoracolumbar junctional kyphosis due to osteoporotic vertebral fracture

Elsevier

Available online 15 March 2023

Journal of Orthopaedic ScienceAuthor links open overlay panel, , , , , , , , , , , , , AbstractBackground

Thoracolumbar junctional kyphosis (TLJK) due to osteoporotic vertebral fracture (OVF) negatively impacts patients’ quality of life. The necessity of pelvic fixation in corrective surgery for TLJK due to OVF remains controversial. This study aimed to: 1) evaluate the surgical outcomes of major corrective surgery for thoracolumbar junctional kyphosis due to osteoporotic vertebral fracture, and 2) identify the risk factors for distal junctional failure to identify potential candidates for pelvic fixation.

Methods

Patients who underwent surgical correction (fixed TLJK>40°, OVF located at T11–L2, the lowermost instrumented vertebra at or above L5) were included. Sagittal vertical axis, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis (L1-S1), local kyphosis, and lower lumbar lordosis (L4-S1) were assessed. Proximal and distal junctional kyphosis (P/DJK) and failures (P/DJF) were evaluated. Pre/postoperative spinopelvic parameters were compared between DJF and non-DJF patients.

Results

Thirty-one patients (mean age: 72.3 ± 7.9 years) were included. PJK was observed in five patients (16.1%), while DJK in 11 (35.5%). Twelve cases (38.7%) were categorized as failure. Among the patients with PJK, there was only one patient (20%) categorized as PJF and required an additional surgery. Contrary, all of eleven patients with DJK were categorized as DJF, among whom six (54.5%) required additional surgery for pelvic fixation. In comparisons between DJF and non-DJF patients, there was no significant difference in pre/postoperative LK (pre/post, p = 0.725, p = 0.950). However, statistically significant differences were observed in the following preoperative alignment parameters: SVA (p = 0.014), LL (p = 0.001), LLL (p = 0.006), PT (p = 0.003), and PI-LL (p < 0.001).

Conclusions

Spinopelvic parameters, which represent the compensatory function of lumbar hyperlordosis and pelvic retroversion, have notable impacts on surgical outcomes in correction surgery for TLJK due to OVF. Surgeons should consider each patient's compensatory function when choosing a surgical approach.

Section snippetsEthical statement

This study was approved by Institutional Review Committees of Showa University and Japanese Red Cross Medical Center. Informed consent from each study participant was waived due to retrospective design of this study in accordance with the legislations of the Institutional Review Committees of participating institutions.

Funding

This work was supported in part by Grant-in-Aid for Scientific Research from Japan Society for the Promotion of Science (grant number 21K09333 and 22K12896). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Patients and surgical procedures

This retrospective, observational, multicenter study was conducted at three institutions. The study was approved by the institutional review boards of all the participating institutions. The clinical and radiographic data of patients with TLJK due to OVF who underwent surgical correction between 2014 and 2020 were retrospectively reviewed. The inclusion criteria were as follows: 1) fixed kyphotic deformity >40° due to OVF located at T11–L2; 2) treatment with major correction surgery via PSO,

Patient demographics

We reviewed 45 consecutive patients who had undergone corrective surgery for TLJK secondary to OVF. Fourteen patients were excluded due to spinopelvic fixation and insufficient radiographic assessment; therefore, 31 patients (11 men and 20 women) who had undergone corrective surgery without pelvic fixation were included in the final analysis. The mean age (± standard deviation [SD] [range]) was 72.3 ± 7.9 (50–86), and the number of OVFs at each level was three at T11, 17 at T12, 17 at L1, and

Discussion

In this study, although surgical correction of TLJK was generally acceptable, a substantial number of patients developed junctional kyphosis (PJK, five cases, 16.1%; DJK, 11 cases, 35.4%) as well as clinical failure (12/31 cases, 38.7%) after corrective surgery. Moreover, failure predominantly occurred in the distal junctional region (11 patients, 91.7% of failure cases). On comparing DJF and non-DJF patients, our results demonstrated that there were significant differences in pre and

Declaration of competing interest

All authors declare that they have no conflict of interest.

Acknowledgments

None.

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© 2023 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.

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