Incidence, Risk Factors, and Natural Course of Proximal Junctional Kyphosis Surgical Outcomes Review of Adult Idiopathic Scoliosis. Minimum 5 Years of Follow-up
Incidence, Risk Factors, and Natural Course of Proximal Junctional Kyphosis Surgical Outcomes Review of Adult Idiopathic Scoliosis. Minimum 5 Years of Follow-up
复制标题
DOI：
10.1097/brs.0b013e31824e4888
复制
发表时间：
2012-08-01
期刊：
影响因子：
3
通讯作者：
Boachie-Adjei, Oheneba
中科院分区：
文献类型：
--
作者：
Yagi, Mitsuru;King, Akilah B.;Boachie-Adjei, Oheneba
研究设计.成人脊柱侧凸手术治疗患者的回顾性病例系列研究。本研究的目的是通过对接受长器械脊柱融合术的成人特发性脊柱侧凸患者的长期随访，评估近端交界性脊柱后凸（PJK）的发生率、危险因素和自然病程。虽然最近的报道显示了PJK的患病率，临床结果和可能的危险因素，相当多的报告显示了长期随访结果。这是一项对连续76例接受长器械脊柱融合术治疗的成人脊柱侧凸患者的病历和X线片的回顾性分析。对术前、术后即刻、术后2年、术后5年和随访时的影像学测量和人口统计学数据进行了审查。还对术后脊柱侧凸研究协会评分和奥斯韦斯特里残疾指数进行了评价。采用Student t检验比较平均值。P值小于0.05且95%可信区间为有意义。平均年龄为48.8岁（范围：23-75岁），平均随访时间为7.3年（范围：5-14年）。在17例患者中发现了PJK。脊柱侧凸研究协会和奥斯韦斯特里残疾指数未显示PJK组和非PJK组之间存在显著差异; 2例患者因局部疼痛接受了额外手术。76%的PJK在手术后3个月内被发现。尽管53%的PJK总程度在术后3个月内进展，但PJK持续进展至最终随访。既往存在低骨密度、后路脊柱融合（PSF）、与骶骨融合、脊柱整体对线不良、矢状面垂直轴改变较大是PJK的显著危险因素（P = 0.04，P < 0.001，P = 0.02，P < 0.0001，P = 0.01）。在至少5年的长期回顾中，76%的PJK发生在术后3个月内。预先存在的低骨密度、PSF、骶骨融合、不适当的整体脊柱对线和较大的矢状垂直轴变化是PJK的重要风险因素。对于PJK患者应进行仔细的长期随访。
Study Design. A retrospective case series of surgically treated patients with adult scoliosis.Objective. The purpose of this study was to evaluate the incidence, risk factors, and natural course of proximal junctional kyphosis (PJK) in a long-term follow-up of patients with adult idiopathic scoliosis undergoing long instrumented spinal fusion.Summary of Background Data. Although recent reports have showed the prevalence, clinical outcomes, and the possible risk factors of PJK, quite a few reports have showed long-term follow-up outcome.Materials and Methods. This is a retrospective review of the charts and radiographs of 76 consecutive patients with adult scoliosis treated with long instrumented spinal fusion. Radiographical measurements and demographic data were reviewed on preoperation, immediate postoperation, 2 years postoperation, 5 years postoperation, and at follow-up. Postoperative Scoliosis Research Society scores and Oswestry Disability Index were also evaluated. Means were compared with Student t test. A P value of less than 0.05 with 95% confidence interval was considered significant.Results. The mean age was 48.8 years (range, 23-75 yr) and the average follow-up was 7.3 years (range, 5-14 yr). PJK has been identified in 17 patients. The Scoliosis Research Society and Oswestry Disability Index did not demonstrate significant differences between PJK group and non-PJK group; 2 patients had additional surgeries performed for local pain. Seventy-six percent of PJK has been identified within 3 months after surgery. Despite the fact that 53% of total degree of PJK was progressed within 3 months after surgery, PJK continuously progressed to the final follow-up. Pre-existing low bone mineral density, posterior spinal fusion (PSF), fusion to sacrum, inappropriate global spine alignment, and greater sagittal vertical axis change were identified as significant risk factors for PJK (P = 0.04, P < 0.001, P = 0.02, P < 0.0001, and P = 0.01).Conclusion. In a long-term review of minimum 5 years, 76% of PJK occurred within 3 months after surgery. Pre-existing low bone mineral density, PSF, fusion to the sacrum, inappropriate global spine alignment, and greater sagittal vertical axis change were significant risk factors for PJK. Careful long-term follow-up should be done for a patient with PJK.