Anatomic Trajectory Screw Fixation at Upper Instrumented Vertebra Is a Substantial Risk Factor for Proximal Junctional Kyphosis

Jong Myung Jung, Seong-Jae Hyun, Ki Jeong Kim, Tae-Ahn Jahng, Hyun Jib Kim, Yunhee Choi

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: This study aimed to investigate the risk of proximal junction kyphosis (PJK) and proximal junction failure (PJF) associated with screw trajectory (straightforward vs. mixed vs. anatomic) at upper instrumented vertebra (UIV). Methods: A single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥4 levels (the UIV of the thoracolumbar spine, T9–L2, and the lower instrumented vertebra at the sacrum or pelvis) was retrospectively reviewed. Patients were divided into 3 groups according to UIV screw trajectory: group S, 2 straightforward screws; group M, 1 straightforward screw and 1 anatomic trajectory screw; and group A, 2 anatomic trajectory screws. Results: A total of 83 patients were included in this study, including 51 in group S, 16 in group M, and 16 in group A. The incidence of PJK in group S (12 patients, 23.5%), group M (7 patients, 43.8%), and group A (9 patients, 56.3%) significantly increased in sequence by group (P = 0.044). Anatomic trajectory screw fixation increased the risk for PJF requiring revision surgery compared with straightforward screw fixation (3 patients [18.8%] vs. 1 patient [2.0%]; P = 0.040). Multivariable analysis identified that anatomic trajectory screw fixation was a significant risk factor for PJK (P = 0.008; adjusted odds ratio = 7.591; 95% confidence interval, 1.69–34.093). Conclusion: Anatomic trajectory screw fixation at the UIV is a substantial risk factor for PJK and PJF. To reduce PJK and PJF, straightforward screw fixation at the UIV is recommended in adult spinal deformity correction surgery.

Original languageEnglish
Pages (from-to)e522-e529
JournalWorld Neurosurgery
Volume129
DOIs
StatePublished - 1 Sep 2019

Fingerprint

Kyphosis
Spine
Sacrum
Pelvis
Reoperation
Odds Ratio
Confidence Intervals
Incidence

Keywords

  • Adult spinal deformity
  • Proximal junction failure
  • Proximal junction kyphosis
  • Screw trajectory
  • Upper instrumented vertebra

Cite this

@article{5014c20fd7414bca8ff786d2c3fe8de4,
title = "Anatomic Trajectory Screw Fixation at Upper Instrumented Vertebra Is a Substantial Risk Factor for Proximal Junctional Kyphosis",
abstract = "Background: This study aimed to investigate the risk of proximal junction kyphosis (PJK) and proximal junction failure (PJF) associated with screw trajectory (straightforward vs. mixed vs. anatomic) at upper instrumented vertebra (UIV). Methods: A single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥4 levels (the UIV of the thoracolumbar spine, T9–L2, and the lower instrumented vertebra at the sacrum or pelvis) was retrospectively reviewed. Patients were divided into 3 groups according to UIV screw trajectory: group S, 2 straightforward screws; group M, 1 straightforward screw and 1 anatomic trajectory screw; and group A, 2 anatomic trajectory screws. Results: A total of 83 patients were included in this study, including 51 in group S, 16 in group M, and 16 in group A. The incidence of PJK in group S (12 patients, 23.5{\%}), group M (7 patients, 43.8{\%}), and group A (9 patients, 56.3{\%}) significantly increased in sequence by group (P = 0.044). Anatomic trajectory screw fixation increased the risk for PJF requiring revision surgery compared with straightforward screw fixation (3 patients [18.8{\%}] vs. 1 patient [2.0{\%}]; P = 0.040). Multivariable analysis identified that anatomic trajectory screw fixation was a significant risk factor for PJK (P = 0.008; adjusted odds ratio = 7.591; 95{\%} confidence interval, 1.69–34.093). Conclusion: Anatomic trajectory screw fixation at the UIV is a substantial risk factor for PJK and PJF. To reduce PJK and PJF, straightforward screw fixation at the UIV is recommended in adult spinal deformity correction surgery.",
keywords = "Adult spinal deformity, Proximal junction failure, Proximal junction kyphosis, Screw trajectory, Upper instrumented vertebra",
author = "Jung, {Jong Myung} and Seong-Jae Hyun and Kim, {Ki Jeong} and Tae-Ahn Jahng and Kim, {Hyun Jib} and Yunhee Choi",
year = "2019",
month = "9",
day = "1",
doi = "10.1016/j.wneu.2019.05.198",
language = "English",
volume = "129",
pages = "e522--e529",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

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Anatomic Trajectory Screw Fixation at Upper Instrumented Vertebra Is a Substantial Risk Factor for Proximal Junctional Kyphosis. / Jung, Jong Myung; Hyun, Seong-Jae; Kim, Ki Jeong; Jahng, Tae-Ahn; Kim, Hyun Jib; Choi, Yunhee.

In: World Neurosurgery, Vol. 129, 01.09.2019, p. e522-e529.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Anatomic Trajectory Screw Fixation at Upper Instrumented Vertebra Is a Substantial Risk Factor for Proximal Junctional Kyphosis

AU - Jung, Jong Myung

AU - Hyun, Seong-Jae

AU - Kim, Ki Jeong

AU - Jahng, Tae-Ahn

AU - Kim, Hyun Jib

AU - Choi, Yunhee

PY - 2019/9/1

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N2 - Background: This study aimed to investigate the risk of proximal junction kyphosis (PJK) and proximal junction failure (PJF) associated with screw trajectory (straightforward vs. mixed vs. anatomic) at upper instrumented vertebra (UIV). Methods: A single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥4 levels (the UIV of the thoracolumbar spine, T9–L2, and the lower instrumented vertebra at the sacrum or pelvis) was retrospectively reviewed. Patients were divided into 3 groups according to UIV screw trajectory: group S, 2 straightforward screws; group M, 1 straightforward screw and 1 anatomic trajectory screw; and group A, 2 anatomic trajectory screws. Results: A total of 83 patients were included in this study, including 51 in group S, 16 in group M, and 16 in group A. The incidence of PJK in group S (12 patients, 23.5%), group M (7 patients, 43.8%), and group A (9 patients, 56.3%) significantly increased in sequence by group (P = 0.044). Anatomic trajectory screw fixation increased the risk for PJF requiring revision surgery compared with straightforward screw fixation (3 patients [18.8%] vs. 1 patient [2.0%]; P = 0.040). Multivariable analysis identified that anatomic trajectory screw fixation was a significant risk factor for PJK (P = 0.008; adjusted odds ratio = 7.591; 95% confidence interval, 1.69–34.093). Conclusion: Anatomic trajectory screw fixation at the UIV is a substantial risk factor for PJK and PJF. To reduce PJK and PJF, straightforward screw fixation at the UIV is recommended in adult spinal deformity correction surgery.

AB - Background: This study aimed to investigate the risk of proximal junction kyphosis (PJK) and proximal junction failure (PJF) associated with screw trajectory (straightforward vs. mixed vs. anatomic) at upper instrumented vertebra (UIV). Methods: A single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥4 levels (the UIV of the thoracolumbar spine, T9–L2, and the lower instrumented vertebra at the sacrum or pelvis) was retrospectively reviewed. Patients were divided into 3 groups according to UIV screw trajectory: group S, 2 straightforward screws; group M, 1 straightforward screw and 1 anatomic trajectory screw; and group A, 2 anatomic trajectory screws. Results: A total of 83 patients were included in this study, including 51 in group S, 16 in group M, and 16 in group A. The incidence of PJK in group S (12 patients, 23.5%), group M (7 patients, 43.8%), and group A (9 patients, 56.3%) significantly increased in sequence by group (P = 0.044). Anatomic trajectory screw fixation increased the risk for PJF requiring revision surgery compared with straightforward screw fixation (3 patients [18.8%] vs. 1 patient [2.0%]; P = 0.040). Multivariable analysis identified that anatomic trajectory screw fixation was a significant risk factor for PJK (P = 0.008; adjusted odds ratio = 7.591; 95% confidence interval, 1.69–34.093). Conclusion: Anatomic trajectory screw fixation at the UIV is a substantial risk factor for PJK and PJF. To reduce PJK and PJF, straightforward screw fixation at the UIV is recommended in adult spinal deformity correction surgery.

KW - Adult spinal deformity

KW - Proximal junction failure

KW - Proximal junction kyphosis

KW - Screw trajectory

KW - Upper instrumented vertebra

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