Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignment Target in Patients With Adult Spinal Deformity: Risk Factor Analysis of 196 Cases Undergoing Low Thoracic to Pelvic Fusion

초록

Objective: To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target. Methods: The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of > 28 degrees plus a difference in PJA of > 22 degrees or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF. Results: The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001-1.129; p = 0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001-1.013; p = 0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205-19.621; p = 0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109-1.164; p <0.001) were significant risk factors for PJF development. Conclusion: A sizeable proportion of patients (21. 9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.

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