Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine

2024

Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure

Sample size: 232 publication 10 minutes Evidence: moderate

Author Information

Author(s): Onafowokan Oluwatobi O., Lafage Renaud, Tretiakov Peter, Smith Justin S., Line Breton G., Diebo Bassel G., Daniels Alan H., Gum Jeffrey L., Protopsaltis Themistocles S., Hamilton David Kojo, Buell Thomas, Soroceanu Alex, Scheer Justin, Eastlack Robert K., Mullin Jeffrey P., Mundis Gregory, Hosogane Naobumi, Yagi Mitsuru, Anand Neel, Okonkwo David O., Wang Michael Y., Klineberg Eric O., Kebaish Khaled M., Lewis Stephen, Hostin Richard, Gupta Munish Chandra, Lenke Lawrence G., Kim Han Jo, Ames Christopher P., Shaffrey Christopher I., Bess Shay, Schwab Frank J., Lafage Virginie, Burton Douglas, Passias Peter G.

Primary Institution: Duke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, Durham, NC, USA

Hypothesis

Patients with proximal junctional kyphosis or failure will demonstrate distinct patterns in outcomes based on whether they are fused to the upper or lower thoracic spine.

Conclusion

Patients initially fused to the lower thoracic spine have a higher incidence of proximal junctional kyphosis and lower rates of improvement in disability, but a lower risk of neurological complications if reoperation is needed.

Supporting Evidence

Postoperative rates of proximal junctional kyphosis were lower in patients fused to the upper thoracic spine compared to the lower thoracic spine.
Patients with upper thoracic fusion had a lower reoperation rate compared to those with lower thoracic fusion.
Patients initially fused to the lower thoracic spine had lower rates of improvement in disability metrics.

Takeaway

This study shows that where you fuse the spine can change how well patients do after surgery. Fusing higher up might help them recover better.

Methodology

This was a retrospective analysis of a multi-center database of adult spine deformity patients who underwent fusion surgery and were followed for up to 5 years.