Effect of pelvic compensatory capacity on the occurrence of post-operative proximal junctional kyphosis in adult spinal deformity utilized second sacral alar-iliac screw
10.3760/cma.j.cn121113-20231204-00361
- VernacularTitle:骨盆代偿潜能对脊柱畸形经第2骶髂螺钉固定术后近端交界性后凸发生的影响
- Author:
Dongyue LI
1
;
Zongshan HU
;
Jie LI
;
Yanjie XU
;
Zezhang ZHU
;
Yong QIU
;
Zhen LIU
Author Information
1. 南京医科大学鼓楼临床医学院骨科，脊柱外科，南京 210008
- Keywords:
Adult;
Kyphosis;
Spinal fusion;
Pelvic compensation
- From:
Chinese Journal of Orthopaedics
2024;44(10):651-657
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the correlation between pelvic compensatory capacity and proximal junctional kyphosis (PJK) in patients with adult spinal deformity undergoing spino-pelvic fixation utilizing second sacral alar iliac (S 2AI). Methods:A cohort of 55 patients diagnosed with adult spinal deformity and treated with spino-pelvic fixation utilizing S 2AI between January 2016 and January 2019 was included. The pelvic tilt to pelvic incidence ratio (PT to PI ratio, PTr) was used to categorize patients into high PTr group (PT/PI>0.4) and low PTr group (PT/PI<0.4). Subsequently, patients were further classified into PJK group and non-PJK group based on the occurrence of PJK during the last follow-up. Radiographic parameters such as Cobb angle, coronal balance distance (CBD), global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), proximal junctional angle (PJA), T 1 pelvic angle (T 1PA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and PI-LL were measured preoperatively, postoperatively, and at final follow-up. The chi-square test was employed to compare the incidence of PJK between the high PTr and low PTr groups at the last follow-up. Additionally, multivariable logistic regression analysis was conducted to identify independent risk factors for PJK. Results:The incidence of PJK was significantly higher in the high PTr group compared to the low PTr group [high PTr group (38%) vs. low PTr group (8%), P<0.05]. Multivariable logistic regression analysis identified pre-operative PTr [ OR=3.274, 95% CI(1.100, 36.973), P=0.035], post-operative PTr [ OR=5.700, 95% CI(1.271, 65.272), P=0.029], and PJA at the last follow-up [ OR=1.274, 95% CI(0.998, 1.624), P=0.009] as independent risk factors for PJK. Conclusion:Patients with higher PTr exhibited poor pelvic compensatory ability, struggled to maintain optimal sagittal balance post-operation, and were at increased risk of developing PJK during follow-up.
