학술논문
Predicting the Occurrence of Postoperative Distal Junctional Kyphosis in Cervical Deformity Patients
RESEARCH--HUMAN--CLINICAL STUDIES
RESEARCH--HUMAN--CLINICAL STUDIES
Document Type
Report
Author
Passias, Peter G.; Horn, Samantha R.; Oh, Cheongeun; Lafage, Renaud; Lafage, Virginie; Smith, Justin S.; Line, Breton; Protopsaltis, Themistocles S.; Yagi, Mitsuru; Bortz, Cole A.; Segreto, Frank A.; Alas, Haddy; Diebo, Bassel G.; Sciubba, Daniel M.; Kelly, Michael P.; Daniels, Alan H.; Klineberg, Eric O.; Burton, Douglas C.; Hart, Robert A.; Schwab, Frank J.; Bess, Shay; Shaffrey, Christopher I.; Ames, Christopher P.
Source
Neurosurgery. January 2020, Vol. 86 Issue 1, pE38, 9 p.
Subject
Language
English
ISSN
0148-396X
Abstract
Cervical deformity (CD) includes a wide range of disorders and etiologies, including spondylosis, trauma, congenital, ankylosing spondylitis, among others. (1,2) Severe CD can result in debilitating disability related to decreased [...]
BACKGROUND: Distal junctional kyphosis (DJK) development after cervical deformity (CD)-corrective surgery is a growing concern for surgeons and patients. Few studies have investigated risk factors that predict the occurrence of DJK. OBJECTIVE: To predict DJK development after CD surgery using predictive modeling. METHODS: CD criteria was at least one of the following: C2-C7 Coronal/Cobb > 10[degrees], C2-7 sagittal vertical axis (cSVA) > 4 cm, chin-brow vertical angle > 25[degrees]. DJK was defined as the development of an angle RESULTS: One hundred seventeen CD patients were included. At any postoperative visit up to 1 yr, 23.1% of CD patients developed DJK. DJK was predicted with high accuracy using a combination of baseline demographic, clinical, and surgical factors by the following factors: preoperative neurological deficit, use of transition rod, C2-C7 lordosis (CL) 31[degrees], and cSVA > 54 mm. In the model using only baseline demographic/clinical predictors of DJK, presence of comorbidities, presence of baseline neurological deficit, and high preoperative C2-T3 angle were included in the final model (area under the curve = 87%). The final model using only surgical predictors for DJK included combined approach, posterior upper instrumented vertebrae below C4, use of transition rod, lack of anterior corpectomy, more than 3 posterior osteotomies, and performance of a 3-column osteotomy. CONCLUSION: Preoperative assessment and consideration should be given to these factors that are predictive of DJK to mitigate poor outcomes. KEY WORDS: Cervical deformity, Distal junctional kyphosis, Complications, Predictive analytics
BACKGROUND: Distal junctional kyphosis (DJK) development after cervical deformity (CD)-corrective surgery is a growing concern for surgeons and patients. Few studies have investigated risk factors that predict the occurrence of DJK. OBJECTIVE: To predict DJK development after CD surgery using predictive modeling. METHODS: CD criteria was at least one of the following: C2-C7 Coronal/Cobb > 10[degrees], C2-7 sagittal vertical axis (cSVA) > 4 cm, chin-brow vertical angle > 25[degrees]. DJK was defined as the development of an angle RESULTS: One hundred seventeen CD patients were included. At any postoperative visit up to 1 yr, 23.1% of CD patients developed DJK. DJK was predicted with high accuracy using a combination of baseline demographic, clinical, and surgical factors by the following factors: preoperative neurological deficit, use of transition rod, C2-C7 lordosis (CL) 31[degrees], and cSVA > 54 mm. In the model using only baseline demographic/clinical predictors of DJK, presence of comorbidities, presence of baseline neurological deficit, and high preoperative C2-T3 angle were included in the final model (area under the curve = 87%). The final model using only surgical predictors for DJK included combined approach, posterior upper instrumented vertebrae below C4, use of transition rod, lack of anterior corpectomy, more than 3 posterior osteotomies, and performance of a 3-column osteotomy. CONCLUSION: Preoperative assessment and consideration should be given to these factors that are predictive of DJK to mitigate poor outcomes. KEY WORDS: Cervical deformity, Distal junctional kyphosis, Complications, Predictive analytics