The importance of thoracolumbar junctional orientation, change in thoracolumbar angle, and overcorrection of lumbar lordosis in development of proximal junctional kyphosis in adult spinal deformity surgery

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  • 1 Department of Orthopedic Surgery, Chungang University Hospital, Seoul;
  • | 2 Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam; and
  • | 3 Department of Orthopedic Surgery, Korea University Ansan Hospital, Gyeonggi-do, South Korea
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OBJECTIVE

Changes in the thoracolumbar angle (TLA) would play a pivotal role in the reciprocal changes following spine realignment surgery, thereby leading to the development of proximal junctional kyphosis (PJK). This study aimed to investigate the association between TLA and the development of PJK following adult spinal deformity surgery.

METHODS

A total of 107 patients were divided into PJK+ and PJK− groups according to the development of PJK within 12 months after surgery. The TLA and spinopelvic radiological parameters were compared between the PJK+ and PJK− groups. A multivariate logistic regression model was used to identify the risk factors for PJK. The receiver operating characteristic curves of the regression models were used to investigate the cutoff values of significant parameters needed so that PJK would not occur.

RESULTS

The change in TLA (ΔTLA) in the PJK+ group was significantly larger than in the PJK− group (6.7° ± 7.9° and 2.2° ± 8.1°, respectively; p = 0.006). Multivariate logistic regression analysis demonstrated that age, postoperative pelvic incidence–lumbar lordosis, and ΔTLA were significant risk factors for PJK. The risk of developing PJK was higher when the postoperative pelvic incidence–lumbar lordosis was < 5.2 and the ΔTLA was > 3.58°.

CONCLUSIONS

The present study highlights the thinking that extensive correction of TLA and lumbar lordosis should be avoided in patients with adult spinal deformity. Overcorrection of TLA of > 3.58° could result in higher odds of PJK.

ABBREVIATIONS

ASD = adult spinal deformity; AUC = area under the curve; BMD = bone mineral density; ODI = Oswestry Disability Index; PI-LL = pelvic incidence–lumbar lordosis; PJK = proximal junctional kyphosis; PT = pelvic tilt; ROC = receiver operating characteristic; SS = sacral slope; SVA = sagittal vertical axis; TLA = thoracolumbar angle; ΔTLA = change in TLA; TLJ = thoracolumbar junctional; TLS = thoracolumbar slope; ΔTLS = change in TLS; UIV = upper instrumented vertebra.

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