Predictive risk factors for mechanical complications after multilevel posterior cervical instrumented fusion

Sun-Joon Yoo MD1, Jeong-Yoon Park MD, PhD1, Dong-Kyu Chin MD, PhD1, Keun-Su Kim MD, PhD1, Yong-Eun Cho MD, PhD1, and Kyung-Hyun Kim MD, PhD1
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  • 1 Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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OBJECTIVE

Mechanical complications should be considered following the correction of multilevel posterior cervical instrumented fusion. This study aimed to investigate clinical data on the patients’ pre- and postoperative cervical alignment in terms of the incidence of mechanical complications after multilevel posterior cervical instrumented fusion.

METHODS

Between January 2008 and December 2018, 156 consecutive patients who underwent posterior cervical laminectomy and instrumented fusion surgery of 4 or more levels and were followed up for more than 2 years were included in this study. Age, sex, bone mineral density (BMD), BMI, mechanical complications, and pre- and postoperative radiographic factors were analyzed using multivariate logistic regression analysis to investigate the factors related to mechanical complications.

RESULTS

Of the 156 patients, 114 were men and 42 were women; the mean age was 60.38 years (range 25–83 years), and the mean follow-up duration of follow-up was 37.56 months (range 24–128 months). Thirty-seven patients (23.7%) experienced mechanical complications, and 6 of them underwent revision surgery. The significant risk factors for mechanical complications were low BMD T-score (−1.36 vs −0.58, p = 0.001), a large number of fused vertebrae (5.08 vs 4.54, p = 0.003), a large preoperative C2–7 sagittal vertical axis (SVA; 32.28 vs 23.24 mm, p = 0.002), and low preoperative C2–7 lordosis (1.85° vs 8.83°, p = 0.001). The clinical outcomes demonstrated overall improvement in both groups; however, the neck visual analog scale, Neck Disability Index, and Japanese Orthopaedic Association scores after surgery were significantly worse in the mechanical complication group compared with the group without mechanical complications.

CONCLUSIONS

Low BMD, a large number of fused vertebrae, a large preoperative C2–7 SVA, and low C2–7 lordosis were significant risk factors for mechanical complications after posterior cervical fusion surgery. The results of this study could be valuable for preoperative counseling, medical treatment, or surgical planning when multilevel posterior cervical instrumented fusion surgery is performed.

ABBREVIATIONS

BMD = bone mineral density; DJF = distal junctional failure; DJK = distal junctional kyphosis; GAP = Global Alignment and Proportion; JOA = Japanese Orthopaedic Association; LIV = lower instrumented vertebra; NDI = Neck Disability Index; PJF = proximal junctional failure; PJK = proximal junctional kyphosis; SVA = sagittal vertical axis; UIV = upper instrumented vertebra; VAS = visual analog scale.

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  • 1

    Farrokhi MR, Ghaffarpasand F, Khani M, Gholami M. An evidence-based stepwise surgical approach to cervical spondylotic myelopathy: a narrative review of the current literature. World Neurosurg. 2016;94:97110.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2012;71(3):662669.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Ames CP, Blondel B, Scheer JK, et al. Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976). 2013;38(22)(suppl 1):S149S160.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Hardacker JW, Shuford RF, Capicotto PN, Pryor PW. Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine (Phila Pa 1976). 1997;22(13):14721480.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Patwardhan AG, Khayatzadeh S, Havey RM, et al. Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J. 2018;27(1)(suppl 1):2538.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Passias PG, Horn SR, Jalai CM, et al. Cervical alignment changes in patients developing proximal junctional kyphosis following surgical correction of adult spinal deformity. Neurosurgery. 2018;83(4):675682.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Lee JC, Lee SH, Peters C, Riew KD. Adjacent segment pathology requiring reoperation after anterior cervical arthrodesis: the influence of smoking, sex, and number of operated levels. Spine (Phila Pa 1976). 2015;40(10):E571E577.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999;81(4):519528.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Noh SH, Ha Y, Obeid I, et al. Modified global alignment and proportion scoring with body mass index and bone mineral density (GAPB) for improving predictions of mechanical complications after adult spinal deformity surgery. Spine J. 2020;20(5):776784.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Yilgor C, Sogunmez N, Boissiere L, et al. Global Alignment and Proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am. 2017;99(19):16611672.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Lau D, Clark AJ, Scheer JK, et al. Proximal junctional kyphosis and failure after spinal deformity surgery: a systematic review of the literature as a background to classification development. Spine (Phila Pa 1976). 2014;39(25):20932102.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    O’Leary PT, Bridwell KH, Lenke LG, et al. Risk factors and outcomes for catastrophic failures at the top of long pedicle screw constructs: a matched cohort analysis performed at a single center. Spine (Phila Pa 1976). 2009;34(20):21342139.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Anderson PA, Henley MB, Grady MS, Montesano PX, Winn HR. Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine (Phila Pa 1976). 1991;16(3)(suppl):S72S79.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Schultz KD Jr, McLaughlin MR, Haid RW Jr, Comey CH, Rodts GE Jr, Alexander J. Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders. J Neurosurg. 2000;93(2)(suppl):214221.

    • Search Google Scholar
    • Export Citation
  • 15

    Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C II. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976). 2005;30(14):16431649.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Hostin R, McCarthy I, O'Brien M, et al. Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976). 2013;38(12):10081015.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Lowe TG, Lenke L, Betz R, et al. Distal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention. Spine (Phila Pa 1976). 2006;31(3):299302.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976). 2012;37(12):10771082.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Passias PG, Horn SR, Oh C, et al. Predicting the occurrence of postoperative distal junctional kyphosis in cervical deformity patients. Neurosurgery. 2020;86(1):E38E46.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Smith JS, Buell TJ, Shaffrey CI, et al. Prospective multicenter assessment of complication rates associated with adult cervical deformity surgery in 133 patients with minimum 1-year follow-up. J Neurosurg Spine. 2020;33(5):588600.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Cheng H, Gary LC, Curtis JR, et al. Estimated prevalence and patterns of presumed osteoporosis among older Americans based on Medicare data. Osteoporos Int. 2009;20(9):15071515.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Giannoudis PV, Schneider E. Principles of fixation of osteoporotic fractures. J Bone Joint Surg Br. 2006;88(10):12721278.

  • 23

    Yagi M, Fujita N, Tsuji O, et al. Low bone-mineral density is a significant risk for proximal junctional failure after surgical correction of adult spinal deformity: a propensity score-matched analysis. Spine (Phila Pa 1976). 2018;43(7):485491.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Guzman JZ, Feldman ZM, McAnany S, Hecht AC, Qureshi SA, Cho SK. Osteoporosis in cervical spine surgery. Spine (Phila Pa 1976). 2016;41(8):662668.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Alhashash M, Shousha M, Boehm H. Adjacent segment disease after cervical spine fusion: evaluation of a 70 patient long-term follow-up. Spine (Phila Pa 1976). 2018;43(9):605609.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Cammarata M, Aubin CE, Wang X, Mac-Thiong JM. Biomechanical risk factors for proximal junctional kyphosis: a detailed numerical analysis of surgical instrumentation variables. Spine (Phila Pa 1976). 2014;39(8):E500E507.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Lee SH, Kim KT, Seo EM, Suk KS, Kwack YH, Son ES. The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults. J Spinal Disord Tech. 2012;25(2):E41E47.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Maruo K, Ha Y, Inoue S, et al. Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity. Spine (Phila Pa 1976). 2013;38(23):E1469E1476.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Yagi M, King AB, Boachie-Adjei O. Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up. Spine (Phila Pa 1976). 2012;37(17):14791489.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Lafage R, Schwab F, Glassman S, et al. Age-adjusted alignment goals have the potential to reduce PJK. Spine (Phila Pa 1976). 2017;42(17):12751282.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31

    Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013;19(2):141159.

    • Crossref
    • Search Google Scholar
    • Export Citation

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