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Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity.

Publication ,  Journal Article
Hostin, R; McCarthy, I; OʼBrien, M; Bess, S; Line, B; Boachie-Adjei, O; Burton, D; Gupta, M; Ames, C; Deviren, V; Kebaish, K; Shaffrey, C ...
Published in: Spine (Phila Pa 1976)
May 20, 2013

STUDY DESIGN: Multicenter, retrospective series. OBJECTIVE: To analyze the incidence, mode, and location of acute proximal junctional failures (APJFs) after surgical treatment of adult spinal deformity. SUMMARY OF BACKGROUND DATA: Early proximal junctional failures above adult deformity constructs are a serious clinical problem; however, the incidence and nature of early APJFs remain unclear. METHODS: A total of 1218 consecutive adult spinal deformity surgeries across 10 deformity centers were retrospectively reviewed to evaluate the incidence and nature of APJF, defined as any of the following within 28 weeks of index procedure: minimum 15° post-operative increase in proximal junctional kyphosis, vertebral fracture of upper instrumented vertebrae (UIV) or UIV + 1, failure of UIV fixation, or need for proximal extension of fusion within 6 months of surgery. RESULTS: Sixty-eight APJF cases were identified out of 1218 consecutive surgeries (5.6%). Patients had a mean age of 63 years (range, 26-82 yr), mean fusion levels of 9.8 (range, 4-18), and mean time to APJF of 11.4 weeks (range, 1.5-28 wk). Fracture was the most common failure mode (47%), followed by soft-tissue failure (44%). Failures most often occurred in the thoracolumbar region (TL-APJF) compared with the upper thoracic region (UT-APJF), with 66% of patients experiencing TL-APJF compared with 34% experiencing UT-APJF. Fracture was significantly more common for TL-APJF relative to UT-APJF (P = 0.00), whereas soft-tissue failure was more common for UT-APJF (P < 0.02). Patients experiencing TL-APJF were also older (P = 0.00), had fewer fusion levels (P = 0.00), and had worse postoperative sagittal vertical axis (P < 0.01). CONCLUSION: APJFs were identified in 5.6% of patients undergoing surgical treatment of adult spinal deformity, with failures occurring primarily in the TL region of the spine. There is evidence that the mode of failure differs depending on the location of UIV, with TL failures more likely due to fracture and UT failures more likely due to soft-tissue failures.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

May 20, 2013

Volume

38

Issue

12

Start / End Page

1008 / 1015

Location

United States

Related Subject Headings

  • United States
  • Treatment Failure
  • Time Factors
  • Thoracic Vertebrae
  • Spinal Fusion
  • Spinal Fractures
  • Scoliosis
  • Risk Factors
  • Retrospective Studies
  • Reoperation
 

Citation

APA
Chicago
ICMJE
MLA
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Hostin, R., McCarthy, I., OʼBrien, M., Bess, S., Line, B., Boachie-Adjei, O., … International Spine Study Group, . (2013). Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976), 38(12), 1008–1015. https://doi.org/10.1097/BRS.0b013e318271319c
Hostin, Richard, Ian McCarthy, Michael OʼBrien, Shay Bess, Breton Line, Oheneba Boachie-Adjei, Doug Burton, et al. “Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity.Spine (Phila Pa 1976) 38, no. 12 (May 20, 2013): 1008–15. https://doi.org/10.1097/BRS.0b013e318271319c.
Hostin R, McCarthy I, OʼBrien M, Bess S, Line B, Boachie-Adjei O, et al. Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976). 2013 May 20;38(12):1008–15.
Hostin, Richard, et al. “Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity.Spine (Phila Pa 1976), vol. 38, no. 12, May 2013, pp. 1008–15. Pubmed, doi:10.1097/BRS.0b013e318271319c.
Hostin R, McCarthy I, OʼBrien M, Bess S, Line B, Boachie-Adjei O, Burton D, Gupta M, Ames C, Deviren V, Kebaish K, Shaffrey C, Wood K, Hart R, International Spine Study Group. Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976). 2013 May 20;38(12):1008–1015.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

May 20, 2013

Volume

38

Issue

12

Start / End Page

1008 / 1015

Location

United States

Related Subject Headings

  • United States
  • Treatment Failure
  • Time Factors
  • Thoracic Vertebrae
  • Spinal Fusion
  • Spinal Fractures
  • Scoliosis
  • Risk Factors
  • Retrospective Studies
  • Reoperation