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The Fate of Proximal Junctional Vertebral Fractures after Long-Segment Spinal Fixation : Are There Predictable Radiologic Characteristics for Revision surgery?

Authors
 Hyun Jun Jang  ;  Jeong Yoon Park  ;  Sung Uk Kuh  ;  Dong Kyu Chin  ;  Keun Su Kim  ;  Yong Eun Cho  ;  Bang Sang Hahn  ;  Kyung Hyun Kim 
Citation
 JOURNAL OF KOREAN NEUROSURGICAL SOCIETY, Vol.64(3) : 437-446, 2021-04 
Journal Title
JOURNAL OF KOREAN NEUROSURGICAL SOCIETY
ISSN
 2005-3711 
Issue Date
2021-04
Keywords
Fractures, Compression ; Kyphosis ; Postoperative complications ; Reoperation ; Spinal fusion/adverse effect
Abstract
Objective: To investigate the radiographic characteristics of the uppermost instrumented vertebrae (UIV) and UIV+1 compression fractures that are predictive of revision surgery following long-segment spinal fixation.

Methods: A total 27 patients who presented newly developed compression fracture at UIV, UIV+1 after long segment spinal fixation (minimum 5 vertebral bodies, lowest instrumented vertebra of L5 or distal) were reviewed retrospectively. Patients were divided into two groups according to following management : revisional surgery (group A, n=13) and conservative care (group B, n=14). Pre- and postoperative images, and images taken shortly before and after the occurrence of fracture were evaluated for radiologic characteristics.

Results: Despite similar degrees of surgical correction of deformity, the fate of the two groups with proximal junctional compression fractures differed. Immediately after the fracture, the decrement of adjacent disc height in group A (32.3±7.6 mm to 23.7±8.4 mm, Δ=8.5±6.9 mm) was greater than group B (31.0±13.9 mm to 30.1±15.5 mm, Δ=0.9±2.9 mm, p=0.003). Pre-operative magnetic resonance imaging indicated that group A patients have a higher grade of disc degeneration adjacent to fractured vertebrae compared to group B (modified Pfirrmann grade, group A : 6.10±0.99, group B : 4.08±0.90, p=0.004). Binary logistic regression analysis indicated that decrement of disc height was the only associated risk factor for future revision surgery (odds ratio, 1.891; 95% confidence interval, 1.121-3.190; p=0.017).

Conclusion: Proximal junctional vertebral compression fractures with greater early-stage decrement of adjacent disc height were associated with increased risk of future neurological deterioration and necessity of revision. The condition of adjacent disc degeneration should be considered regarding severity and revision rate of proximal junctional kyphosis/proximal junction failures.
Files in This Item:
T202102902.pdf Download
DOI
10.3340/jkns.2020.0236
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kuh, Sung Uk(구성욱) ORCID logo https://orcid.org/0000-0003-2566-3209
Kim, Kyung Hyun(김경현)
Kim, Keun Su(김근수) ORCID logo https://orcid.org/0000-0002-3384-5638
Park, Jeong Yoon(박정윤) ORCID logo https://orcid.org/0000-0002-3728-7784
Jang, Hyun Jun(장현준)
Cho, Yong Eun(조용은) ORCID logo https://orcid.org/0000-0001-9815-2720
Chin, Dong Kyu(진동규) ORCID logo https://orcid.org/0000-0002-9835-9294
Hahn, Bang Sang(한방상)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184351
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