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OBJECTIVE Patients undergoing long-segment fusions from the lower thoracic spine to the sacrum for adult spinal deformity correction are in danger of proximal junctional kyphosis. After long fusions for ASD, the authors investigated whether HU values were correlated with PJK after long fusions for ASD because Hounsfield units on CT correlate with BMD. METHODS The authors conducted a retrospective review of patients older than 50 years who underwent ASD reconstruction from the LT spine to the sacrum in the period from October 2007 to January 2018, with a minimum 2-year follow-up. The study inclusion criteria were met by 29 patients with PJK and 25 patients without a mean age of 64. 91 years and a mean follow-up of 3. 19 years; there were 29 patients with PJK and 25 patients without; Patients with PJK and T1 pelvic angle were both significantly higher in patients with a PJK and non-working pelvic tilt, respectively. Patients with PJK, UIV+1, and UIV+2 were 120. 41, 124. 52, and 129. 28, respectively, and 152. 80, 155. 96, and 160. 00 in the patients without PJK, respectively, respectively. 104 HU at the UIV, 113 HU at the UIV+1, and 110 HU at the UIV+2 implying the highest HU value by Youden index. CONCLUSIONS IMPACT HU blood tests were lower compared to ASD's sacrum fusions from the LT spine to the sacrum for ASD at the UIV, UIV+1, and UIV+2. The analysis of HU values on preoperative CTs can be a useful adjunct to ASD surgery planning.
Source link: https://doi.org/10.3171/2020.5.focus20192
Objective Objectives Objective Objectives of this paper The aim of this paper was to investigate the incidence and risk factors of proximal junctional kyphosis in patients with ankylosing spondylitis who underwent pedicle osteotomy. METHODS The records of 83 patients with AS and thoracolumbar kyphosis who underwent surgery at the authors' U2019 hospital between 2007 and 2013 were reviewed, along with the authors' u2019 institution. Patients with PJK had a greater thoracokinetic axis and a larger sagittal vertical axis preoperatively than those without PJK. The number of patients with PJK whose fusion extended to the sacrum was 42. 2%, more than the number of patients with PJK whose lowest instrumented vertebra was above the sacrum. When compared to the non-PJK group, Oswestry Disability Index scores did not rise in the PJK group. CONCLUSIONS The authors found that PJK occurs postoperatively in patients with AS with a prevalence of 14. 5%.
Source link: https://doi.org/10.3171/2017.11.spine17228
Since extensive open-door cervical laminoplasty, Preoperative and postoperative cervical sagittal imbalance and global sagittal distination are risk factors for postoperative cervical kyphosis. In patients with cervical sagittal instability without spinal sagittal imbalance, there was no correlation between postoperative cervical kyphosis after ELAP and preoperative global sagittal spinal alignment in patients with cervical sagittal myelopathy without spinal sagittal difference. METHODS Among the 84 consecutive patients who underwent ELAP for CSM at the authors' U2019 hospital, 43 patients with no preoperative cervical kyphosis, and spinal sagittal imbalance were included in the study. The difference in preoperative global sagittal spinal alignment between the postoperative cervical lordosis group and the cervical kyphosis group was determined. CONCLUSIONS A small SVA accompanied by lumbar hypermordosis is the typical response leading to postoperative cervical kyphosis after ELAP in patients with CSM without preoperative cervical and global spinal sagittal imbalance.
Source link: https://doi.org/10.3171/2017.12.spine17557
OBJECTIVE The posterior longitudinal ligament decompression and fixation of the posterior longitudinal ligament in the thoracic spine can be determined with an indicator of spinal cord decompression measured in the sagittal view on MRI using an index of spinal cord decompression based on the ossification-kyphosis angle. In addition, it is also unknown if spinal cord decompression of the ventral side is necessary for the treatment of OPLL. T-OPLL's effectiveness was investigated during this retrospective review, since the range of posterior decompression methods using the OKA had been determined. paraphrasedoutput:METHODS The MRI-based OKA represents the difference between the superior margin on the decompression site's cranial vertebral body and the lower posterior margin at the caudal vertebral body of the decompression site, as well as the maximum OPLL's prominence. In groups U and O, respectively, the mean patient ages were 50. 5 and 62. 1 years, and the mean preoperative Japanese Orthopaedic Association scores were 5. 9 and 6. 0. CONCLUSIONS There was no difference between patients with and without adequate spinal cord decompression in determining the recovery rate of the JOA score between patients with and without sufficient spinal cord decompression. The first-line surgical procedure of posterior decompression and fixation with the option of posterior decompression or fixation being an OKA u2264 23-u00b0 before surgery reduces the chance of postoperative disability and may result in a more successful outcome.
Source link: https://doi.org/10.3171/2017.12.spine17549
OBJECTIVE Proximal junctional failure can progress to proximal junctional degeneration, a common early and costly drawback of multisegment spinal surgery for the treatment of adult spinal deformity. As a result of the required muscle dissection and posterior ligament abnormalities, sublaminar band placement has been suggested as a potential way to reduce PJK and PJF, but it does carry the risk of a paradoxical rise in these conditions. In this report, the authors prospectively assess the risk, as well as the early clinical and radiological effects of sublaminar band insertion at the upper instrumented vertebra plus 1 level. METHODS Between August 2015 and February 2017, 40 consecutive patients underwent either upper or lower thoracic sublaminar band placement at the UIV+1 during long-segment thoracic subdeisis surgery at the UIV+1. Both pre- and postoperatively, all patients underwent medical examination, as well as radiological examination with anteroposterior and lateral 36-inch whole-spine standing radiographs. After surgery, Median's visual analog scale scores for back pain have significantly increased. After surgery, the Oswestry Disability Index's scores have also increased. PJK is a form of PJF in this group, but there were no cases of PJF in this cohort. The UIV+1's thoracolumbar instrumented arthrodesis placement is relatively secure and is not associated with an elevated incidence of PJK. Following ASD surgery, a large-scale and long-term evaluation is required to determine the potential use of sublaminar bands in reducing the incidence of PJK and PJF. No. of clinical trial registration is available.
Source link: https://doi.org/10.3171/2017.8.spine17672
OBJECTIVE PROXIMMIAL kyphosis is a well-known, yet vaguely characterized complication of adult spinal deformity surgery. There is no universal definition for PJK, but most studies show that PJK is an increase in the proximal junctional angle of greater than 10 percent (u201320, u00b0). Ligament augmentation is a novel approach for PJK reduction that gives greater strength to the upper instrumented vertebra and adjacent segments while also lowering junctional tensions at those levels. METHODS IN THIS ANALYSIS METHODS IN this research, ligament augmentation was used in a longitudinal deformity patient group at a single hospital in a series of adult spine deformity patients. Univariate and multivariate experiments were carried out to determine factors associated with PJA and proximal junctional dysfunction, which was defined as PJK requiring surgical intervention in PJK. RESULTS A total of 200 consecutive patients were included in this study: 100 patients before the introduction of ligament augmentation, and 100 patients after the introduction of this technology. The average age of the ligament augmentation cohort was 66 years, with 67% of patients being women. In the ligament augmentation group, the mean change in PJA was 6 u00b0, relative to 14 u00b0 in the control group. A PJA change in eighty-four patients was less than 10% u00b0. Only ligament augmentation showed a strong relationship with PJF in a separate model. Compared to a closely related historical cohort, ligament augmentation is associated with a dramatic decline in PJK and PJF. These results support the introduction of ligament augmentation in surgery for adult spinal deformity, especially in patients with a high risk of acquiring PJK and PJF.
Source link: https://doi.org/10.3171/2017.9.spine1710
After surgery involving either the ventral or dorsal approach, a Cervical kyphotic deformation may occur. Regardless of the reason, the formation of a cervical kyphotic deformity should be avoided, if possible, and corrected when appropriate. The authors relates to the authors' experience with a ventral correction of iatrogenic cervical kyphosis. A retrospective review of cases involving postoperative iatrogenic cervical kyphosis corrected by a ventral technique was carried out. Mechanical neck pain was present in the majority of patients' symptom profile. The mean change in the sagittal angle during the follow-up period was 2. 2 billion units of lordosis. In all but one patient, there was only one patient with a ventral approach to cervical deformity correction. Both patients improved postoperatively, and three others had complete relief of their preoperative symptoms. Deformity correction should be considered when signs are related to postoperative kyphosis.
Source link: https://doi.org/10.3171/spi.2003.98.1.0001
In an adult patient with congenital kyphosis Type I in whom spinal angiography correlated vascular with vertebral anomalies, the authors explore the case. Imaging revealed that the L-1 and L-2 vertebrae had not completely developed, resulting in kyphotic deformity similar to that of L-3; the anterior portion of T-12 nearly corresponded with that of L-3; this anomaly resulted in significant mobility in flexion and extension. On T2 -weighted images, magnetic resonance imaging revealed distal spinal cord atrophy and signal change. The right and left segmental arteries in both L-1 and L-2 arteries were found from a common trunk from the aorta, according to spinal angiography. In this case of congenital kyphosis Type I, the presence of similar anomalies of the segmental arteries and vertebrae suggests that a connection may exist between the earliest spinal vertebral and vertebral structures.
Source link: https://doi.org/10.3171/spi.2006.5.3.259
The odopathic kyphosis is characterized by anterior wedging of u2265 5u00b0 at three contiguous vertebrae treated with either nonoperative or operative therapy. Bracing is the most common component of nonoperative care, while surgical intervention is typically performed with either a combined anterior-posterior fusion or posterior-only strategy. The authors' systematic review of the literature on SK included indications for diagnosis, ease of diagnosis, and loss of correction as a result of time. Methods used in PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library were among the peer-reviewed English-language journals on the operative and nonoperative treatment of SK in the peer-reviewed English-language literature from 1950 to 2017. If they did not have clinical trials and statistics specific to SK, described fewer than two patients, or discussed findings in nonhuman models, they were rejected. At last follow-up, year of diagnosis, and complications of therapy, different treatments were extracted included diagnostic signs and techniques, maximum pretreatment kyphosis, immediate post-treatment kyphosis, and treatment kyphosis. RESULTS Of 659 unique studies, 45 of whom met our inclusion criteria, include 1829 unique patients. The most common problems among surgically treated patients were hardware malfunctions and proximal or distal junctional kyphosis. Compared to combined anterior-posterior fusion and bracing, both groups delivered greater correction than bracing. CONCLUSIONS The results reveal that for patients with SK, surgery provides the most accurate diagnosis and monitoring of correction relative to bracing. Posterior-only fusion may have greater correction and similar loss of correction compared to anterior-posterior approaches, as well as a smaller complication profile.
Source link: https://doi.org/10.3171/2019.8.spine19500
This report investigates the impact of various postoperative apex locations on osteotomy surgical and clinical outcomes in patients with AS and thoracolumbar kyphosis. In addition, a subgroup analysis was carried out among patients with a postoperative apex located in T6u201311 and postoperatively the entire AS cohort was compared with normal controls regarding the thoracic spine's location. Both postoperatively and at the last follow-up between the two groups, the patients in group 1 had significantly less horizontal distance between the C7-vertical line and the apex than the patients in group 2. Patients undergoing an osteotomy at L3 had limited apex relocation but larger SVA correction than those at L1 or L2. CONCLUSIONS AS patients with an apex located at T8 or above following surgery tended to have improved SVA correction than those with a more centrally located apical vertebra.
Source link: https://doi.org/10.3171/2018.12.spine18752
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