Objective To identify risk factors and establish radiographic criteria for distal junctional failure (DJF) in patients with adult spinal deformity (ASD), who underwent fusion surgery stopping at L5.
Methods This retrospective study was undertaken from January 2016 to December 2020. Patients with ASD who underwent fusion surgery (≥5 levels) stopping at L5 were analyzed. DJF was defined as symptomatic adjacent segment pathology at the lumbosacral junction necessitating consideration for revision surgery. Demographic data and radiographic measurements were compared between the DJF and non-DJF groups. Receiver operating characteristic curve analysis was performed to identify the radiographic cutoff value for DJF.
Results Among 76 patients, 16 (21.1%) experienced DJF. DJF was associated with older age, antidepressant/anxiolytic medication, longer level of fusions, and worse preoperative sagittal alignment. Antidepressant/anxiolytic medication (odds ratio, 5.60) and preoperative pelvic incidence (PI)–lumbar lordosis (LL) mismatch>40° (odds ratio, 5.87) were independent risk factors for DJF. Without both factors, the incidence of DJF has been greatly reduced (9.1%). Two radiographic criteria were determined for DJF: last distal junctional angle (DJA)>-5° and Δ last DJA–post DJA>5°. When both criteria were met, the sensitivity and specificity of the DJF were 93.3% and 91.7%, respectively.
Conclusion Use of antidepressant/anxiolytic medication and preoperative PI–LL mismatch >40° were independent risk factors for DJF. DJF could be diagnosed using postoperative changes in the DJA. If both criteria were met, DJF could be strongly suggested.
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Hong Kyung Shin, Jin Hoon Park, Sang Ryong Jeon, Sung Woo Roh, Dae Jean Jo, Seung-Jae Hyun, Yong-Jae Cho, for the Korean Spinal Deformity Society (KSDS)
Neurospine 2023;20(4):1469-1476. Published online December 31, 2023
Objective Two commonly used techniques for spinopelvic fixation in adult deformity surgery are iliac screw (IS) and sacral 2 alar-iliac screw (S2AI) fixations. In this article, we systematically meta-analyzed the complications of sacropelvic fixation for adult deformity surgery comparing IS and S2AI.
Methods The PubMed, Embase, Web of Science, and Cochrane clinical trial databases were systematically searched until March 29, 2023. The proportion of postoperative complications, including implant failure, revision, screw prominence, and wound complications after sacropelvic fixation, were pooled with a random-effects model. Subgroup analyses for the method of sacropelvic fixation were conducted.
Results Ten studies with a total of 1,931 patients (IS, 925 patients; S2AI, 1,006 patients) were included. The pooled proportion of implant failure was not statistically different between the IS and S2AI groups (21.9% and 18.9%, respectively) (p = 0.59). However, revision was higher in the IS group (21.0%) than that in the S2AI group (8.5%) (p = 0.02). Additionally, screw prominence was higher in the IS group (9.6%) than that in the S2AI group (0.0%) (p < 0.01), and wound complication was also higher in the IS group (31.7%) than that in the S2AI group (3.9%) (p < 0.01).
Conclusion IS and S2AI fixations showed that both techniques had similar outcomes in terms of implant failure. However, S2AI was revealed to have better outcomes than IS in terms of revision, screw prominence, and wound complications.
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Objective To compare the outcomes of S1 foraminal hooks and iliac screws regarding fusion rate at the lumbosacral junction and protective effects on S1 screws.
Methods From January 2017 to December 2019, consecutive patients who underwent long fusions (uppermost instrumented vertebra at or above L1) to the sacrum for adult spinal deformity were enrolled. Patients were divided into S1 foraminal hook group and iliac screw group. Radiographic parameters and the incidence of pseudarthrosis and instrument failure at the lumbosacral junction were compared between the groups.
Results Twenty-nine patients (male:female = 1:28) with a mean age of 73.6 ± 6.8 years were evaluated. Sixteen patients (55.2%) had S1 foraminal hook fixation and 13 patients (44.8%) had iliac screw fixation. Lumbar lordosis, sacral slope, and sagittal vertical axis did not differ between the groups preoperatively and postoperatively. The rate of L5/S1 pseudarthrosis was significantly higher in S1 foraminal hook group (5 of 16, 31.3%), compared to iliac screw group (0 of 13, 0%; p = 0.048). Instrument failure at the lumbosacral junction trended toward a higher rate in S1 foraminal hook group (6 of 16, 37.5%) than in iliac screw group (1 of 13, 7.7%), without statistical significance (p = 0.09). Proximal junctional kyphosis/failure occurred less often in S1 foraminal hook group (2 of 16, 12.5%) than in iliac screw group (3 of 13, 30.8%) without statistical significance (p = 0.36).
Conclusion Treatment with S1 foraminal hooks achieved equivalent satisfactory sagittal correction with proportioned alignment compared to that with iliac screws. However, S1 foraminal hooks did not provide enough structural support to the lumbosacral junction in long fusions to the sacrum.
Citations
Citations to this article as recorded by
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