Predicting the Occurrence of Postoperative Distal Junctional Kyphosis in Cervical Deformity Patients.
Publication Title
Neurosurgery
Document Type
Article
Publication Date
1-1-2020
Keywords
Adult; Cervical Vertebrae; Female; Humans; Kyphosis; Male; Middle Aged; Orthopedic Procedures; Postoperative Complications; Retrospective Studies; Risk Factors; Spinal Curvatures
Abstract
BACKGROUND: Distal junctional kyphosis (DJK) development after cervical deformity (CD)-corrective surgery is a growing concern for surgeons and patients. Few studies have investigated risk factors that predict the occurrence of DJK.
OBJECTIVE: To predict DJK development after CD surgery using predictive modeling.
METHODS: CD criteria was at least one of the following: C2-C7 Coronal/Cobb > 10°, C2-7 sagittal vertical axis (cSVA) > 4 cm, chin-brow vertical angle > 25°. DJK was defined as the development of an angle
RESULTS: One hundred seventeen CD patients were included. At any postoperative visit up to 1 yr, 23.1% of CD patients developed DJK. DJK was predicted with high accuracy using a combination of baseline demographic, clinical, and surgical factors by the following factors: preoperative neurological deficit, use of transition rod, C2-C7 lordosis (CL)31°, and cSVA > 54 mm. In the model using only baseline demographic/clinical predictors of DJK, presence of comorbidities, presence of baseline neurological deficit, and high preoperative C2-T3 angle were included in the final model (area under the curve = 87%). The final model using only surgical predictors for DJK included combined approach, posterior upper instrumented vertebrae below C4, use of transition rod, lack of anterior corpectomy, more than 3 posterior osteotomies, and performance of a 3-column osteotomy.
CONCLUSION: Preoperative assessment and consideration should be given to these factors that are predictive of DJK to mitigate poor outcomes.
Clinical Institute
Neurosciences (Brain & Spine)
Clinical Institute
Orthopedics & Sports Medicine
Specialty/Research Institute
Orthopedics
Specialty/Research Institute
Neurosciences
Specialty/Research Institute
Surgery
