Age-Adjusted Alignment Goals Have the Potential to Reduce PJK
Retrospective cohort. To explore proximal junctional kyphosis (PJK) as a function of age-adjusted surgical correction goals. Recent adult spinal deformity (ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed t...
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| Published in: | Spine (Philadelphia, Pa. 1976) Vol. 42; no. 17; p. 1275 |
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| Main Authors: | , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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01.09.2017
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| ISSN: | 1528-1159, 1528-1159 |
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| Abstract | Retrospective cohort.
To explore proximal junctional kyphosis (PJK) as a function of age-adjusted surgical correction goals.
Recent adult spinal deformity (ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK.
ASD patients with fusions to the pelvis were included and stratified into three groups: young adults (YA <40 years old), middle aged (MA: 40-65 years old), and the elderly (ED >65 years old). Analysis of variance compared the groups with respect to 1-year postoperative alignments and 1-year offsets from age-specific alignment targets.
A total of 679 patients were enrolled (mean age = 61 years old, 77% female, body mass index = 28.1). At 1 year postoperatively, there was a significant decrease in pelvic tilt (PT; 29-23°), spinopelvic mismatch (pelvic incidence [PI]-lumbar lordosis [LL]) (28-5°), and sagittal vertical axis (SVA; 110-37 mm); overall incidence of PJK was 45.1%. Stratification by age (YA, n = 28; MA, n = 389; ED, n = 262) revealed an increase in PJK incidence with age: YA = 17.9%, MA = 43.8%, and ED = 50.2% (P < 0.001). PJK patients had smaller postoperative PI-LL mismatches (ED 0.8° vs. 9.8°, MA 3.1° vs. 7.3°) than non-PJK patients, without any significant differences in PT or SVA. Analysis of the postoperative offsets from age-specific norms revealed that PJK patients in the two older subgroups and in the study cohort as a whole were overcorrected as compared to non-PJK patients (PI-LL offset-all: -5.2° vs. 2.8°, MA: -1° vs. +4°, ED: -11° vs. -2°; SVA offset-all: -10 mm vs. 7 mm, MA: -3 mm vs. 10 mm, ED: -18 mm vs. -6 mm). The correlation coefficients between PJK angles and the offsets from age-adjusted objective were small (0.320 for PI-LL, 0.114 for PT, and 0.136 for SVA).
Overall, this study suggests that PJK patients were overcorrected when compared to age-adjusted alignment goals. Certainly, elderly patients are subject to independent risk factors for PJK, making the prevention of PJK complex. However, individualized optimization of surgical alignment can improve outcomes. This emphasizes the need for surgeons to incorporate age-specific alignment targets into the standard preoperative planning process.
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| AbstractList | Retrospective cohort.
To explore proximal junctional kyphosis (PJK) as a function of age-adjusted surgical correction goals.
Recent adult spinal deformity (ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK.
ASD patients with fusions to the pelvis were included and stratified into three groups: young adults (YA <40 years old), middle aged (MA: 40-65 years old), and the elderly (ED >65 years old). Analysis of variance compared the groups with respect to 1-year postoperative alignments and 1-year offsets from age-specific alignment targets.
A total of 679 patients were enrolled (mean age = 61 years old, 77% female, body mass index = 28.1). At 1 year postoperatively, there was a significant decrease in pelvic tilt (PT; 29-23°), spinopelvic mismatch (pelvic incidence [PI]-lumbar lordosis [LL]) (28-5°), and sagittal vertical axis (SVA; 110-37 mm); overall incidence of PJK was 45.1%. Stratification by age (YA, n = 28; MA, n = 389; ED, n = 262) revealed an increase in PJK incidence with age: YA = 17.9%, MA = 43.8%, and ED = 50.2% (P < 0.001). PJK patients had smaller postoperative PI-LL mismatches (ED 0.8° vs. 9.8°, MA 3.1° vs. 7.3°) than non-PJK patients, without any significant differences in PT or SVA. Analysis of the postoperative offsets from age-specific norms revealed that PJK patients in the two older subgroups and in the study cohort as a whole were overcorrected as compared to non-PJK patients (PI-LL offset-all: -5.2° vs. 2.8°, MA: -1° vs. +4°, ED: -11° vs. -2°; SVA offset-all: -10 mm vs. 7 mm, MA: -3 mm vs. 10 mm, ED: -18 mm vs. -6 mm). The correlation coefficients between PJK angles and the offsets from age-adjusted objective were small (0.320 for PI-LL, 0.114 for PT, and 0.136 for SVA).
Overall, this study suggests that PJK patients were overcorrected when compared to age-adjusted alignment goals. Certainly, elderly patients are subject to independent risk factors for PJK, making the prevention of PJK complex. However, individualized optimization of surgical alignment can improve outcomes. This emphasizes the need for surgeons to incorporate age-specific alignment targets into the standard preoperative planning process.
3. Retrospective cohort.STUDY DESIGNRetrospective cohort.To explore proximal junctional kyphosis (PJK) as a function of age-adjusted surgical correction goals.OBJECTIVETo explore proximal junctional kyphosis (PJK) as a function of age-adjusted surgical correction goals.Recent adult spinal deformity (ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK.SUMMARY OF BACKGROUND DATARecent adult spinal deformity (ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK.ASD patients with fusions to the pelvis were included and stratified into three groups: young adults (YA <40 years old), middle aged (MA: 40-65 years old), and the elderly (ED >65 years old). Analysis of variance compared the groups with respect to 1-year postoperative alignments and 1-year offsets from age-specific alignment targets.METHODSASD patients with fusions to the pelvis were included and stratified into three groups: young adults (YA <40 years old), middle aged (MA: 40-65 years old), and the elderly (ED >65 years old). Analysis of variance compared the groups with respect to 1-year postoperative alignments and 1-year offsets from age-specific alignment targets.A total of 679 patients were enrolled (mean age = 61 years old, 77% female, body mass index = 28.1). At 1 year postoperatively, there was a significant decrease in pelvic tilt (PT; 29-23°), spinopelvic mismatch (pelvic incidence [PI]-lumbar lordosis [LL]) (28-5°), and sagittal vertical axis (SVA; 110-37 mm); overall incidence of PJK was 45.1%. Stratification by age (YA, n = 28; MA, n = 389; ED, n = 262) revealed an increase in PJK incidence with age: YA = 17.9%, MA = 43.8%, and ED = 50.2% (P < 0.001). PJK patients had smaller postoperative PI-LL mismatches (ED 0.8° vs. 9.8°, MA 3.1° vs. 7.3°) than non-PJK patients, without any significant differences in PT or SVA. Analysis of the postoperative offsets from age-specific norms revealed that PJK patients in the two older subgroups and in the study cohort as a whole were overcorrected as compared to non-PJK patients (PI-LL offset-all: -5.2° vs. 2.8°, MA: -1° vs. +4°, ED: -11° vs. -2°; SVA offset-all: -10 mm vs. 7 mm, MA: -3 mm vs. 10 mm, ED: -18 mm vs. -6 mm). The correlation coefficients between PJK angles and the offsets from age-adjusted objective were small (0.320 for PI-LL, 0.114 for PT, and 0.136 for SVA).RESULTSA total of 679 patients were enrolled (mean age = 61 years old, 77% female, body mass index = 28.1). At 1 year postoperatively, there was a significant decrease in pelvic tilt (PT; 29-23°), spinopelvic mismatch (pelvic incidence [PI]-lumbar lordosis [LL]) (28-5°), and sagittal vertical axis (SVA; 110-37 mm); overall incidence of PJK was 45.1%. Stratification by age (YA, n = 28; MA, n = 389; ED, n = 262) revealed an increase in PJK incidence with age: YA = 17.9%, MA = 43.8%, and ED = 50.2% (P < 0.001). PJK patients had smaller postoperative PI-LL mismatches (ED 0.8° vs. 9.8°, MA 3.1° vs. 7.3°) than non-PJK patients, without any significant differences in PT or SVA. Analysis of the postoperative offsets from age-specific norms revealed that PJK patients in the two older subgroups and in the study cohort as a whole were overcorrected as compared to non-PJK patients (PI-LL offset-all: -5.2° vs. 2.8°, MA: -1° vs. +4°, ED: -11° vs. -2°; SVA offset-all: -10 mm vs. 7 mm, MA: -3 mm vs. 10 mm, ED: -18 mm vs. -6 mm). The correlation coefficients between PJK angles and the offsets from age-adjusted objective were small (0.320 for PI-LL, 0.114 for PT, and 0.136 for SVA).Overall, this study suggests that PJK patients were overcorrected when compared to age-adjusted alignment goals. Certainly, elderly patients are subject to independent risk factors for PJK, making the prevention of PJK complex. However, individualized optimization of surgical alignment can improve outcomes. This emphasizes the need for surgeons to incorporate age-specific alignment targets into the standard preoperative planning process.CONCLUSIONOverall, this study suggests that PJK patients were overcorrected when compared to age-adjusted alignment goals. Certainly, elderly patients are subject to independent risk factors for PJK, making the prevention of PJK complex. However, individualized optimization of surgical alignment can improve outcomes. This emphasizes the need for surgeons to incorporate age-specific alignment targets into the standard preoperative planning process.3.LEVEL OF EVIDENCE3. |
| Author | Glassman, Steve Lafage, Virginie Schwab, Frank Bess, Shay Harris, Bradley Line, Breton Kim, HanJo Lafage, Renaud Henry, Jensen Burton, Doug Hart, Robert Klineberg, Eric Ames, Christopher Sheer, Justin |
| Author_xml | – sequence: 1 givenname: Renaud surname: Lafage fullname: Lafage, Renaud organization: Spine Service, Hospital for Special Surgery, New York, NY – sequence: 2 givenname: Frank surname: Schwab fullname: Schwab, Frank organization: Spine Service, Hospital for Special Surgery, New York, NY – sequence: 3 givenname: Steve surname: Glassman fullname: Glassman, Steve organization: Department of Orthopedic Surgery, University of Louisville Medical Center, Louisville, KY – sequence: 4 givenname: Shay surname: Bess fullname: Bess, Shay organization: Spine Division, Department of Orthopaedics, NYU Langone Medical Center, New York, NY – sequence: 5 givenname: Bradley surname: Harris fullname: Harris, Bradley organization: Spine Division, Department of Orthopaedics, NYU Langone Medical Center, New York, NY – sequence: 6 givenname: Justin surname: Sheer fullname: Sheer, Justin organization: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 7 givenname: Robert surname: Hart fullname: Hart, Robert organization: Department of Orthopaedic Surgery, Oregon Health Sciences University, Portland, OR – sequence: 8 givenname: Breton surname: Line fullname: Line, Breton organization: Rocky Mountain Hospital for Children Denver, Denver, CO – sequence: 9 givenname: Jensen surname: Henry fullname: Henry, Jensen organization: Spine Division, Department of Orthopaedics, NYU Langone Medical Center, New York, NY – sequence: 10 givenname: Doug surname: Burton fullname: Burton, Doug organization: Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS – sequence: 11 givenname: HanJo surname: Kim fullname: Kim, HanJo organization: Spine Service, Hospital for Special Surgery, New York, NY – sequence: 12 givenname: Eric surname: Klineberg fullname: Klineberg, Eric organization: Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA – sequence: 13 givenname: Christopher surname: Ames fullname: Ames, Christopher organization: Department of Neurosurgery, San Francisco Medical Center, University of California, CA – sequence: 14 givenname: Virginie surname: Lafage fullname: Lafage, Virginie organization: Spine Service, Hospital for Special Surgery, New York, NY |
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| Snippet | Retrospective cohort.
To explore proximal junctional kyphosis (PJK) as a function of age-adjusted surgical correction goals.
Recent adult spinal deformity... Retrospective cohort.STUDY DESIGNRetrospective cohort.To explore proximal junctional kyphosis (PJK) as a function of age-adjusted surgical correction... |
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| SubjectTerms | Age Factors Aged Female Humans Kyphosis - epidemiology Kyphosis - prevention & control Kyphosis - surgery Male Middle Aged Orthopedic Procedures - methods Orthopedic Procedures - statistics & numerical data Retrospective Studies |
| Title | Age-Adjusted Alignment Goals Have the Potential to Reduce PJK |
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