Identification of Decision Criteria for Revision Surgery Among Patients With Proximal Junctional Failure After Surgical Treatment of Spinal Deformity

Dallas, TX Southern Methodist University
Spine (Impact Factor: 2.3). 06/2013; 38(19). DOI: 10.1097/BRS.0b013e31829fedde
Source: PubMed


Study Design: Multi-center, retrospective, consecutive case series.Objective: This study aims to identify demographic and radiographic characteristics that influence the decision to perform revision surgery among patients with Proximal Junctional Failure (PJF).Summary of Background Data: Revision rates following PJF remain relatively high, yet the decision criteria for performing revision surgeries is not uniform and varies by surgeon. A better understanding of the factors that impact the decision to perform revision surgery is important in order to improve efficiency of surgical treatment for adult spinal deformity (ASD).Methods: A cohort of 57 PJF patients was identified retrospectively from 1,218 consecutive ASD patients. PJF was identified based on 10° post-operative increase in kyphosis between upper instrumented vertebra (UIV) and UIV+2, along with one or more of the following: fracture of the vertebral body of UIV or UIV +1, posterior osseo-ligamentous disruption, or pull-out of instrumentation at the UIV. Univariate statistical analysis was performed using t-tests and Fisher's exact tests. Multivariate analysis was performed using logistic regression.Results: Twenty-seven (47.4%) patients underwent revision surgery within 6 months of the index operation. Regression results revealed that patients with combined posterior/anterior approaches at index were significantly more likely to undergo revision (p = 0.001) as were patients with more extreme PJK angulation (p = 0.034). Patients sustaining trauma were also significantly more likely to undergo revision (p = 0.019). Variables approaching but not reaching significance as predictors of revision included female gender (p = 0.066) and higher SVA (p = 0.090).Conclusions: The decision to perform revision surgery is complicated and varies by surgeon. Factors that appear to influence this decision include traumatic etiology of PJF, severity of PJK angulation, higher SVA, and female gender. Factors that were expected to influence revision but had no statistical effect included soft-tissue versus bony mode of failure, age, levels fused, and upper thoracic versus thoracolumbar proximal junction.

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