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Purpose <p>To determine if iatrogenic posterior translation (UIV SPi) at the upper instrumented vertebrae (UIV) is associated with increased mechanical complications and secondarily to generate and validate a UIV SPi threshold for increased complications.</p> Methods <p>Two patient databases were utilized: one for generating a UIV SPi threshold and another for validation. Patients with a UIV between T8-L1 and a LIV at ilium were included. A receiver operating curve (ROC) curve analyses was performed to generate a threshold that predicted proximal junctional complications. This UIV SPi angle (-16.0°) was rounded to -15.0° for practical clinical use and validated in a separate cohort. Patients were stratified as above (most translated, MT) or below (least translated, LT) the threshold for comparative demographic and outcomes analyses.</p> Results <p>Generation of the threshold on 192 patients (122 LT, 70 MT) revealed that the MT group had higher absolute postoperative UIV SVA (MT=-56.1 ± 23.1&#xa0;mm vs. LT=-10.4 ± 31.8&#xa0;mm, <i>p</i> &lt; 0.001), higher PT (25.7° vs. 19.3°, <i>p</i> &lt; 0.001), and 2.8–5.8 times greater odds of postoperative proximal junctional complications at 2-years (<i>p</i> &lt; 0.05). Validation on 135 patients (95 LT, 40 MT) revealed that the MT group had 11.7 times greater odds of radiographic PJK and had 4.5 times greater odds of all-cause reoperations (<i>p</i> &lt; 0.05).</p> Conclusion <p>Patients with UIV posterior translation, despite similar PI-LL and T1PA, exhibit a high PT and experience higher odds of proximal junctional complications. Our findings support limiting the UIV SPi to &lt; 15° of posterior translation to mitigate postoperative mechanical complications.</p> Level of evidence <p>IV.</p>

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Iatrogenic posterior translation of the construct at the uppermost instrumented vertebrae is associated with proximal junctional kyphosis

  • 期刊论文

  • 发表日期：

    2025年2月17日

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  • Bassel G. Diebo,
  • Mariah Balmaceno-Criss,
  • Renaud Lafage,
  • Manjot Singh,
  • Mohammad Daher,
  • D. Kojo Hamilton,
  • Justin S. Smith,
  • Robert K. Eastlack,
  • Richard Fessler,
  • Jeffrey L. Gum,
  • Munish C. Gupta,
  • Richard Hostin,
  • Khaled M. Kebaish,
  • Han Jo Kim,
  • Eric O. Klineberg,
  • Stephen Lewis,
  • Breton G. Line,
  • Pierce D. Nunley,
  • Gregory M. Mundis,
  • Peter G. Passias,
  • Themistocles S. Protopsaltis,
  • Thomas Buell,
  • Justin K. Scheer,
  • Jeffery Mullin,
  • Alex Soroceanu,
  • Christopher P. Ames,
  • Lawrence G. Lenke,
  • Shay Bess,
  • Christopher I. Shaffrey,
  • Frank J. Schwab,
  • Douglas C. Burton,
  • Virginie Lafage,
  • Alan H. Daniels

摘要

Purpose

To determine if iatrogenic posterior translation (UIV SPi) at the upper instrumented vertebrae (UIV) is associated with increased mechanical complications and secondarily to generate and validate a UIV SPi threshold for increased complications.

Methods

Two patient databases were utilized: one for generating a UIV SPi threshold and another for validation. Patients with a UIV between T8-L1 and a LIV at ilium were included. A receiver operating curve (ROC) curve analyses was performed to generate a threshold that predicted proximal junctional complications. This UIV SPi angle (-16.0°) was rounded to -15.0° for practical clinical use and validated in a separate cohort. Patients were stratified as above (most translated, MT) or below (least translated, LT) the threshold for comparative demographic and outcomes analyses.

Results

Generation of the threshold on 192 patients (122 LT, 70 MT) revealed that the MT group had higher absolute postoperative UIV SVA (MT=-56.1 ± 23.1 mm vs. LT=-10.4 ± 31.8 mm, p < 0.001), higher PT (25.7° vs. 19.3°, p < 0.001), and 2.8–5.8 times greater odds of postoperative proximal junctional complications at 2-years (p < 0.05). Validation on 135 patients (95 LT, 40 MT) revealed that the MT group had 11.7 times greater odds of radiographic PJK and had 4.5 times greater odds of all-cause reoperations (p < 0.05).

Conclusion

Patients with UIV posterior translation, despite similar PI-LL and T1PA, exhibit a high PT and experience higher odds of proximal junctional complications. Our findings support limiting the UIV SPi to < 15° of posterior translation to mitigate postoperative mechanical complications.

Level of evidence

IV.