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Purpose <p>To examine the incidences and risk factors for proximal/distal junctional kyphosis (PJK/DJK) and failure (PJF/DJF) after a short-segment (≤ 4 levels) minimally invasive surgery (MIS) combination involving anterior column realignment (ACR), lateral lumbar interbody fusion (LLIF), and percutaneous pedicle screw (PPS) fixation for adult spinal deformity (ASD).</p> Methods <p>Ninety-five elderly ASD patients (mean age, 73.1 years) with pelvic incidence (PI)-lumbar lordosis (LL) mismatch &gt; 10° underwent single-stage short-segment MIS (mean, 3.1 [range 2–4] segments) extending to L4 or L5. Exclusion criteria included: thoracic scoliosis as main deformity; thoracolumbar junction kyphosis &gt; 25°; ankylosed facet joints; L5-S1 instability; and prior spinal fusion.</p> Results <p>Operative time averaged 158&#xa0;min; blood loss, 98 mL. At ≥ 2-year follow up, PJK occurred in 11.6%, PJF in 7.4%, DJK in 0%, and DJF in 2.1%. In the non-PJK/P(D)JF group, PI-LL mismatch improved from 30.5 ± 1.3° to 12.6 ± 1.3° (<i>p</i> &lt; 0.0001), whereas loss of correction compromised gain in PJK/PJF groups. Compared with non-PJK/P(D)JF group, PJK patients showed significantly lower bone mineral density (<i>p</i> = 0.0323), and PJF patients exhibited significantly greater postoperative increase in upper arc of lordosis (ΔUAL: 5.7 ± 0.7° vs. 11.3 ± 2.3°; <i>p</i> = 0.0200), without significant difference in L1-S1 lordosis (ΔLL). DJK/DJF rates remained markedly lower than those reported in recent literature.</p> Conclusions <p>This MIS approach minimized access-related morbidity, operative time, and blood loss, while achieving PJK/PJF rates comparable to or lower than those from long-segment open or MIS techniques. Greater ΔUAL–but not ΔLL–in the PJF group implies that restoring lordosis in more physiological locations may protect against PJF.</p>

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Proximal and distal junctional failures after a short-segment minimally invasive surgery combination that incorporates anterior column realignment (ACR) for adult spinal deformity

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Yoichi Tani,
  • Takahiro Tanaka,
  • Nobuhiro Naka,
  • Naoto Ono,
  • Koki Kawashima,
  • Masaaki Paku,
  • Masayuki Ishihara,
  • Takashi Adachi,
  • Shinichirou Taniguchi,
  • Muneharu Ando,
  • Takanori Saito

摘要

Purpose

To examine the incidences and risk factors for proximal/distal junctional kyphosis (PJK/DJK) and failure (PJF/DJF) after a short-segment (≤ 4 levels) minimally invasive surgery (MIS) combination involving anterior column realignment (ACR), lateral lumbar interbody fusion (LLIF), and percutaneous pedicle screw (PPS) fixation for adult spinal deformity (ASD).

Methods

Ninety-five elderly ASD patients (mean age, 73.1 years) with pelvic incidence (PI)-lumbar lordosis (LL) mismatch > 10° underwent single-stage short-segment MIS (mean, 3.1 [range 2–4] segments) extending to L4 or L5. Exclusion criteria included: thoracic scoliosis as main deformity; thoracolumbar junction kyphosis > 25°; ankylosed facet joints; L5-S1 instability; and prior spinal fusion.

Results

Operative time averaged 158 min; blood loss, 98 mL. At ≥ 2-year follow up, PJK occurred in 11.6%, PJF in 7.4%, DJK in 0%, and DJF in 2.1%. In the non-PJK/P(D)JF group, PI-LL mismatch improved from 30.5 ± 1.3° to 12.6 ± 1.3° (p < 0.0001), whereas loss of correction compromised gain in PJK/PJF groups. Compared with non-PJK/P(D)JF group, PJK patients showed significantly lower bone mineral density (p = 0.0323), and PJF patients exhibited significantly greater postoperative increase in upper arc of lordosis (ΔUAL: 5.7 ± 0.7° vs. 11.3 ± 2.3°; p = 0.0200), without significant difference in L1-S1 lordosis (ΔLL). DJK/DJF rates remained markedly lower than those reported in recent literature.

Conclusions

This MIS approach minimized access-related morbidity, operative time, and blood loss, while achieving PJK/PJF rates comparable to or lower than those from long-segment open or MIS techniques. Greater ΔUAL–but not ΔLL–in the PJF group implies that restoring lordosis in more physiological locations may protect against PJF.