Abstract
Background
Thoracolumbar junctional kyphosis (TLJK) due to osteoporotic vertebral fracture (OVF)
negatively impacts patients’ quality of life. The necessity of pelvic fixation in
corrective surgery for TLJK due to OVF remains controversial. This study aimed to:
1) evaluate the surgical outcomes of major corrective surgery for thoracolumbar junctional
kyphosis due to osteoporotic vertebral fracture, and 2) identify the risk factors
for distal junctional failure to identify potential candidates for pelvic fixation.
Methods
Patients who underwent surgical correction (fixed TLJK>40°, OVF located at T11–L2,
the lowermost instrumented vertebra at or above L5) were included. Sagittal vertical
axis, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis (L1-S1), local
kyphosis, and lower lumbar lordosis (L4-S1) were assessed. Proximal and distal junctional
kyphosis (P/DJK) and failures (P/DJF) were evaluated. Pre/postoperative spinopelvic
parameters were compared between DJF and non-DJF patients.
Results
Thirty-one patients (mean age: 72.3 ± 7.9 years) were included. PJK was observed in
five patients (16.1%), while DJK in 11 (35.5%). Twelve cases (38.7%) were categorized
as failure. Among the patients with PJK, there was only one patient (20%) categorized
as PJF and required an additional surgery. Contrary, all of eleven patients with DJK
were categorized as DJF, among whom six (54.5%) required additional surgery for pelvic
fixation. In comparisons between DJF and non-DJF patients, there was no significant
difference in pre/postoperative LK (pre/post, p = 0.725, p = 0.950). However, statistically
significant differences were observed in the following preoperative alignment parameters:
SVA (p = 0.014), LL (p = 0.001), LLL (p = 0.006), PT (p = 0.003), and PI-LL (p < 0.001).
Conclusions
Spinopelvic parameters, which represent the compensatory function of lumbar hyperlordosis
and pelvic retroversion, have notable impacts on surgical outcomes in correction surgery
for TLJK due to OVF. Surgeons should consider each patient's compensatory function
when choosing a surgical approach.
Keywords
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Article info
Publication history
Published online: March 15, 2023
Accepted:
March 1,
2023
Received in revised form:
February 23,
2023
Received:
December 13,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.
