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.
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.
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).
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.
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- Vertebral fractures: clinical importance and management.Am J Med. 2016 Feb; 129 (10): 221.e1
- Osteoporosis in the European union: medical management, epidemiology and economic burden. A report prepared in collaboration with the international osteoporosis foundation (IOF) and the European federation of pharmaceutical industry associations (EFPIA).Arch Osteoporosis. 2013 Dec; 8: 136
- Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis.Osteoporos Int. 2016 Oct; 27: 2891-2900
- Treatment of osteoporotic vertebral fractures.Orthop Traumatol Surg Res. 2021 Feb; 107102779
- Osteoporotic thoracolumbar fractures-how are they different? -classification and treatment algorithm.J Orthop Trauma. 2017 Sep; 31: S49-S56
- Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures: a meta-analysis.Medicine (Baltim). 2016 Aug; 95e4491
- Impact of spinal kyphosis on gastroesophageal reflux disease symptoms in patients with osteoporosis.Osteoporos Int. 2009 Jul; 20: 1193-1198
- Back pain in osteoporotic vertebral fractures.Osteoporos Int. 2008 Jul; 19: 895-903
- Quality of life in patients with osteoporotic vertebral fractures.Asian Spine J. 2014 Oct 18; 8: 653-658
- Surgical management of posttraumatic thoracolumbar kyphosis.Spine J. 2008 Jul-Aug; 8: 666-677
- Surgical treatment of post-traumatic kyphosis in the thoracolumbar spine: indications and technical aspects.Eur Spine J. 2010 Mar; 19 (Suppl 1): S69-S73
- Modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis.J Trauma. 2011 Jul; 71: 209-216
- Modified grade 4 osteotomy for the correction of post-traumatic thoracolumbar kyphosis: a retrospective study of 42 patients.Medicine (Baltim). 2020 Sep 11; 99e22204
- Modified partial pedicle subtraction osteotomy for the correction of post-traumatic thoracolumbar kyphosis.Spine J. 2015 Sep 1; 15: 2009-2015
- Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis.J Neurosurg Spine. 2015 Jul; 23: 42-48
- Long adult deformity fusions to L5 and the sacrum. A matched cohort analysis.Spine (Phila Pa. 2004 Sep 15; 29 (1976): 1996-2005
- Thoracolumbar deformity arthrodesis stopping at L5: fate of the L5-S1 disc, minimum 5-year follow-up.Spine (Phila Pa. 2007 Nov 15; 32 (1976): 2771-2776
- Compensatory mechanism of the spine after corrective surgery without lumbar-sacral fixation for traumatic thoracolumbar kyphotic spine deformity.J Orthop Sci. 2018 Mar; 23: 253-257
- Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study.Spine (Phila Pa. 2012 May 20; 37 (1976): 1077-1082
- Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management.J Bone Joint Surg Am. 2011 Jun 1; 93: 1057-1063
- Risk factors for recollapse of new vertebral compression fractures after percutaneous kyphoplasty in geriatric patients: establishment of a nomogram.BMC Muscoskel Disord. 2022 May 14; 23: 458
- Distal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention.Spine (Phila Pa. 2006 Feb 1; 31 (1976): 299-302
- Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae.J Neurosurg Spine. 2013 Sep; 19: 360-369
- Changes in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy: a comprehensive radiographic analysis.Spine (Phila Pa. 2012 Feb 1; 37 (1976): E180-E187
- A systematic review of risk factors associated with distal junctional failure in adult spinal deformity surgery.Clin Spine Surg. 2021 Nov 1; 34: 347-354
- Impact of spinal correction surgeries with osteotomy and pelvic fixation in patients with kyphosis due to osteoporotic vertebral fractures.Asian Spine J. 2021 Aug; 15: 523-532
- Risk factors for perioperative blood transfusions in adult spinal deformity surgery.World Neurosurg. 2018 Jul; 115: e731-e737
- Postoperative disability after long corrective fusion to the pelvis in elderly patients with spinal deformity.Spine (Phila Pa. 2018 Jul 15; 43 (1976): E804-E812
- A Japanese nationwide multicenter survey on perioperative complications of corrective fusion for elderly patients with adult spinal deformity.J Orthop Sci. 2017 Mar; 22: 237-242
- Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms.Eur Spine J. 2014 Jun; 23: 1177-1189
Published online: March 15, 2023
Accepted: March 1, 2023
Received in revised form: February 23, 2023
Received: December 13, 2022
Publication stageIn Press Corrected Proof
© 2023 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.