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KMID : 1148120230130010010
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Journal of Advanced Spine Surgery
2023 Volume.13 No. 1 p.10 ~ p.22
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Risk Factors for Radiographic Progression of Proximal Junctional Fracture in Patients Undergoing Surgical Treatment for Adult Spinal Deformity
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Park Se-Jun
Lee Chong-Suh
Park Jin-Sung
Jeon Chung-Youb
Ma Chang-Hyun
Shin Tae-Soo
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Abstract
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Objective : Proximal junctional fracture (PJFx) at the uppermost instrumented vertebra (UIV) or UIV+1 is the most
common mechanism of PJF. There are few studies assessing the radiographic progression after PJFx development.
Therefore, this study sought to identify the risk factors for radiographic progression of PJFx in surgical treatment for
ASD.
Methods : In this retrospective study, among 317 patients aged > 60 years who underwent ≥5-level fusion from the
sacrum, 76 with PJFx development were included. According to the change in proximal junctional angle (PJA),
two groups were created: Group P (change ≥10°) and Group NP (change <10°). Patient, surgical, and radiographic
variables were compared between the groups to demonstrate risk factors for PJFx progression using uni- and
multivariate analysis. The receiver operating characteristic (ROC) curve was used to calculate cutoff values. Clinical
outcomes, such as visual analog scale (VAS) scores for back and leg pain, the Oswestry Disability Index (ODI) score,
and the Scoliosis Research Society (SRS)-22 score, and revision rate were compared between the two groups.
Results : The mean age at the index surgery was 71.1 years, and there were 67 women enrolled in the study (88.2%).
There were 45 patients in Group P and 31 in Group NP. A mean increase of PJA was 15.6° (from 23.2° to 38.8°) in
Group P and 3.7° (from 17.2° to 20.9°) in Group NP. The clinical outcomes were significantly better in Group NP than
Group P, including back VAS score, ODI value, and the SRS-22 scores for all items. Revision rate was significantly
greater in group P than in group NP (17.8% vs. 51.6%, p=0.001). Multivariate analysis revealed that overcorrection
relative to the age-adjusted ideal pelvic incidence (PI)?lumbar lordosis (LL) target at the index surgery (odds ratio
[OR]=4.484, p=0.030], PJA at the time of PJFx identification (OR=1.097, p=0.009), fracture at UIV versus UIV+1 (OR
=3.410, p=0.027) were significant risk factors for PJFx progression. The cutoff value of PJA for PJFx progression was
calculated as 21° using the ROC curve.
Conclusions : The risk factors for further progression of PJFx were overcorrection relative to age-adjusted PI?LL target
at the index surgery, PJA > 21° at initial presentation, and fracture at the UIV level. Close monitoring is warranted for
such patients not to miss the timely revision surgery.
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KEYWORD
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Proximal junctional fracture, Adult spinal deformity, Progression, Risk factors
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