Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity

Robert Hart, Ian McCarthy, Michael O'brien, Shay Bess, Brett Line, Oheneba Boachie Adjei, Doug Burton, Munish Gupta, Christopher Ames, Vedat Deviren, Khaled M Kebaish, Christopher Shaffrey, Kirkham Wood, Richard Hostin

Research output: Contribution to journalArticle

Abstract

Study Design. Multicenter, retrospective, consecutive case series. Objective. This study aims to identify demographic and radiographical characteristics that influence the decision to perform revision surgery among patients with proximal junctional failure (PJF). Summary of Background Data. Revision rates after PJF remain relatively high, yet the decision criteria for performing revision surgical procedures are not uniform and vary by surgeon. A better understanding of the factors that impact the decision to perform revision surgery is important in order to improve efficiency of surgical treatment of adult spinal deformity. Methods. A cohort of 57 patients with PJF was identified retrospectively from 1218 consecutive patients with adult spinal deformity. PJF was identified on the basis of 10 ° postoperative increase in kyphosis between upper instrumented vertebra (UIV) and UIV + 2, along with 1 or more of the following: fracture of the vertebral body of UIV or UIV + 1, posterior osseoligamentous disruption, or pullout of instrumentation at the UIV. Univariate statistical analysis was performed using t tests and Fisher exact tests. Multivariate analysis was performed using logistic regression. Results. Twenty-seven (47.4%) patients underwent revision surgery within 6 months of the index operation. Regression results revealed that patients with combined posterior/anterior approaches at index were significantly more likely to undergo revision ( P = 0.001) as were patients with more extreme proximal junctional kyphosis angulation ( P = 0.034). Patients sustaining trauma were also significantly more likely to undergo revision ( P = 0.019). Variables approaching but not reaching significance as predictors of revision included female sex ( P = 0.066) and higher sagittal vertical axis (SVA) ( P = 0.090). Conclusion. The decision to perform revision surgery is complicated and varies by surgeon. Factors that seem to influence this decision include traumatic etiology of PJF, severity of proximal junctional kyphosis angulation, higher SVA, and female sex. Factors that were expected to influence revision but had no statistical effect included soft tissue versus bony mode of failure, age, levels fused, and upper thoracic versus thoracolumbar proximal junction.

Original languageEnglish (US)
JournalSpine
Volume38
Issue number19
DOIs
StatePublished - Sep 1 2013

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Reoperation
Spine
Kyphosis
Therapeutics
Thorax
Multivariate Analysis
Logistic Models
Demography
Wounds and Injuries

Keywords

  • Adult spinal deformity
  • Proximal junctional failure
  • Revision surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity. / Hart, Robert; McCarthy, Ian; O'brien, Michael; Bess, Shay; Line, Brett; Adjei, Oheneba Boachie; Burton, Doug; Gupta, Munish; Ames, Christopher; Deviren, Vedat; Kebaish, Khaled M; Shaffrey, Christopher; Wood, Kirkham; Hostin, Richard.

In: Spine, Vol. 38, No. 19, 01.09.2013.

Research output: Contribution to journalArticle

Hart, R, McCarthy, I, O'brien, M, Bess, S, Line, B, Adjei, OB, Burton, D, Gupta, M, Ames, C, Deviren, V, Kebaish, KM, Shaffrey, C, Wood, K & Hostin, R 2013, 'Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity', Spine, vol. 38, no. 19. https://doi.org/10.1097/BRS.0b013e31829fedde
Hart, Robert ; McCarthy, Ian ; O'brien, Michael ; Bess, Shay ; Line, Brett ; Adjei, Oheneba Boachie ; Burton, Doug ; Gupta, Munish ; Ames, Christopher ; Deviren, Vedat ; Kebaish, Khaled M ; Shaffrey, Christopher ; Wood, Kirkham ; Hostin, Richard. / Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity. In: Spine. 2013 ; Vol. 38, No. 19.
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abstract = "Study Design. Multicenter, retrospective, consecutive case series. Objective. This study aims to identify demographic and radiographical characteristics that influence the decision to perform revision surgery among patients with proximal junctional failure (PJF). Summary of Background Data. Revision rates after PJF remain relatively high, yet the decision criteria for performing revision surgical procedures are not uniform and vary by surgeon. A better understanding of the factors that impact the decision to perform revision surgery is important in order to improve efficiency of surgical treatment of adult spinal deformity. Methods. A cohort of 57 patients with PJF was identified retrospectively from 1218 consecutive patients with adult spinal deformity. PJF was identified on the basis of 10 ° postoperative increase in kyphosis between upper instrumented vertebra (UIV) and UIV + 2, along with 1 or more of the following: fracture of the vertebral body of UIV or UIV + 1, posterior osseoligamentous disruption, or pullout of instrumentation at the UIV. Univariate statistical analysis was performed using t tests and Fisher exact tests. Multivariate analysis was performed using logistic regression. Results. Twenty-seven (47.4{\%}) patients underwent revision surgery within 6 months of the index operation. Regression results revealed that patients with combined posterior/anterior approaches at index were significantly more likely to undergo revision ( P = 0.001) as were patients with more extreme proximal junctional kyphosis angulation ( P = 0.034). Patients sustaining trauma were also significantly more likely to undergo revision ( P = 0.019). Variables approaching but not reaching significance as predictors of revision included female sex ( P = 0.066) and higher sagittal vertical axis (SVA) ( P = 0.090). Conclusion. The decision to perform revision surgery is complicated and varies by surgeon. Factors that seem to influence this decision include traumatic etiology of PJF, severity of proximal junctional kyphosis angulation, higher SVA, and female sex. Factors that were expected to influence revision but had no statistical effect included soft tissue versus bony mode of failure, age, levels fused, and upper thoracic versus thoracolumbar proximal junction.",
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author = "Robert Hart and Ian McCarthy and Michael O'brien and Shay Bess and Brett Line and Adjei, {Oheneba Boachie} and Doug Burton and Munish Gupta and Christopher Ames and Vedat Deviren and Kebaish, {Khaled M} and Christopher Shaffrey and Kirkham Wood and Richard Hostin",
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AU - Hart, Robert

AU - McCarthy, Ian

AU - O'brien, Michael

AU - Bess, Shay

AU - Line, Brett

AU - Adjei, Oheneba Boachie

AU - Burton, Doug

AU - Gupta, Munish

AU - Ames, Christopher

AU - Deviren, Vedat

AU - Kebaish, Khaled M

AU - Shaffrey, Christopher

AU - Wood, Kirkham

AU - Hostin, Richard

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N2 - Study Design. Multicenter, retrospective, consecutive case series. Objective. This study aims to identify demographic and radiographical characteristics that influence the decision to perform revision surgery among patients with proximal junctional failure (PJF). Summary of Background Data. Revision rates after PJF remain relatively high, yet the decision criteria for performing revision surgical procedures are not uniform and vary by surgeon. A better understanding of the factors that impact the decision to perform revision surgery is important in order to improve efficiency of surgical treatment of adult spinal deformity. Methods. A cohort of 57 patients with PJF was identified retrospectively from 1218 consecutive patients with adult spinal deformity. PJF was identified on the basis of 10 ° postoperative increase in kyphosis between upper instrumented vertebra (UIV) and UIV + 2, along with 1 or more of the following: fracture of the vertebral body of UIV or UIV + 1, posterior osseoligamentous disruption, or pullout of instrumentation at the UIV. Univariate statistical analysis was performed using t tests and Fisher exact tests. Multivariate analysis was performed using logistic regression. Results. Twenty-seven (47.4%) patients underwent revision surgery within 6 months of the index operation. Regression results revealed that patients with combined posterior/anterior approaches at index were significantly more likely to undergo revision ( P = 0.001) as were patients with more extreme proximal junctional kyphosis angulation ( P = 0.034). Patients sustaining trauma were also significantly more likely to undergo revision ( P = 0.019). Variables approaching but not reaching significance as predictors of revision included female sex ( P = 0.066) and higher sagittal vertical axis (SVA) ( P = 0.090). Conclusion. The decision to perform revision surgery is complicated and varies by surgeon. Factors that seem to influence this decision include traumatic etiology of PJF, severity of proximal junctional kyphosis angulation, higher SVA, and female sex. Factors that were expected to influence revision but had no statistical effect included soft tissue versus bony mode of failure, age, levels fused, and upper thoracic versus thoracolumbar proximal junction.

AB - Study Design. Multicenter, retrospective, consecutive case series. Objective. This study aims to identify demographic and radiographical characteristics that influence the decision to perform revision surgery among patients with proximal junctional failure (PJF). Summary of Background Data. Revision rates after PJF remain relatively high, yet the decision criteria for performing revision surgical procedures are not uniform and vary by surgeon. A better understanding of the factors that impact the decision to perform revision surgery is important in order to improve efficiency of surgical treatment of adult spinal deformity. Methods. A cohort of 57 patients with PJF was identified retrospectively from 1218 consecutive patients with adult spinal deformity. PJF was identified on the basis of 10 ° postoperative increase in kyphosis between upper instrumented vertebra (UIV) and UIV + 2, along with 1 or more of the following: fracture of the vertebral body of UIV or UIV + 1, posterior osseoligamentous disruption, or pullout of instrumentation at the UIV. Univariate statistical analysis was performed using t tests and Fisher exact tests. Multivariate analysis was performed using logistic regression. Results. Twenty-seven (47.4%) patients underwent revision surgery within 6 months of the index operation. Regression results revealed that patients with combined posterior/anterior approaches at index were significantly more likely to undergo revision ( P = 0.001) as were patients with more extreme proximal junctional kyphosis angulation ( P = 0.034). Patients sustaining trauma were also significantly more likely to undergo revision ( P = 0.019). Variables approaching but not reaching significance as predictors of revision included female sex ( P = 0.066) and higher sagittal vertical axis (SVA) ( P = 0.090). Conclusion. The decision to perform revision surgery is complicated and varies by surgeon. Factors that seem to influence this decision include traumatic etiology of PJF, severity of proximal junctional kyphosis angulation, higher SVA, and female sex. Factors that were expected to influence revision but had no statistical effect included soft tissue versus bony mode of failure, age, levels fused, and upper thoracic versus thoracolumbar proximal junction.

KW - Adult spinal deformity

KW - Proximal junctional failure

KW - Revision surgery

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