Thoracolumbar Junction Orientation: A Novel Guide for Sagittal Correction and Proximal Junctional Kyphosis Prediction in Adult Spinal Deformity Patients
- Authors
- Moon, Hong Joo; Bridwell, Keith H.; Theologis, Alekos A.; Kelly, Micheal P.; Lertudomphonwanit, Thamrong; Lenke, Lawrence G.; Gupta, Munish C.
- Issue Date
- 1월-2021
- Publisher
- OXFORD UNIV PRESS INC
- Keywords
- Lumbar degenerative kyphosis; Proximal junctional kyphosis; Reciprocal change; Thracolumbar junction orientation; Thoracolumbar slope; Sagittal alignment
- Citation
- NEUROSURGERY, v.88, no.1, pp.55 - 62
- Indexed
- SCIE
SCOPUS
- Journal Title
- NEUROSURGERY
- Volume
- 88
- Number
- 1
- Start Page
- 55
- End Page
- 62
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/50215
- DOI
- 10.1093/neuros/nyaa311
- ISSN
- 0148-396X
- Abstract
- BACKGROUND: Novel radiographic sagittal parameters of the thoracolumbar junction orientation (TLJO, thoracolumbar slope [TLS] and thoracolumbar tilt [TLT]) have been introduced and correlated with lumbopelvic parameters and thoracic kyphosis. OBJECTIVE: To determine a predictive model for reciprocal thoracic kyphosis and proximal junctional kyphosis (PJK) based on the TLJO. METHODS: A total of 127 patients who had fusion fromsacrum to T10-L2 from 2004 to 2014 were reviewed. TK (T5-T12), PI, SS, PT, LL, and proximal junctional angle (PJA) were measured preoperatively, 6 wk postoperatively, and at final follow-up. TLJO was measured by TLS and TLT. Changes between time points were determined (preop-6 wk = Delta Parameter(Pre6wk) and preop-final follow/up= Delta Parameter(PreFinal)). Scoliosis Research Society (SRS) and Oswestry Disability Index (ODI) questionnaires were evaluated at final follow-up. Patients were divided into 2 groups based on the presence of PJK (Delta PJA(PreFinal) >15 degrees). Independent t-tests and receiver operating characteristic (ROC) curves were used to investigate the significance of differences and cut-off values. Pearson correlations and linear regressions were used to analyze the entire cohort to determine the relationship between the changes in parameters. RESULTS: Compared to patients without PJK (n = 100), those with PJK (n = 27) had significantly lower SRS scores and significantly greater Delta TKPreFinal, Delta LLPre6wk, and Delta TLSPre6wk. To maintain in the nonPJK group, ROC curves demonstrated a cut-off value of -9.4 degrees for Delta TLSPre6wk. PJK was significantly correlated with Delta TKPreFinal and Delta TLSPre6wk. The linear correlation revealed that Delta TLSPre6wk < -25.3 degrees is the risk factor of PJK > 15 degrees. CONCLUSION: As change of TLS reflects lumbopelvic realignment and influences reciprocal TK, reducing the change of TLS may be a sagittal realignment guideline to reduce the risk of PJK.
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