Age-adjusted Alignment Goals Have the Potential to Reduce PJK

ISSG

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Abstract

STUDY DESIGN.: Retrospective cohort OBJECTIVE.: To explore proximal junctional kyphosis(PJK) as a function of age-adjusted surgical correction goals. SUMMARY OF BACKGROUND DATA.: Recent adult spinal deformity(ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK. METHODS.: ASD patients with fusions to the pelvis were included and stratified into three groups: young adults(YA<40yo), middle aged(MA: 40–65yo), the elderly(ED>65yo). ANOVA analysis compared the groups with respect to 1-year post-operative alignments and 1-year offsets from age-specific alignment targets. RESULTS.: 679 patients were enrolled(mean age=61yo,77%F,BMI=28.1). At 1-year post-op, there was a significant decrease in PT(29 to 23°), spino-pelvic mismatch[PI-LL] (28 to 5°), and SVA(110 to 37?mm); overall incidence of PJK was 45.1%. Stratification by age (YA, n?=?28; MA, n?=?389; ED, n?=?262) revealed an increase in PJK incidence with age: YA?=?17.9%, MA?=?43.8%, and ED?=?50.2% (p?<?0.001). PJK patients had smaller post-operative PI-LL mismatches(ED 0.8 vs. 9.8°, MA 3.1 vs. 7.3°) than non-PJK patients, without any significant differences in PT or SVA. Analysis of the post-operative offsets from age-specific norms revealed that PJK patients in the two older sub-groups and in the study cohort as a whole were overcorrected as compared to non-PJK patients(PI-LL Offset: All:-5.2vs2.8°, MA:-1vs+4°, ED:-11vs-2°; SVA Offset: All:-10vs7?mm, MA:-3vs10?mm, ED:-18vs-6?mm). The correlation coefficients between PJK angles and the offsets from age-adjusted objective were small (0.320 for PI-LL, 0.114 for PT and 0.136 for SVA). CONCLUSIONS.: Overall, this study suggests that PJK patients were overcorrected when compared to age-adjusted alignment goals. Certainly, elderly patients are subject to independent risk factors for PJK, making the prevention of PJK complex. However, individualized optimization of surgical alignment can improve outcomes. This emphasizes the need for surgeons to incorporate age-specific alignment targets into the standard pre-operative planning process.Level of Evidence: 3

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Mar 3 2017

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Kyphosis
Incidence
Pelvis
Young Adult
Analysis of Variance

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Age-adjusted Alignment Goals Have the Potential to Reduce PJK. / ISSG.

In: Spine, 03.03.2017.

Research output: Contribution to journalArticle

@article{bc93c7ef267644debc60434149b929f2,
title = "Age-adjusted Alignment Goals Have the Potential to Reduce PJK",
abstract = "STUDY DESIGN.: Retrospective cohort OBJECTIVE.: To explore proximal junctional kyphosis(PJK) as a function of age-adjusted surgical correction goals. SUMMARY OF BACKGROUND DATA.: Recent adult spinal deformity(ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK. METHODS.: ASD patients with fusions to the pelvis were included and stratified into three groups: young adults(YA<40yo), middle aged(MA: 40–65yo), the elderly(ED>65yo). ANOVA analysis compared the groups with respect to 1-year post-operative alignments and 1-year offsets from age-specific alignment targets. RESULTS.: 679 patients were enrolled(mean age=61yo,77{\%}F,BMI=28.1). At 1-year post-op, there was a significant decrease in PT(29 to 23°), spino-pelvic mismatch[PI-LL] (28 to 5°), and SVA(110 to 37?mm); overall incidence of PJK was 45.1{\%}. Stratification by age (YA, n?=?28; MA, n?=?389; ED, n?=?262) revealed an increase in PJK incidence with age: YA?=?17.9{\%}, MA?=?43.8{\%}, and ED?=?50.2{\%} (p?<?0.001). PJK patients had smaller post-operative PI-LL mismatches(ED 0.8 vs. 9.8°, MA 3.1 vs. 7.3°) than non-PJK patients, without any significant differences in PT or SVA. Analysis of the post-operative offsets from age-specific norms revealed that PJK patients in the two older sub-groups and in the study cohort as a whole were overcorrected as compared to non-PJK patients(PI-LL Offset: All:-5.2vs2.8°, MA:-1vs+4°, ED:-11vs-2°; SVA Offset: All:-10vs7?mm, MA:-3vs10?mm, ED:-18vs-6?mm). The correlation coefficients between PJK angles and the offsets from age-adjusted objective were small (0.320 for PI-LL, 0.114 for PT and 0.136 for SVA). CONCLUSIONS.: Overall, this study suggests that PJK patients were overcorrected when compared to age-adjusted alignment goals. Certainly, elderly patients are subject to independent risk factors for PJK, making the prevention of PJK complex. However, individualized optimization of surgical alignment can improve outcomes. This emphasizes the need for surgeons to incorporate age-specific alignment targets into the standard pre-operative planning process.Level of Evidence: 3",
author = "ISSG and Renaud Lafage and Frank Schwab and Steve Glassman and Shay Bess and Bradley Harris and Justin Sheer and Robert Hart and Breton Line and Jensen Henry and Doug Burton and Kim, {Han Jo} and Eric Klineberg and Christopher Ames and Virginie Lafage",
year = "2017",
month = "3",
day = "3",
doi = "10.1097/BRS.0000000000002146",
language = "English (US)",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",

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T1 - Age-adjusted Alignment Goals Have the Potential to Reduce PJK

AU - ISSG

AU - Lafage, Renaud

AU - Schwab, Frank

AU - Glassman, Steve

AU - Bess, Shay

AU - Harris, Bradley

AU - Sheer, Justin

AU - Hart, Robert

AU - Line, Breton

AU - Henry, Jensen

AU - Burton, Doug

AU - Kim, Han Jo

AU - Klineberg, Eric

AU - Ames, Christopher

AU - Lafage, Virginie

PY - 2017/3/3

Y1 - 2017/3/3

N2 - STUDY DESIGN.: Retrospective cohort OBJECTIVE.: To explore proximal junctional kyphosis(PJK) as a function of age-adjusted surgical correction goals. SUMMARY OF BACKGROUND DATA.: Recent adult spinal deformity(ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK. METHODS.: ASD patients with fusions to the pelvis were included and stratified into three groups: young adults(YA<40yo), middle aged(MA: 40–65yo), the elderly(ED>65yo). ANOVA analysis compared the groups with respect to 1-year post-operative alignments and 1-year offsets from age-specific alignment targets. RESULTS.: 679 patients were enrolled(mean age=61yo,77%F,BMI=28.1). At 1-year post-op, there was a significant decrease in PT(29 to 23°), spino-pelvic mismatch[PI-LL] (28 to 5°), and SVA(110 to 37?mm); overall incidence of PJK was 45.1%. Stratification by age (YA, n?=?28; MA, n?=?389; ED, n?=?262) revealed an increase in PJK incidence with age: YA?=?17.9%, MA?=?43.8%, and ED?=?50.2% (p?<?0.001). PJK patients had smaller post-operative PI-LL mismatches(ED 0.8 vs. 9.8°, MA 3.1 vs. 7.3°) than non-PJK patients, without any significant differences in PT or SVA. Analysis of the post-operative offsets from age-specific norms revealed that PJK patients in the two older sub-groups and in the study cohort as a whole were overcorrected as compared to non-PJK patients(PI-LL Offset: All:-5.2vs2.8°, MA:-1vs+4°, ED:-11vs-2°; SVA Offset: All:-10vs7?mm, MA:-3vs10?mm, ED:-18vs-6?mm). The correlation coefficients between PJK angles and the offsets from age-adjusted objective were small (0.320 for PI-LL, 0.114 for PT and 0.136 for SVA). CONCLUSIONS.: Overall, this study suggests that PJK patients were overcorrected when compared to age-adjusted alignment goals. Certainly, elderly patients are subject to independent risk factors for PJK, making the prevention of PJK complex. However, individualized optimization of surgical alignment can improve outcomes. This emphasizes the need for surgeons to incorporate age-specific alignment targets into the standard pre-operative planning process.Level of Evidence: 3

AB - STUDY DESIGN.: Retrospective cohort OBJECTIVE.: To explore proximal junctional kyphosis(PJK) as a function of age-adjusted surgical correction goals. SUMMARY OF BACKGROUND DATA.: Recent adult spinal deformity(ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK. METHODS.: ASD patients with fusions to the pelvis were included and stratified into three groups: young adults(YA<40yo), middle aged(MA: 40–65yo), the elderly(ED>65yo). ANOVA analysis compared the groups with respect to 1-year post-operative alignments and 1-year offsets from age-specific alignment targets. RESULTS.: 679 patients were enrolled(mean age=61yo,77%F,BMI=28.1). At 1-year post-op, there was a significant decrease in PT(29 to 23°), spino-pelvic mismatch[PI-LL] (28 to 5°), and SVA(110 to 37?mm); overall incidence of PJK was 45.1%. Stratification by age (YA, n?=?28; MA, n?=?389; ED, n?=?262) revealed an increase in PJK incidence with age: YA?=?17.9%, MA?=?43.8%, and ED?=?50.2% (p?<?0.001). PJK patients had smaller post-operative PI-LL mismatches(ED 0.8 vs. 9.8°, MA 3.1 vs. 7.3°) than non-PJK patients, without any significant differences in PT or SVA. Analysis of the post-operative offsets from age-specific norms revealed that PJK patients in the two older sub-groups and in the study cohort as a whole were overcorrected as compared to non-PJK patients(PI-LL Offset: All:-5.2vs2.8°, MA:-1vs+4°, ED:-11vs-2°; SVA Offset: All:-10vs7?mm, MA:-3vs10?mm, ED:-18vs-6?mm). The correlation coefficients between PJK angles and the offsets from age-adjusted objective were small (0.320 for PI-LL, 0.114 for PT and 0.136 for SVA). CONCLUSIONS.: Overall, this study suggests that PJK patients were overcorrected when compared to age-adjusted alignment goals. Certainly, elderly patients are subject to independent risk factors for PJK, making the prevention of PJK complex. However, individualized optimization of surgical alignment can improve outcomes. This emphasizes the need for surgeons to incorporate age-specific alignment targets into the standard pre-operative planning process.Level of Evidence: 3

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