Publication: Thoracolumbar junction orientation: A novel guide for sagittal correction and proximal junctional kyphosis prediction in adult spinal deformity patients
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Issued Date
2021-01-01
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ISSN
15244040
0148396X
0148396X
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2-s2.0-85098531717
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Mahidol University
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SCOPUS
Bibliographic Citation
Neurosurgery. Vol.88, No.1 (2021), 55-62
Suggested Citation
Hong Joo Moon, Keith H. Bridwell, Alekos A. Theologis, Micheal P. Kelly, Thamrong Lertudomphonwanit, Lawrence G. Lenke, Munish C. Gupta Thoracolumbar junction orientation: A novel guide for sagittal correction and proximal junctional kyphosis prediction in adult spinal deformity patients. Neurosurgery. Vol.88, No.1 (2021), 55-62. doi:10.1093/neuros/nyaa311 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/78867
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Title
Thoracolumbar junction orientation: A novel guide for sagittal correction and proximal junctional kyphosis prediction in adult spinal deformity patients
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 from sacrum 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 = ΔParameterPre6wk and preop-final follow/up = ΔParameterPreFinal). 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 (ΔPJAPreFinal >15◦). 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 ΔTKPreFinal, ΔLLPre6wk, and ΔTLSPre6wk. To maintain in the nonPJK group, ROC curves demonstrated a cut-off value of −9.4◦ for ΔTLSPre6wk. PJK was significantly correlated with ΔTKPreFinal and ΔTLSPre6wk. The linear correlation revealed that ΔTLSPre6wk < −25.3◦ is the risk factor of PJK > 15◦. 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.