Title

Clinical outcomes and proximal junctional failure in adult spinal deformity patients corrected to normative alignment versus functional alignment

Authors

Themistocles S. Protopsaltis, Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Fares Ani, Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Alexandra Soroceanu, Department of Orthopedic Surgery, University of Calgary, Alberta, Canada.
Renaud Lafage, Department of Orthopedic Surgery, Northwell Health, New York, New York.
Han Jo Kim, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
Eaman Balouch, Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Zoe Norris, Department of Orthopedic Surgery, George Washington University, Washington, DC.
Justin S. Smith, Department of Neurological Surgery, University of Virginia Health, Charlottesville, Virginia.
Alan H. Daniels, Department of Orthopedic Surgery, Brown University, East Providence, Rhode Island.
Eric O. Klineberg, Department of Orthopedic Surgery, University of California, Davis, California.
Christopher P. Ames, Department of Neurological Surgery, University of California, San Francisco, California.
Robert Hart, Department of Orthopedic Surgery, Swedish Medical Center, Seattle, Washington.
Shay Bess, Department of Spine Surgery, Denver International Spine Center, Denver, Colorado.
Christopher I. Shaffrey, Department of Neurological Surgery, Duke Health, Durham, North Carolina.
Frank J. Schwab, Department of Orthopedic Surgery, Northwell Health, New York, New York.
Lawrence G. Lenke, Department of Orthopedic Surgery, Columbia University, New York, New York; and.
Virginie Lafage, Department of Orthopedic Surgery, Northwell Health, New York, New York.
Munish C. Gupta, Department of Orthopedic Surgery, Washington University in St. Louis, Missouri.

Document Type

Journal Article

Publication Date

7-21-2023

Journal

Journal of neurosurgery. Spine

DOI

10.3171/2023.5.SPINE221266

Keywords

HRQOL; PJF; PJK; PROM; age; alignment; functional; health-related quality of life; normative; patient-reported outcome measure; pelvic incidence; proximal junctional failure; proximal junctional kyphosis; spine deformity

Abstract

OBJECTIVE: The objective of this study was to explore the rate of proximal junctional failure (PJF) and functional outcomes of normative alignment goals compared with alignment targets based on age-appropriate physical function. METHODS: Baseline relationships between age, pelvic incidence (PI), and a component of the T1 pelvic angle (TPA) within the fusion were analyzed in adult spinal deformity (ASD) patients and compared with those of asymptomatic patients. Linear regression modeling was used to determine alignment based on PI and age in asymptomatic patients (normative alignment), and in ASD patients, alignment corresponding to age-appropriate functional status (functional alignment). A cohort of 288 ASD patients was split into two groups based on whether the patient was closer to their normative or functional alignment goal at their 6-week postoperative radiographic follow-up. The rates of proximal junctional kyphosis (PJK) and PJF were determined for each cohort. RESULTS: In the 288 ASD patients included in this pre- to postoperative analysis, there was no difference in baseline alignment or health-related quality of life (HRQOL) between the normative alignment and functional alignment groups. At 6 weeks, patients with normative alignment had a smaller TPA (4.45° vs 14.1°) and PI minus lumbar lordosis (-7.24° vs 7.4°) (both p < 0.0001) and higher PJK (40% vs 27.2%, p = 0.03) and PJF (17% vs 6.8%, p = 0.008) rates than patients with functional alignment. CONCLUSIONS: Correction in ASD patients to normative alignment resulted in higher rates of PJK and PJF without improvements in HRQOL. Correction in ASD patients to functional alignment that mirrors the physical function of their age-matched asymptomatic peers is recommended.

Department

School of Medicine and Health Sciences Resident Works

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