Assessing Abnormal Proximal Junctional Angles in Adult Spinal Deformity

医学 后凸 队列 矢状面 无症状的 回顾性队列研究 畸形 人口 外科 椎骨 队列研究 规范性 解剖 内科学 射线照相术 哲学 认识论 环境卫生
作者
Marc Khalifé,Renaud Lafage,Alan H. Daniels,Bassel G. Diebo,Jonathan Elysée,Christopher P. Ames,Shay R. Bess,Douglas C. Burton,Robert K. Eastlack,Munish C. Gupta,Richard A. Hostin,Khaled M. Kebaish,Han-Jo Kim,Eric O. Klineberg,Gregory M. Mundis,David O. Okonkwo,Pierre Guigui,Emmanuelle Ferrero,Wafa Skalli,Ayman Assi
出处
期刊:Spine [Lippincott Williams & Wilkins]
被引量:1
标识
DOI:10.1097/brs.0000000000005141
摘要

Study design: Multicentric retrospective study of prospectively collected data. Objective: Based on normative data from a cohort of asymptomatic volunteers, this study sought to determine the rate of abnormal values of proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, and compare it with PJK rate. Summary of Background Data: Proximal junctional kyphosis (PJK) definition does not take the vertebral level into account. Methods: This study included 721 healthy volunteers and 824 ASD surgery patients with 2-year postoperative follow-up. Normative values for each disc and vertebral body between T1 and T12 were analyzed, then normative values for PJA at each thoracic level were defined in the volunteer cohort as the mean±2 standard deviations. PJA abnormal values at the upper instrumented vertebra (UIV) were compared with Glattes’ and Lovecchio’s definitions for PJK in the ASD population at two years. Results: Mean age was 37.7±16.3 in the volunteer cohort, with 50.5% of females. Mean thoracic kyphosis (TK) was -50.9±10.8°. Corridors of normality included PJA greater than 20° between T3 and T12. Mean age was 60.5±14.0 years in the ASD cohort, with 77.2% of females. Mean baseline TK was -37.4±19.9°, with a significant increase after surgery (-15.6±15.3°, P<0.001 ). There was 46.2% of PJK according to Glattes’ versus 8.7% according to Lovecchio’s and 22.9% of kyphotic PJA compared to normative values (P<0.001 ). Conclusion: This study provides normative values for segmental and regional alignment of thoracic spine, used to describe abnormal values of PJA for each level. Using level-adjusted PJA values allows a more precise assessment of abnormal proximal angles and question the definition for PJK. Level of evidence: II
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