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Acute Proximal Junctional Failure after Deformity Surgery in Patients Older than 55 Years
168S
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S
P150. Predictive Factors for APJF after Adult Deformity Surgery with the UIV in the Thoracolumbar (TL) Spine Prokopis Annis, MD1, Brandon D. Lawrence, MD1, W. Ryan Spiker, MD1, Michael D. Daubs, MD2, Darrel S. Brodke, MD1; 1University of Utah Department of Orthopaedics, Salt Lake City, UT, US; 2Las Vegas, NV, US BACKGROUND CONTEXT: Acute Proximal Junctional Failure (APJF), was recently defined by the International Spine Study Group (ISSG) as: postoperative fracture of the upper instrumented vertebrae (UIV) or UIVþ1; UIV implant failure; proximal junctional kyphosis (PJK) increase $15 ; or need for proximal extension of the fusion within 6 months of surgery. The incidence and revision rates of APJF have been reported to be higher when the UIV is located in the lower thoracic or lumbar (TL) spine mostly because of high incidence of UIV or UIVþ1 fractures. Sagittal deformity overcorrection has been considered as a potential risk factor. PURPOSE: The purpose of this study is to assess independent predictive factors and timing for revisions of APJF in adult deformity patients with UIV in the TL (T9-L2) spine. STUDY DESIGN/SETTING: Retrospective review of prospectively collected database of adult spinal deformity patients at a single university center. PATIENT SAMPLE: We reviewed 135 consecutive patients, with minimum 2-year follow-up, mean follow-up 42 months (24-126), and mean age 66 years (24-86). All were treated operatively for adult spinal deformity ($ 5 levels fused) at a single institution, and all with UIV in the TL spine (T9-L2). OUTCOME MEASURES: Early (!24 months) and final follow-up revision rates following thoracolumbar fusions for adult spinal deformity. METHODS: Demographic data were reviewed and radiographic parameters were measured preoperatively, immediately postoperatively, at 6 months and at the final follow-up. Fusions were divided into 3 cohorts based on the UIV location (T9-T10 vs T11-T12 vs L1-L2). Incidence and failure modes of APJF, as well as timing for APJF revision are reported. Risk factors for APJF were assessed with univariate and multivariate regression analysis models. RESULTS: 135 consecutive patients were reviewed, with mean follow-up 42 months (24-126). Mean age was 66 years (24-86). There were no differences in the preoperative radiographic parameters between patients in any of the 3 cohorts with APJF. The incidence of APJF was 38.5%, with a trend towards higher APJF in the T9-T10 group (p50.07). When UIV was at T10 the incidence of APJF was 57.1%, significantly higher than the adjacent vertebrae, T9 and T11 (p50.03 and p50.01 respectively). The overall revision rate for APJF was 17%, most often for UIV fracture, while PJK $15 alone had the highest 2 and 5 year survival (100%). Univariate analysis revealed preoperative SVA O5cm, postoperative PJA O5 and thoracic kyphosis O30 , and instrumentation to the pelvis as risk factors for APJF. Multivariate regression analysis confirmed postoperative PJAO5 , and greater correction of LL as independent risk factors for APJF. CONCLUSIONS: The incidence of APJF in adult deformity patients is high if the UIV is in the lower thoracic or lumbar spine, with a trend toward higher rates when the UIV is at T9-10. Fracture at the UIV lead to the highest revision rate, while PJK $15 had the longest revision-free survival. Postoperative PJA O5 and greater correction of LL are independent risk factors for APJF. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.404
P151. Acute Proximal Junctional Failure after Deformity Surgery in Patients Older than 55 Years Prokopis Annis, MD1, Brandon D. Lawrence, MD1, W. Ryan Spiker, MD1, Michael D. Daubs, MD2, Darrel S. Brodke, MD1;
1 2
University of Utah Department of Orthopaedics, Salt Lake City, UT, US; Las Vegas, NV, US
BACKGROUND CONTEXT: The incidence of acute proximal junctional failure (APJF) was recently reported to be 5.6% in all comers after adult spinal deformity surgery. While age is thought to be a risk factor there are no reports focused on PJF following deformity surgery in an older patient population. PURPOSE: The purpose of this study was to report incidence, location, mode of failure and early (!2 year) and late (O2 years) revision rates. STUDY DESIGN/SETTING: Retrospective review of prospectively collected database of adult spinal deformity patients at a single university center. PATIENT SAMPLE: Retrospective review of 161 consecutive patients, mean age 68 years (55-86) with mean follow-up 42 months (24-126), treated at a single institution for deformity. OUTCOME MEASURES: Evaluation of APJF in patients over 55 years of age following surgery for spinal deformity. Early (!2 years) and late (O2 years) revision rates for APJF. METHODS: A radiographic and charts review was performed. Radiographic measurements included preoperative, immediately postoperative and at 6 months proximal junctional angle (PJA), thoracolumbar sagittal (lumbar lordosis (LL), thoracic kyphosis (ThK), thoracolumbar kyphosis (TLK)), pelvic (pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS)) and global sagittal alignment parameters (global sagittal alignment (GSA), sagittal vertical axis (SVA), PI-LL mismatch)). APJF was defined as: fracture of the UIV or UIVþ1; UIV implant failure; proximal junctional kyphosis (PJK) increase $15 ; or need for proximal extension of the fusion within 6 months of surgery. Incidence, location, mode of failure and early and overall revision rates were reported. Subgroup analysis was based on location of the UIV: upper thoracic (UT), lower thoracic (LT) or lumbar (L) spine. RESULTS: The incidence of APJF was 35% (57 of 161), and 28% (16) of those patients required early revision. APJF was more common among patients with the UIV in the LT spine (41%) as compared to those with the UIV in the UT (22%) or L spine (34%). UIV or UIVþ1 fracture was the most common failure mode (65%) when the UIV was in the LT or L spine (p50.0074). PJK increase O 15 , without fracture or implant failure, was the most common failure mode (88%) when the UIV was in the UT (p50.0016), but did not required revision surgery. All early and late revisions of APJF were in fusions with the UIV in the LT or L spine CONCLUSIONS: The incidence of APJF after adult deformity surgery in patients over 55 years of age was 35%, and 28% of those patients required early revision. Failures and revisions most commonly occurred with APJF in the LT and L spine. Upper thoracic UIV failures most frequently presented with increased kyphosis without fracture or implant failure, and did not require revision. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.405
P152. Thoracic Volume and Pulmonary Function at Minimum of 20-Years Following Treatment of Adolescent Idiopathic Scoliosis: Preliminary Results Charles Gerald T. Ledonio, MD1, Kristin England, BA, MD2, A. Noelle Larson, MD3, David W. Polly, Jr., MD4, Michael J. Yaszemski, MD, PhD5; 1Minneapolis, MN, US; 2University of Minnesota Department of Orthopaedic Surgery, Minneapolis, MN, US; 3Mayo Clinic, Rochester, MN, US; 4University of Minnesota Physicians, Minneapolis, MN, US; 5 Rochester, MN, US BACKGROUND CONTEXT: Long-term follow-up studies of adolescent scoliosis patients are limited.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S
P150. Predictive Factors for APJF after Adult Deformity Surgery with the UIV in the Thoracolumbar (TL) Spine Prokopis Annis, MD1, Brandon D. Lawrence, MD1, W. Ryan Spiker, MD1, Michael D. Daubs, MD2, Darrel S. Brodke, MD1; 1University of Utah Department of Orthopaedics, Salt Lake City, UT, US; 2Las Vegas, NV, US BACKGROUND CONTEXT: Acute Proximal Junctional Failure (APJF), was recently defined by the International Spine Study Group (ISSG) as: postoperative fracture of the upper instrumented vertebrae (UIV) or UIVþ1; UIV implant failure; proximal junctional kyphosis (PJK) increase $15 ; or need for proximal extension of the fusion within 6 months of surgery. The incidence and revision rates of APJF have been reported to be higher when the UIV is located in the lower thoracic or lumbar (TL) spine mostly because of high incidence of UIV or UIVþ1 fractures. Sagittal deformity overcorrection has been considered as a potential risk factor. PURPOSE: The purpose of this study is to assess independent predictive factors and timing for revisions of APJF in adult deformity patients with UIV in the TL (T9-L2) spine. STUDY DESIGN/SETTING: Retrospective review of prospectively collected database of adult spinal deformity patients at a single university center. PATIENT SAMPLE: We reviewed 135 consecutive patients, with minimum 2-year follow-up, mean follow-up 42 months (24-126), and mean age 66 years (24-86). All were treated operatively for adult spinal deformity ($ 5 levels fused) at a single institution, and all with UIV in the TL spine (T9-L2). OUTCOME MEASURES: Early (!24 months) and final follow-up revision rates following thoracolumbar fusions for adult spinal deformity. METHODS: Demographic data were reviewed and radiographic parameters were measured preoperatively, immediately postoperatively, at 6 months and at the final follow-up. Fusions were divided into 3 cohorts based on the UIV location (T9-T10 vs T11-T12 vs L1-L2). Incidence and failure modes of APJF, as well as timing for APJF revision are reported. Risk factors for APJF were assessed with univariate and multivariate regression analysis models. RESULTS: 135 consecutive patients were reviewed, with mean follow-up 42 months (24-126). Mean age was 66 years (24-86). There were no differences in the preoperative radiographic parameters between patients in any of the 3 cohorts with APJF. The incidence of APJF was 38.5%, with a trend towards higher APJF in the T9-T10 group (p50.07). When UIV was at T10 the incidence of APJF was 57.1%, significantly higher than the adjacent vertebrae, T9 and T11 (p50.03 and p50.01 respectively). The overall revision rate for APJF was 17%, most often for UIV fracture, while PJK $15 alone had the highest 2 and 5 year survival (100%). Univariate analysis revealed preoperative SVA O5cm, postoperative PJA O5 and thoracic kyphosis O30 , and instrumentation to the pelvis as risk factors for APJF. Multivariate regression analysis confirmed postoperative PJAO5 , and greater correction of LL as independent risk factors for APJF. CONCLUSIONS: The incidence of APJF in adult deformity patients is high if the UIV is in the lower thoracic or lumbar spine, with a trend toward higher rates when the UIV is at T9-10. Fracture at the UIV lead to the highest revision rate, while PJK $15 had the longest revision-free survival. Postoperative PJA O5 and greater correction of LL are independent risk factors for APJF. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.404
P151. Acute Proximal Junctional Failure after Deformity Surgery in Patients Older than 55 Years Prokopis Annis, MD1, Brandon D. Lawrence, MD1, W. Ryan Spiker, MD1, Michael D. Daubs, MD2, Darrel S. Brodke, MD1;
1 2
University of Utah Department of Orthopaedics, Salt Lake City, UT, US; Las Vegas, NV, US
BACKGROUND CONTEXT: The incidence of acute proximal junctional failure (APJF) was recently reported to be 5.6% in all comers after adult spinal deformity surgery. While age is thought to be a risk factor there are no reports focused on PJF following deformity surgery in an older patient population. PURPOSE: The purpose of this study was to report incidence, location, mode of failure and early (!2 year) and late (O2 years) revision rates. STUDY DESIGN/SETTING: Retrospective review of prospectively collected database of adult spinal deformity patients at a single university center. PATIENT SAMPLE: Retrospective review of 161 consecutive patients, mean age 68 years (55-86) with mean follow-up 42 months (24-126), treated at a single institution for deformity. OUTCOME MEASURES: Evaluation of APJF in patients over 55 years of age following surgery for spinal deformity. Early (!2 years) and late (O2 years) revision rates for APJF. METHODS: A radiographic and charts review was performed. Radiographic measurements included preoperative, immediately postoperative and at 6 months proximal junctional angle (PJA), thoracolumbar sagittal (lumbar lordosis (LL), thoracic kyphosis (ThK), thoracolumbar kyphosis (TLK)), pelvic (pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS)) and global sagittal alignment parameters (global sagittal alignment (GSA), sagittal vertical axis (SVA), PI-LL mismatch)). APJF was defined as: fracture of the UIV or UIVþ1; UIV implant failure; proximal junctional kyphosis (PJK) increase $15 ; or need for proximal extension of the fusion within 6 months of surgery. Incidence, location, mode of failure and early and overall revision rates were reported. Subgroup analysis was based on location of the UIV: upper thoracic (UT), lower thoracic (LT) or lumbar (L) spine. RESULTS: The incidence of APJF was 35% (57 of 161), and 28% (16) of those patients required early revision. APJF was more common among patients with the UIV in the LT spine (41%) as compared to those with the UIV in the UT (22%) or L spine (34%). UIV or UIVþ1 fracture was the most common failure mode (65%) when the UIV was in the LT or L spine (p50.0074). PJK increase O 15 , without fracture or implant failure, was the most common failure mode (88%) when the UIV was in the UT (p50.0016), but did not required revision surgery. All early and late revisions of APJF were in fusions with the UIV in the LT or L spine CONCLUSIONS: The incidence of APJF after adult deformity surgery in patients over 55 years of age was 35%, and 28% of those patients required early revision. Failures and revisions most commonly occurred with APJF in the LT and L spine. Upper thoracic UIV failures most frequently presented with increased kyphosis without fracture or implant failure, and did not require revision. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.405
P152. Thoracic Volume and Pulmonary Function at Minimum of 20-Years Following Treatment of Adolescent Idiopathic Scoliosis: Preliminary Results Charles Gerald T. Ledonio, MD1, Kristin England, BA, MD2, A. Noelle Larson, MD3, David W. Polly, Jr., MD4, Michael J. Yaszemski, MD, PhD5; 1Minneapolis, MN, US; 2University of Minnesota Department of Orthopaedic Surgery, Minneapolis, MN, US; 3Mayo Clinic, Rochester, MN, US; 4University of Minnesota Physicians, Minneapolis, MN, US; 5 Rochester, MN, US BACKGROUND CONTEXT: Long-term follow-up studies of adolescent scoliosis patients are limited.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.