Spine Surgery and Related Research
Online ISSN : 2432-261X
ISSN-L : 2432-261X
ORIGINAL ARTICLE
Risk Factors for Proximal Junctional Fracture Following Fusion Surgery for Osteoporotic Vertebral Collapse with Delayed Neurological Deficits: A Retrospective Cohort Study of 403 Patients
Koji TamaiHidetomi TeraiAkinobu SuzukiHiroaki NakamuraKei WatanabeKeiichi KatsumiMasayuki OhashiYohei ShibuyaTomohiro IzumiToru HiranoTakashi KaitoTomoya YamashitaHiroyasu FujiwaraYukitaka NagamotoYuji MatsuokaHidekazu SuzukiHirosuke NishimuraAtsushi TagamiSyuta YamadaShinji AdachiToshitaka YoshiiShuta UshioKatsumi HarimayaKenichi KawaguchiNobuhiko YokoyamaHidekazu OishiToshiro DoiAtsushi KimuraHirokazu InoueGen InoueMasayuki MiyagiWataru SaitoAtsushi NakanoDaisuke SakaiTadashi NukagaShota IkegamiMasayuki ShimizuToshimasa FutatsugiSeiji OhtoriTakeo FuruyaSumihisa OritaShiro ImagamaKei AndoKazuyoshi KobayashiKatsuhito KiyasuHideki MurakamiKatsuhito YoshiokaShoji SekiMichio HongoKenichiro KakutaniTakashi YurubeYasuchika AokiMasashi OshimaMasahiko TakahataAkira IwataHirooki EndoTetsuya AbeToshinori TsukanishiKazuyoshi NakanishiKota WatanabeTomohiro HikataSatoshi SuzukiNorihiro IsogaiEijiro OkadaHaruki FunaoSeiji UedaYuta ShionoKenya NojiriNaobumi HosoganeKen Ishii
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JOURNALS OPEN ACCESS

2019 Volume 3 Issue 2 Pages 171-177

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Abstract

Introduction: Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC.

Methods: This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for ≥2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis.

Results: Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm2 (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228).

Conclusions: PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm2 may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.

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© 2019 The Japanese Society for Spine Surgery and Related Research.

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