Effect of Different Types of Upper Instrumented Vertebrae Instruments on Proximal Junctional Kyphosis Following Adult Spinal Deformity Surgery: Pedicle Screw versus Transverse Process Hook

Akira Matsumura; Takashi Namikawa; Minori Kato; Shoichiro Oyama; Yusuke Hori; Akito Yabu; Noriaki Hidaka; Hiroaki Nakamura

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자료유형: 학술저널

저자정보: Akira Matsumura (Osaka City General Hospital) Takashi Namikawa (Osaka City General Hospital) Minori Kato (Osaka City General Hospital) Shoichiro Oyama (Osaka City General Hospital) Yusuke Hori (Osaka City General Hospital) Akito Yabu (Osaka City General Hospital) Noriaki Hidaka (Osaka City General Hospital) Hiroaki Nakamura (Osaka City University Graduate School of Medicine)

저널정보: 대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.12 No.4

발행연도: 2018.1

수록면: 622 - 631 (10page)

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Study Design: Retrospective comparative study. Purpose: To compare the incidence of proximal junctional kyphosis (PJK) between transverse process hooks (TPHs) and pedicle screws (PSs) at the upper instrumented vertebrae (UIV) following adult spinal deformity (ASD) surgery. Overview of Literature: The choice of UIV implant type may be important for avoiding PJK; however, few comparative clinical studies have evaluated the incidence of PJK according to the type of UIV implant used in ASD surgery. Methods: We retrospectively reviewed 39 consecutive patients with ASD (mean age, 67 years; mean follow-up period, 41 months) who underwent corrective surgery between 2009 and 2013. TPH was used in 17 patients and PS in 22 patients. PJK was defined as the presence of a UIV or UIV±1 fracture, or a change in the proximal junctional angle (PJA) of >20°. Data of patients with TPH and PS were compared. Results: The TPH group had a PJK incidence of 17.6% compared with 27.3% in the PS group (p =0.47). In the TPH group, PJK was a result of UIV fracture in one patient, UIV−1 fracture in one patient, and ligamentous failure in one patient. In the PS group, six patients developed PJK because of UIV fracture. No differences in radiographic parameters were found between the two groups. After analyzing the PJA data in the patients with PJK, the changes in PJA were significantly higher in the PS group than in the TPH group (19.0°/5.0°, p =0.04). Conclusions: Our results show that using TPH as a UIV implant may not prevent PJK; however, using TPH as the UIV anchor may prevent vertebral collapse if cases of UIV fracture. The increased risk of UIV fracture collapse in the PS group may be a result of a higher mechanical load on UIV when using PS.

참고문헌 (29)

참고문헌 신청

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