지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
논문 기본 정보
- 자료유형
- 학술저널
- 저자정보
- 발행연도
- 2024.9
- 수록면
- 856 - 864 (9page)
- DOI
- 10.14245/ns.2448122.061
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초록· 키워드
오류제보하기
Objective: To identify risk factors and establish radiographic criteria for distal junctional failure (DJF) in patients with adult spinal deformity (ASD), who underwent fusion surgery stopping at L5.
Methods: This retrospective study was undertaken from January 2016 to December 2020.
Patients with ASD who underwent fusion surgery ( ≥ 5 levels) stopping at L5 were analyzed.
DJF was defined as symptomatic adjacent segment pathology at the lumbosacral junction necessitating consideration for revision surgery. Demographic data and radiographic measurements were compared between the DJF and non-DJF groups. Receiver operating characteristic curve analysis was performed to identify the radiographic cutoff value for DJF.
Results: Among 76 patients, 16 (21.1%) experienced DJF. DJF was associated with older age, antidepressant/anxiolytic medication, longer level of fusions, and worse preoperative sagittal alignment. Antidepressant/anxiolytic medication (odds ratio, 5.60) and preoperative pelvic incidence (PI)–lumbar lordosis (LL) mismatch > 40° (odds ratio, 5.87) were independent risk factors for DJF. Without both factors, the incidence of DJF has been greatly reduced (9.1%). Two radiographic criteria were determined for DJF: last distal junctional angle (DJA) > -5° and Δ last DJA–post DJA > 5°. When both criteria were met, the sensitivity and specificity of the DJF were 93.3% and 91.7%, respectively.
Conclusion: Use of antidepressant/anxiolytic medication and preoperative PI–LL mismatch > 40° were independent risk factors for DJF. DJF could be diagnosed using postoperative changes in the DJA. If both criteria were met, DJF could be strongly suggested.
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