Early catastrophic proximal junctional fracture after spinal instrumentation in geriatric patients

Öz

Aim: The purpose of this investigation was to evaluate the effectiveness of pedicle screw fixation and bilateral hooks in the prevention of proximal junctional kyphosis (PJK) and proximal junctional proximal junctional insufficiency/failure (PJI) among high-risk elderly patients. Material and Methods: This retrospective study included 56 high-risk elderly patients who underwent long-segment spinal instrumentation and fusion between 2021 and 2024. Group A consisted of 26 patients who received pedicle screw fixation, while Group B comprised 30 patients who underwent bilateral hook placement during surgery. The primary outcomes were the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Preoperative and postoperative assessments, including the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) for functional status, and the 36-Item Short Form Health Survey (SF-36) for quality of life, were retrieved from patient medical records. Results: PJK occurred in 26.9% of the pedicle screw group (Group A) compared with 6.7% in the bilateral-hook group (Group B), while PJF rates were 19.2% and 3.3%, respectively (p < 0.05). Neurologic deficits developed in 11.5% in Group A and 3.3% in Group B (p = 0.044). Significant improvements were observed in postoperative VAS, ODI, and SF-36 scores in both groups, with Group B showing better outcomes (p < 0.001). Age over 70 years (OR 1.68–2.24), T-score ≤ −2.5 (OR 1.92), number of previous operations (OR 1.64–2.86), an upper-instrumented vertebra at T10 or above (OR 1.78), and pedicle screw fixation (OR 2.84) were independent risk factors for increasing the risk of developing PJK/PJF. Conclusion: This study indicates that the use of bilateral hooks reduces the risk of proximal junctional kyphosis and proximal junctional fracture in elderly high-risk patients after spinal fusion compared with pedicle screw fixation alone. Bilateral-hook placement was associated with lower complication rates and better clinical outcomes in terms of pain reduction, functional improvement, and return to daily activities.

Anahtar Kelimeler

• proximal junction insufficiency
• proximal junction kyphosis
• spine fracture

Geriatrik hastalarda spinal enstrümantasyon sonrası erken katastrofik proksimal junksiyonel kırık

Öz

Amaç: Bu araştırmanın amacı, yüksek riskli yaşlı hastalarda proksimal junksiyonel kifoz (PJK) ve proksimal junksiyonel yetmezlik/fraktür (PJF) gelişiminin önlenmesinde pedikül vida fiksasyonu ve bilateral kanca desteğinin etkinliğini değerlendirmekti. Gereç ve Yöntem: Bu retrospektif çalışmaya 2021–2024 yılları arasında uzun-segment spinal enstrümantasyon ve füzyon uygulanan 56 yüksek riskli yaşlı hasta dahil edildi. Grup A, pedikül vida fiksasyonu uygulanan 26 hastadan; Grup B ise cerrahi sırasında bilateral kanca yerleştirilmesi uygulanan 30 hastadan oluşmaktaydı. Birincil sonuçlar PJK ve PJF gelişimiydi. Hastaların preoperatif ve postoperatif dönemlerde Görsel Analog Skala (VAS), fonksiyon için Oswestry Engellilik İndeksi (ODI) ve yaşam kalitesi için 36 Maddelik Kısa Form Sağlık Anketi (SF-36); değerlendirmeleri hasta dosyalarından toplandı. Bulgular: Pedikül vida grubunda (Grup A) PJK %26,9 oranında görülürken, bu oran bilateral-kanca grubunda (Grup B) %6,7 idi. PJF oranları ise sırasıyla %19,2 ve %3,3 olarak saptandı (p < 0,05). Nörolojik defisit gelişimi Grup A’da %11,5, Grup B’de %3,3 idi (p = 0,044). Her iki grupta da postoperatif VAS, ODI ve SF-36 skorlarında anlamlı iyileşmeler gözlendi; bununla birlikte Grup B daha iyi sonuçlar gösterdi (p < 0,001). Yetmiş yaş üstü olmak (OR: 1,68–2,24), T-skorunun ≤ −2,5 olması (OR: 1,92), geçirilmiş operasyon sayısı (OR: 1,64–2,86), üst enstrümante vertebranın T10 veya daha üst seviyede olması (OR: 1,78) ve pedikül vida fiksasyonu (OR: 2,84) PJK/PJF geliştirme riskini artıran faktörlerdi. Sonuçlar: Bu çalışma, bilateral kanca kullanımının, yalnız pedikül vida fiksasyonuna kıyasla, spinal füzyon sonrası yüksek riskli yaşlı hastalarda PJK ve PJF riskini azalttığını göstermektedir. Bilateral-kanca yerleştirilmesi; ağrının azaltılması, fonksiyonel iyileşme ve günlük aktivitelere dönüş açısından daha düşük komplikasyon oranları ve daha iyi klinik sonuçlar ile ilişkiliydi.

Anahtar Kelimeler

• proksimal junksiyonel yetmezlik
• proksimal junksiyonel kifoz
• spinal kırık

Kaynakça

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