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Change in the Alignment and Distal Junctional Kyphosis Development after Posterior Cervical Spinal Fusion Surgery for Cervical Spondylotic Myelopathy - Risk Factor Analysis

Journal of Korean Neurosurgical Society 2022년 65권 4호 p.549 ~ 557
이정재, 박진훈, Oh Young-Gyu, 신홍경, 박병곤,
소속 상세정보
이정재 ( Lee Jung-Jae ) - University of Ulsan College of Medicine Gangneung Asan Hospital Department of Neurosurgery
박진훈 ( Park Jin-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Neurosurgery
 ( Oh Young-Gyu ) - University of Ulsan College of Medicine Asan Medical Center Department of Neurosurgery
신홍경 ( Shin Hong-Kyung ) - University of Ulsan College of Medicine Asan Medical Center Department of Neurosurgery
박병곤 ( Park Byong-Gon ) - Catholic Kwandong University College of Medicine Department of Physiology

Abstract


Objective: This study analyzed the risk factors in patients who developed distal junctional kyphosis (DJK) after posterior cervical fusion.

Methods: We retrospectively analyzed the clinical and radiographic outcomes of 64 patients, aged ≥18 years (51 and 13 male and female patients, respectively), who underwent single-staged multilevel (3-6 levels) posterior cervical fusion surgery due to multiple cervical spondylotic myelopathy. The surgeries were performed by a single spinal surgeon between January 2012 and December 2017. Demographic data, clinical outcomes, and radiological results were collected. We divided the patients into a DJK group and a non-DJK group according to the presence of DJK and investigated the risk factors by comparing the differences between the two groups.

Results: Of the 64 patients, 13 developed DJK. No significant differences in clinical results were observed between the two groups before and immediately after the surgery. At the final follow-up, a higher visual analog score for neck pain was observed in the DJK group compared to the non-DJK group (p<0.01). The DJK group had a significantly lower T1 slope and a significantly higher C2-7 sagittal vertical axis (SVA) before surgery compared to the non-DJK group (p=0.03 and p<0.01, respectively). Immediately after surgery, the difference between the two groups decreased and no significant difference was observed. However, at the last followup, a significantly higher C2-7 SVA was observed in the DJK group (p<0.01). At the last follow up, there is no discrepancy in T1S-CL. In multiple logistic regression analysis, preoperative higher C2-7 SVA and preoperative lower T1 slope were identified as independent risk factors (p=0.03 and p<0.01, respectively). As a result, it was confirmed that DJK occurred along the process of returning to preoperative values.

Conclusion: DJK can be considered to be caused by cervical misalignment due to excessive change in the surgical site in patients with low T1 slope and high C2-7 SVA before surgery. This also affects the clinical outcome after surgery. It is recommended to refrain from excessive segmental lordosis changes during multilevel cervical post fusion surgery, especially in patients with a small preoperative T1 slope and a large SVA value.

키워드

Cervical vertebrae; Spinal curvatures; Radiology; Pathology

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