Orientation of the Upper-most Instrumented Segment Influences Proximal Junctional Disease Following Adult Spinal Deformity Surgery

Lafage, Renaud; Line, Breton; Gupta, Sachin; Liabaud, Barthélemy; Schwab, Frank J.; Smith, Justin S.; Gum, Jeffrey L.; Ames, Christopher P.; Hostin, Richard A.; Mundis, Gregory M.; Kim, Hee Jin; Bess, Shay; Klineberg, Eric O.; Lafage, Virginie

doi:10.1097/brs.0000000000002191

Cited by 71 publications

(51 citation statements)

References 17 publications

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“…Despite our progress in understanding lumbar morphology, very little is known about thoracic alignment in adults. Understanding normal thoracic kyphosis (TK) is critical given the burden of proximal junctional kyphosis (PJK) in adult deformity surgery; there is already evidence, for instance, to suggest that a lack of proper restoration of TK is associated with PJK 11 . This study aims to address the shortcomings in the existing literature.…”

Section: Introductionmentioning

confidence: 99%

Understanding Thoracic Spine Morphology, Shape, and Proportionality

Lafage

Steinberger

Pesenti

et al. 2020

Spine

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HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

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Section: Introductionmentioning

confidence: 99%

Understanding Thoracic Spine Morphology, Shape, and Proportionality

Lafage

Steinberger

Pesenti

et al. 2020

Spine

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“…Lafage and colleagues reported significant differences in UIV angulation between patients who did and did not develop PJK. 34 Their findings reinforce the importance of preoperative planning, careful UIV selection, and proper rod contouring to reduce PJK.…”

Section: Pseudarthrosis and Instrumentation Failurementioning

confidence: 67%

“…Preplanned machine-bent rods may reduce junctional failures by helping to ensure that desired alignment corrections are achieved, including overall magnitudes of thoracic and lumbar curves, location of LL restoration (e.g., in the lower lumbar levels), and appropriate contouring of the proximal end of the rod. 34,35,84 An overall better definition of individualized alignment objectives, beyond simple age-adjusted objectives, could markedly reduce PJK. 32,36 In the future, more aggressive attention to bone optimization may also reduce junctional fractures.…”

Section: Advances To Further Reduce Complicationsmentioning

confidence: 99%

Treatment of adult thoracolumbar spinal deformity: past, present, and future

Smith

Shaffrey

Ames

et al. 2019

Journal of Neurosurgery: Spine

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Care of the patient with adult spinal deformity (ASD) has evolved from being primarily supportive to now having the ability to directly treat and correct the spinal pathology. The focus of this narrative literature review is to briefly summarize the history of ASD treatment, discuss the current state of the art of ASD care with focus on surgical treatment and current challenges, and conclude with a discussion of potential developments related to ASD surgery.In the past, care for ASD was primarily based on supportive measures, including braces and assistive devices, with few options for surgical treatments that were often deemed high risk and reserved for rare situations. Advances in anesthetic and critical care, surgical techniques, and instrumentation now enable almost routine surgery for many patients with ASD. Despite the advances, there are many remaining challenges currently impacting the care of ASD patients, including increasing numbers of elderly patients with greater comorbidities, high complication and reoperation rates, and high procedure cost without clearly demonstrated cost-effectiveness based on standard criteria. In addition, there remains considerable variability across multiple aspects of ASD surgery. For example, there is currently very limited ability to provide preoperative individualized counseling regarding optimal treatment approaches (e.g., operative vs nonoperative), complication risks with surgery, durability of surgery, and likelihood of achieving individualized patient goals and satisfaction. Despite the challenges associated with the current state-of-the-art ASD treatment, surgery continues to be a primary option, as multiple reports have demonstrated the potential for surgery to significantly improve pain and disability. The future of ASD care will likely include techniques and technologies to markedly reduce complication rates, including greater use of navigation and robotics, and a shift toward individualized medicine that enables improved counseling, preoperative planning, procedure safety, and patient satisfaction.Advances in the care of ASD patients have been remarkable over the past few decades. The current state of the art enables almost routine surgical treatment for many types of ASD that have the potential to significantly improve pain and disability. However, significant challenges remain, including high complication rates, lack of demonstrated cost-effectiveness, and limited ability to meaningfully counsel patients preoperatively on an individual basis. The future of ASD surgery will require continued improvement of predictability, safety, and sustainability.

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“…Hierbei spielt der thorakolumbale Übergang als transitionelle Zone von rigidem Thorax zur relativ felxiblen Lumbalregion eine entscheidende Rolle. So steigt insbesondere bei ausgeprägten Deformitäten das Risiko von Anschlussdegenerationen, -instabilitäten und -frakturen auf über 50 %, wenn die gewählte Instrumentation bei einer lumbalen Korrektur nicht mindestens Th10 oder gar Th9 miteinbezieht [26,27]. Obwohl bis heute eine eindeutige Definition der sog.…”

Section: Risiken Und Komplikationen Beim äLteren Patientenunclassified

Die Veränderung des sagittalen Profils im Alter und dessen therapeutische Relevanz

Tschöke

2018

Die Wirbelsäule

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ZusammenfassungDie steigende Zahl der komplexen Wirbelsäulendeformitäten im Alter stellt eine neue therapeutische Herausforderung dar. Hierbei wird dem komplexen Zusammenspiel der spinopelvinen Kompensationsmechanismen eine besondere Bedeutung zugeschrieben. Obwohl die Analyse der globalen sagittalen Balance wesentlich zum Verständnis dieser Mechanismen beigetragen hat, wird die vereinfachte algebraische Darstellung und Definition des „normalen“ Sagittalprofils dem älteren Patienten mit multiplen degenerativen Veränderungen des Bewegungsapparates nicht gerecht. Vielmehr ist beim älteren Patienten eine durch die unzureichende Flexibilität der benachbarten Strukturen limitierte „Komfort-Balance“ funktionell nicht zwingend nachteilig. Dennoch sollte das therapeutische Ziel immer die Wiederherstellung einer harmonischen Lastverteilung an der Wirbelsäule sein. Bei älteren Patienten mit einer symptomatisch dekompensierten sagittalen Imbalance, bleibt die rein konservative Therapie meist ohne Erfolg. In diesen Fällen sollte immer die strukturell zugrunde liegende Pathologie im Sinne der Profilkorrektur adressiert werden. Die Wahl der operativen Technik, Länge des Konstrukts und dessen Verankerungspunkte müssen dabei die individuellen Möglichkeiten, Risiken und Bedürfnisse des älteren Patienten berücksichtigen, um eine iatrogene Invalidisierung und komplikationsbedingte Sekundäreingriffe zu vermeiden. Mit stetig steigender Lebenserwartung unserer Bevölkerung werden wir uns dem wachsenden Anspruch, auch im hohen Alter aktiv bleiben zu können, stellen müssen. Dies setzt ein ganzheitliches Verständnis der patienteneigenen Leistungsfähigkeit sowie eine realistische Einschätzung des zu erzielenden Ergebnisses und das Beherrschen aller operativer Korrekturtechniken voraus.

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Orientation of the Upper-most Instrumented Segment Influences Proximal Junctional Disease Following Adult Spinal Deformity Surgery

Abstract: 3.

Cited by 71 publications

References 17 publications

Understanding Thoracic Spine Morphology, Shape, and Proportionality

Understanding Thoracic Spine Morphology, Shape, and Proportionality

Treatment of adult thoracolumbar spinal deformity: past, present, and future

Die Veränderung des sagittalen Profils im Alter und dessen therapeutische Relevanz

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