Mechanical complications in adult deformity surgery: behavioral patterns.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

European Spine Journal Pub Date : 2025-03-25 DOI:10.1007/s00586-025-08773-5

Riccardo Raganato, Yann-Philippe Charles, Alejandro Gomez-Rice, Lucía Moreno-Manzanaro, Francisco Javier Pérez-Grueso, Sleiman Haddad, Susana Núñez, Lluís Vila, Louis Boissière, Caglar Yilgor, Frank Kleinstück, Ibrahim Obeid, Ahmet Alanay, Ferrán Pellisé, Javier Pizones

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引用次数: 0

Abstract

Background: Mechanical complications after adult deformity surgery are typically considered as a composite variable. This study aims to differentiate their characteristics and analyze their behavioral patterns based on time-to-onset and predisposing factors.

Methods: This retrospective observational study analyzed patients from a prospective multicenter database. Operated patients were analyzed for proximal junctional kyphosis (PJK), proximal junctional failure (PJF), pseudarthrosis (PA), rod breakage (RB), and no complications. Kaplan-Meier survival analysis and multivariate Cox regression models encompassing clinical, biological, radiographic, and surgical parameters were utilized to identify complication-related factors.

Results: Among 1,505 patients analyzed, 260 (17.3%) developed mechanical complications: PJK (65), PJF (43), PA (56), and RB (96). Similar time-to-event patterns were observed for PJK and PJF (Log-Rank test p = 0.446) (160 days [Q1 = 72; Q3 = 492]), and PA and RB (Log-Rank test p = 0.782) (695 days [Q1 = 371; Q3 = 1059]), clustering them in pairs. Proximal junctional problems (PJK/PJF) and failure of fusion (PA/RB) demonstrated different survival curves (Log-Rank test p < 0.001). Multivariate models associated (p < 0.05) proximal junctional problems with age (OR = 1.039), SF36-PCS (OR = 0.963), number of instrumented levels (OR = 1.123), and immediate postoperative alignment (Relative Lumbar Lordosis [OR = 1.025] and Relative Spinopelvic Alignment [OR = 1.064]). Failure of fusion occurrence was associated (p < 0.05) with number of instrumented levels (OR = 1.127) and 1-year postoperative: age (OR = 1.017), body mass index (OR = 1.044), SF36-PCS (OR = 0.975) and Relative Spinopelvic Alignment (OR = 1.034).

Conclusion: Time-to-onset differed between proximal junctional problems and failure of fusion, and predisposing factors overlap. Nevertheless, the former was associated with immediate postoperative lumbar and global sagittal misalignment, the latter with mid-term biological factors and global sagittal misalignment.

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成人畸形手术中的机械并发症：行为模式。

背景：成人畸形手术后的机械并发症通常被认为是一个复合变量。本研究旨在区分其特征，并根据发病时间和易感因素分析其行为模式。方法：这项回顾性观察性研究分析了来自前瞻性多中心数据库的患者。分析手术患者的近端关节后凸（PJK）、近端关节衰竭（PJF）、假关节（PA）、棒断裂（RB），无并发症。Kaplan-Meier生存分析和多变量Cox回归模型包括临床、生物学、放射学和手术参数来确定并发症相关因素。结果：在分析的1505例患者中，260例（17.3%）出现机械并发症：PJK (65), PJF (43)， PA（56）和RB（96）。PJK和PJF观察到相似的事件发生时间模式（Log-Rank检验p = 0.446）(160天[Q1 = 72；Q3 = 492])， PA和RB (Log-Rank检验p = 0.782)(695天[Q1 = 371；Q3 = 1059])，将它们成对聚类。近端交界处问题（PJK/PJF）和融合失败（PA/RB）表现出不同的生存曲线（Log-Rank检验p）。结论：近端交界处问题和融合失败的发病时间存在差异，且易感因素重叠。然而，前者与术后立即腰椎和整体矢状位错位有关，后者与中期生物学因素和整体矢状位错位有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Spine Journal 医学-临床神经学

CiteScore

4.80

自引率

10.70%

发文量

373

审稿时长

2-4 weeks

期刊介绍： "European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts. Official publication of EUROSPINE, The Spine Society of Europe