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
{"title":"成人畸形手术中的机械并发症：行为模式。","authors":"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","doi":"10.1007/s00586-025-08773-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Mechanical complications in adult deformity surgery: behavioral patterns.\",\"authors\":\"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\",\"doi\":\"10.1007/s00586-025-08773-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":12323,\"journal\":{\"name\":\"European Spine Journal\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-03-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Spine Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00586-025-08773-5\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00586-025-08773-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Mechanical complications in adult deformity surgery: behavioral patterns.
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.
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
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
