Abstract：
OBJECTIVE: To assess, in a large population of Adult Spinal Deformity (ASD) patients, the true interest of varying the upper anchors as a protective measure against Proximal Junctional Kyphosis (PJK), by analyzing and comparing 2 groups of patients defined according to their proximal construct. Another objective of the study is to look for any other factors, radiological or clinical, that would affect the occurrence of the proximal failure.
METHODS: Retrospective review of a prospective ASD database collected from 5 centers. Inclusion criteria were age of at least 18 years, presence of a spinal deformity with instrumentation from T12 or above to the pelvis, with minimum 2 years of follow-up. Demographic data, spinopelvic parameters, functional outcomes and complications were collected. Multiple logistic regression analysis was performed to identify the risk factors that would affect the occurrence of PJK.
RESULTS: 254 patients were included. 166 in the group \"screws proximally\" (SP) and 88 in the group \"hooks proximally\" (HP). There was no difference between both groups for PJK (p = 0.967). The occurrence of PJK was rather associated with greater age and BMI, higher preoperative kyphosis, worst preoperative SRS22 and SF36 scores, greater postoperative Sagittal Vertical Axis (SVA), coronal malalignment and kyphosis.
CONCLUSIONS: The use of proximal hooks was not effective to prevent PJK after ASD surgery, when compared to proximal screws. Worse preoperative functional outcomes and worse postoperative sagittal and also coronal malalignment were the main drivers for the occurrence of PJK regardless the type of proximal implant.
METHODS: Retrospective review of a prospective ASD database collected from 5 centers. Inclusion criteria were age of at least 18 years, presence of a spinal deformity with instrumentation from T12 or above to the pelvis, with minimum 2 years of follow-up. Demographic data, spinopelvic parameters, functional outcomes and complications were collected. Multiple logistic regression analysis was performed to identify the risk factors that would affect the occurrence of PJK.
RESULTS: 254 patients were included. 166 in the group \"screws proximally\" (SP) and 88 in the group \"hooks proximally\" (HP). There was no difference between both groups for PJK (p = 0.967). The occurrence of PJK was rather associated with greater age and BMI, higher preoperative kyphosis, worst preoperative SRS22 and SF36 scores, greater postoperative Sagittal Vertical Axis (SVA), coronal malalignment and kyphosis.
CONCLUSIONS: The use of proximal hooks was not effective to prevent PJK after ASD surgery, when compared to proximal screws. Worse preoperative functional outcomes and worse postoperative sagittal and also coronal malalignment were the main drivers for the occurrence of PJK regardless the type of proximal implant.
摘要：
目的：评估，在大量的成人脊柱畸形（ASD）患者中，改变上锚作为防止近端交界性脊柱后凸(PJK)的保护措施的真正利益，通过分析和比较两组根据近端结构定义的患者。这项研究的另一个目的是寻找任何其他因素，放射学或临床，这将影响近端失败的发生。
方法：回顾性回顾从5个中心收集的前瞻性ASD数据库。纳入标准是年龄至少18岁，从T12或以上到骨盆的器械存在脊柱畸形，至少2年的随访。人口统计数据,脊椎骨盆参数，收集功能结局和并发症.采用多因素logistic回归分析确定影响PJK发生的危险因素。
结果：254例患者被纳入。“近端螺钉”组中的166个（SP）和“近端钩”组中的88个（HP）。两组之间的PJK没有差异（p=0.967）。PJK的发生与更大的年龄和BMI有关，术前脊柱后凸畸形较高，术前最差的SRS22和SF36评分，术后大矢状垂直轴（SVA），冠状错位和后凸畸形。
结论：使用近端钩不能有效预防ASD手术后的PJK，与近端螺钉相比。无论近端植入物的类型如何，术前功能结果更差，术后矢状和冠状排列不良都是PJK发生的主要驱动因素。
方法：回顾性回顾从5个中心收集的前瞻性ASD数据库。纳入标准是年龄至少18岁，从T12或以上到骨盆的器械存在脊柱畸形，至少2年的随访。人口统计数据,脊椎骨盆参数，收集功能结局和并发症.采用多因素logistic回归分析确定影响PJK发生的危险因素。
结果：254例患者被纳入。“近端螺钉”组中的166个（SP）和“近端钩”组中的88个（HP）。两组之间的PJK没有差异（p=0.967）。PJK的发生与更大的年龄和BMI有关，术前脊柱后凸畸形较高，术前最差的SRS22和SF36评分，术后大矢状垂直轴（SVA），冠状错位和后凸畸形。
结论：使用近端钩不能有效预防ASD手术后的PJK，与近端螺钉相比。无论近端植入物的类型如何，术前功能结果更差，术后矢状和冠状排列不良都是PJK发生的主要驱动因素。
