Risk factors for proximal junctional fracture following fusion surgery for osteoporotic vertebral collapse with delayed neurological deficits: A retrospective cohort study of 403 patients

Koji Tamai, Hidetomi Terai, Akinobu Suzuki, Hiroaki Nakamura, Kei Watanabe, Keiichi Katsumi, Masayuki Ohashi, Yohei Shibuya, Tomohiro Izumi, Toru Hirano, Takashi Kaito, Tomoya Yamashita, Hiroyasu Fujiwara, Yukitaka Nagamoto, Yuji Matsuoka, Hidekazu Suzuki, Hirosuke Nishimura, Atsushi Tagami, Syuta Yamada, Shinji AdachiToshitaka Yoshii, Shuta Ushio, Katsumi Harimaya, Kenichi Kawaguchi, Nobuhiko Yokoyama, Hidekazu Oishi, Toshiro Doi, Atsushi Kimura, Hirokazu Inoue, Gen Inoue, Masayuki Miyagi, Wataru Saito, Atsushi Nakano, Daisuke Sakai, Tadashi Nukaga, Shota Ikegami, Masayuki Shimizu, Toshimasa Futatsugi, Seiji Ohtori, Takeo Furuya, Sumihisa Orita, Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Katsuhito Kiyasu, Hideki Murakami, Katsuhito Yoshioka, Shoji Seki, Michio Hongo, Kenichiro Kakutani, Takashi Yurube, Yasuchika Aoki, Masashi Oshima, Masahiko Takahata, Akira Iwata, Hirooki Endo, Tetsuya Abe, Toshinori Tsukanishi, Kazuyoshi Nakanishi, Kota Watanabe, Tomohiro Hikata, Satoshi Suzuki, Norihiro Isogai, Eijiro Okada, Haruki Funao, Seiji Ueda, Yuta Shiono, Kenya Nojiri, Naobumi Hosogane, Ken Ishii

Research output: Contribution to journalArticle

Abstract

Introduction: Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC. Methods: This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for !2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis. Results: Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm2 (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228). Conclusions: PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm2 may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.

Original languageEnglish
Pages (from-to)171-177
Number of pages7
JournalSpine Surgery and Related Research
Volume3
Issue number2
DOIs
Publication statusPublished - Jan 1 2019

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Cohort Studies
Retrospective Studies
Sacrum
ROC Curve
Bone Density
Osteoporosis
Spine
Odds Ratio
Osteoporotic Fractures
Area Under Curve
Registries
Hip
Japan
Multivariate Analysis
Logistic Models
Regression Analysis
Incidence
Surgeons
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology
  • Orthopedics and Sports Medicine

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Risk factors for proximal junctional fracture following fusion surgery for osteoporotic vertebral collapse with delayed neurological deficits : A retrospective cohort study of 403 patients. / Tamai, Koji; Terai, Hidetomi; Suzuki, Akinobu; Nakamura, Hiroaki; Watanabe, Kei; Katsumi, Keiichi; Ohashi, Masayuki; Shibuya, Yohei; Izumi, Tomohiro; Hirano, Toru; Kaito, Takashi; Yamashita, Tomoya; Fujiwara, Hiroyasu; Nagamoto, Yukitaka; Matsuoka, Yuji; Suzuki, Hidekazu; Nishimura, Hirosuke; Tagami, Atsushi; Yamada, Syuta; Adachi, Shinji; Yoshii, Toshitaka; Ushio, Shuta; Harimaya, Katsumi; Kawaguchi, Kenichi; Yokoyama, Nobuhiko; Oishi, Hidekazu; Doi, Toshiro; Kimura, Atsushi; Inoue, Hirokazu; Inoue, Gen; Miyagi, Masayuki; Saito, Wataru; Nakano, Atsushi; Sakai, Daisuke; Nukaga, Tadashi; Ikegami, Shota; Shimizu, Masayuki; Futatsugi, Toshimasa; Ohtori, Seiji; Furuya, Takeo; Orita, Sumihisa; Imagama, Shiro; Ando, Kei; Kobayashi, Kazuyoshi; Kiyasu, Katsuhito; Murakami, Hideki; Yoshioka, Katsuhito; Seki, Shoji; Hongo, Michio; Kakutani, Kenichiro; Yurube, Takashi; Aoki, Yasuchika; Oshima, Masashi; Takahata, Masahiko; Iwata, Akira; Endo, Hirooki; Abe, Tetsuya; Tsukanishi, Toshinori; Nakanishi, Kazuyoshi; Watanabe, Kota; Hikata, Tomohiro; Suzuki, Satoshi; Isogai, Norihiro; Okada, Eijiro; Funao, Haruki; Ueda, Seiji; Shiono, Yuta; Nojiri, Kenya; Hosogane, Naobumi; Ishii, Ken.

In: Spine Surgery and Related Research, Vol. 3, No. 2, 01.01.2019, p. 171-177.

Research output: Contribution to journalArticle

Tamai, K, Terai, H, Suzuki, A, Nakamura, H, Watanabe, K, Katsumi, K, Ohashi, M, Shibuya, Y, Izumi, T, Hirano, T, Kaito, T, Yamashita, T, Fujiwara, H, Nagamoto, Y, Matsuoka, Y, Suzuki, H, Nishimura, H, Tagami, A, Yamada, S, Adachi, S, Yoshii, T, Ushio, S, Harimaya, K, Kawaguchi, K, Yokoyama, N, Oishi, H, Doi, T, Kimura, A, Inoue, H, Inoue, G, Miyagi, M, Saito, W, Nakano, A, Sakai, D, Nukaga, T, Ikegami, S, Shimizu, M, Futatsugi, T, Ohtori, S, Furuya, T, Orita, S, Imagama, S, Ando, K, Kobayashi, K, Kiyasu, K, Murakami, H, Yoshioka, K, Seki, S, Hongo, M, Kakutani, K, Yurube, T, Aoki, Y, Oshima, M, Takahata, M, Iwata, A, Endo, H, Abe, T, Tsukanishi, T, Nakanishi, K, Watanabe, K, Hikata, T, Suzuki, S, Isogai, N, Okada, E, Funao, H, Ueda, S, Shiono, Y, Nojiri, K, Hosogane, N & Ishii, K 2019, 'Risk factors for proximal junctional fracture following fusion surgery for osteoporotic vertebral collapse with delayed neurological deficits: A retrospective cohort study of 403 patients', Spine Surgery and Related Research, vol. 3, no. 2, pp. 171-177. https://doi.org/10.22603/ssrr.2018-0068
Tamai, Koji ; Terai, Hidetomi ; Suzuki, Akinobu ; Nakamura, Hiroaki ; Watanabe, Kei ; Katsumi, Keiichi ; Ohashi, Masayuki ; Shibuya, Yohei ; Izumi, Tomohiro ; Hirano, Toru ; Kaito, Takashi ; Yamashita, Tomoya ; Fujiwara, Hiroyasu ; Nagamoto, Yukitaka ; Matsuoka, Yuji ; Suzuki, Hidekazu ; Nishimura, Hirosuke ; Tagami, Atsushi ; Yamada, Syuta ; Adachi, Shinji ; Yoshii, Toshitaka ; Ushio, Shuta ; Harimaya, Katsumi ; Kawaguchi, Kenichi ; Yokoyama, Nobuhiko ; Oishi, Hidekazu ; Doi, Toshiro ; Kimura, Atsushi ; Inoue, Hirokazu ; Inoue, Gen ; Miyagi, Masayuki ; Saito, Wataru ; Nakano, Atsushi ; Sakai, Daisuke ; Nukaga, Tadashi ; Ikegami, Shota ; Shimizu, Masayuki ; Futatsugi, Toshimasa ; Ohtori, Seiji ; Furuya, Takeo ; Orita, Sumihisa ; Imagama, Shiro ; Ando, Kei ; Kobayashi, Kazuyoshi ; Kiyasu, Katsuhito ; Murakami, Hideki ; Yoshioka, Katsuhito ; Seki, Shoji ; Hongo, Michio ; Kakutani, Kenichiro ; Yurube, Takashi ; Aoki, Yasuchika ; Oshima, Masashi ; Takahata, Masahiko ; Iwata, Akira ; Endo, Hirooki ; Abe, Tetsuya ; Tsukanishi, Toshinori ; Nakanishi, Kazuyoshi ; Watanabe, Kota ; Hikata, Tomohiro ; Suzuki, Satoshi ; Isogai, Norihiro ; Okada, Eijiro ; Funao, Haruki ; Ueda, Seiji ; Shiono, Yuta ; Nojiri, Kenya ; Hosogane, Naobumi ; Ishii, Ken. / Risk factors for proximal junctional fracture following fusion surgery for osteoporotic vertebral collapse with delayed neurological deficits : A retrospective cohort study of 403 patients. In: Spine Surgery and Related Research. 2019 ; Vol. 3, No. 2. pp. 171-177.
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title = "Risk factors for proximal junctional fracture following fusion surgery for osteoporotic vertebral collapse with delayed neurological deficits: A retrospective cohort study of 403 patients",
abstract = "Introduction: Approximately 3{\%} of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC. Methods: This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for !2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis. Results: Sixty-three patients (15.6{\%}) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm2 (sensitivity, 76.5{\%}; specificity, 58.3{\%}), but that of the hip was not (p=0.228). Conclusions: PJFr was found in 16{\%} cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm2 may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.",
author = "Koji Tamai and Hidetomi Terai and Akinobu Suzuki and Hiroaki Nakamura and Kei Watanabe and Keiichi Katsumi and Masayuki Ohashi and Yohei Shibuya and Tomohiro Izumi and Toru Hirano and Takashi Kaito and Tomoya Yamashita and Hiroyasu Fujiwara and Yukitaka Nagamoto and Yuji Matsuoka and Hidekazu Suzuki and Hirosuke Nishimura and Atsushi Tagami and Syuta Yamada and Shinji Adachi and Toshitaka Yoshii and Shuta Ushio and Katsumi Harimaya and Kenichi Kawaguchi and Nobuhiko Yokoyama and Hidekazu Oishi and Toshiro Doi and Atsushi Kimura and Hirokazu Inoue and Gen Inoue and Masayuki Miyagi and Wataru Saito and Atsushi Nakano and Daisuke Sakai and Tadashi Nukaga and Shota Ikegami and Masayuki Shimizu and Toshimasa Futatsugi and Seiji Ohtori and Takeo Furuya and Sumihisa Orita and Shiro Imagama and Kei Ando and Kazuyoshi Kobayashi and Katsuhito Kiyasu and Hideki Murakami and Katsuhito Yoshioka and Shoji Seki and Michio Hongo and Kenichiro Kakutani and Takashi Yurube and Yasuchika Aoki and Masashi Oshima and Masahiko Takahata and Akira Iwata and Hirooki Endo and Tetsuya Abe and Toshinori Tsukanishi and Kazuyoshi Nakanishi and Kota Watanabe and Tomohiro Hikata and Satoshi Suzuki and Norihiro Isogai and Eijiro Okada and Haruki Funao and Seiji Ueda and Yuta Shiono and Kenya Nojiri and Naobumi Hosogane and Ken Ishii",
year = "2019",
month = "1",
day = "1",
doi = "10.22603/ssrr.2018-0068",
language = "English",
volume = "3",
pages = "171--177",
journal = "Spine Surgery and Related Research",
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TY - JOUR

T1 - Risk factors for proximal junctional fracture following fusion surgery for osteoporotic vertebral collapse with delayed neurological deficits

T2 - A retrospective cohort study of 403 patients

AU - Tamai, Koji

AU - Terai, Hidetomi

AU - Suzuki, Akinobu

AU - Nakamura, Hiroaki

AU - Watanabe, Kei

AU - Katsumi, Keiichi

AU - Ohashi, Masayuki

AU - Shibuya, Yohei

AU - Izumi, Tomohiro

AU - Hirano, Toru

AU - Kaito, Takashi

AU - Yamashita, Tomoya

AU - Fujiwara, Hiroyasu

AU - Nagamoto, Yukitaka

AU - Matsuoka, Yuji

AU - Suzuki, Hidekazu

AU - Nishimura, Hirosuke

AU - Tagami, Atsushi

AU - Yamada, Syuta

AU - Adachi, Shinji

AU - Yoshii, Toshitaka

AU - Ushio, Shuta

AU - Harimaya, Katsumi

AU - Kawaguchi, Kenichi

AU - Yokoyama, Nobuhiko

AU - Oishi, Hidekazu

AU - Doi, Toshiro

AU - Kimura, Atsushi

AU - Inoue, Hirokazu

AU - Inoue, Gen

AU - Miyagi, Masayuki

AU - Saito, Wataru

AU - Nakano, Atsushi

AU - Sakai, Daisuke

AU - Nukaga, Tadashi

AU - Ikegami, Shota

AU - Shimizu, Masayuki

AU - Futatsugi, Toshimasa

AU - Ohtori, Seiji

AU - Furuya, Takeo

AU - Orita, Sumihisa

AU - Imagama, Shiro

AU - Ando, Kei

AU - Kobayashi, Kazuyoshi

AU - Kiyasu, Katsuhito

AU - Murakami, Hideki

AU - Yoshioka, Katsuhito

AU - Seki, Shoji

AU - Hongo, Michio

AU - Kakutani, Kenichiro

AU - Yurube, Takashi

AU - Aoki, Yasuchika

AU - Oshima, Masashi

AU - Takahata, Masahiko

AU - Iwata, Akira

AU - Endo, Hirooki

AU - Abe, Tetsuya

AU - Tsukanishi, Toshinori

AU - Nakanishi, Kazuyoshi

AU - Watanabe, Kota

AU - Hikata, Tomohiro

AU - Suzuki, Satoshi

AU - Isogai, Norihiro

AU - Okada, Eijiro

AU - Funao, Haruki

AU - Ueda, Seiji

AU - Shiono, Yuta

AU - Nojiri, Kenya

AU - Hosogane, Naobumi

AU - Ishii, Ken

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC. Methods: This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for !2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis. Results: Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm2 (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228). Conclusions: PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm2 may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.

AB - Introduction: Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC. Methods: This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for !2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis. Results: Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm2 (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228). Conclusions: PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm2 may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.

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U2 - 10.22603/ssrr.2018-0068

DO - 10.22603/ssrr.2018-0068

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JO - Spine Surgery and Related Research

JF - Spine Surgery and Related Research

SN - 2432-261X

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