Predicting development of severe clinically relevant distal junctional kyphosis following adult cervical deformity surgery, with further distinction from mild asymptomatic episodes

2021 ◽  
pp. 1-8
Keyword(s):  
Pelvic Incidence ◽  
High Reliability ◽  
Area Under The Curve ◽  
Vertical Axis ◽  
Cervical Lordosis ◽  
Combined Approach ◽  
Sagittal Vertical Axis ◽  
Asymptomatic Patients ◽  
Distal Junctional Kyphosis ◽  
Junctional Kyphosis

OBJECTIVE This retrospective cohort study aimed to develop a formal predictive model distinguishing between symptomatic and asymptomatic distal junctional kyphosis (DJK). In this study the authors identified a DJK rate of 32.2%. Predictive models were created that can be used with high reliability to help distinguish between severe symptomatic DJK and mild asymptomatic DJK through the use of surgical factors, radiographic parameters, and patient variables. METHODS Patients with cervical deformity (CD) were stratified into asymptomatic and symptomatic DJK groups. Symptomatic: 1) DJK angle (DJKA) > 10° and either reoperation due to DJK or > 1 new-onset neurological sequela related to DJK; or 2) either a DJKA > 20° or ∆DJKA > 20°. Asymptomatic: ∆DJK > 10° in the absence of neurological sequelae. Stepwise logistic regressions were used to identify factors associated with these types of DJK. Decision tree analysis established cutoffs. RESULTS A total of 99 patients with CD were included, with 32.2% developing DJK (34.3% asymptomatic, 65.7% symptomatic). A total of 37.5% of asymptomatic patients received a reoperation versus 62.5% symptomatic patients. Multivariate analysis identified independent baseline factors for developing symptomatic DJK as follows: pelvic incidence (OR 1.02); preoperative cervical flexibility (OR 1.04); and combined approach (OR 6.2). Having abnormal hyperkyphosis in the thoracic spine, more so than abnormal cervical lordosis, was a factor for developing symptomatic disease when analyzed against asymptomatic patients (OR 1.2). Predictive modeling identified factors that were predictive of symptomatic versus no DJK, as follows: myelopathy (modified Japanese Orthopaedic Association score 12–14); combined approach; uppermost instrumented vertebra C3 or C4; preoperative hypermobility; and > 7 levels fused (area under the curve 0.89). A predictive model for symptomatic versus asymptomatic disease (area under the curve 0.85) included being frail, T1 slope minus cervical lordosis > 20°, and a pelvic incidence > 46.3°. Controlling for baseline deformity and disability, symptomatic patients had a greater cervical sagittal vertical axis (4–8 cm: 47.6% vs 27%) and were more malaligned according to their Scoliosis Research Society sagittal vertical axis measurement (OR 0.1) than patients without DJK at 1 year (all p < 0.05). Despite their symptomatology and higher reoperation rate, outcomes equilibrated in the symptomatic cohort at 1 year following revision. CONCLUSIONS Overall, 32.2% of patients with CD suffered from DJK. Symptomatic DJK can be predicted with high reliability. It can be further distinguished from asymptomatic occurrences by taking into account pelvic incidence and baseline cervicothoracic deformity severity.

The utility of supine radiographs in the assessment of thoracic flexibility and risk of proximal junctional kyphosis

2021 ◽  
pp. 1-7
Author(s):  
Francis Lovecchio ◽  
Renaud Lafage ◽  
Jonathan Charles Elysee ◽  
Alex Huang ◽  
Bryan Ang ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Vertical Axis ◽  
Control Analysis ◽  
Proximal Junctional Kyphosis ◽  
Sagittal Vertical Axis ◽  
Significant Difference ◽  
Junctional Kyphosis

OBJECTIVE Supine radiographs have successfully been used for preoperative planning of lumbar deformity corrections. However, they have not been used to assess thoracic flexibility, which has recently garnered attention as a potential contributor to proximal junctional kyphosis (PJK). The purpose of this study was to compare supine to standing radiographs to assess thoracic flexibility and to determine whether thoracic flexibility is associated with PJK. METHODS A retrospective study was conducted of a single-institution database of patients with adult spinal deformity (ASD). Sagittal alignment parameters were compared between standing and supine and between pre- and postoperative radiographs. Thoracic flexibility was determined as the change between preoperative standing thoracic kyphosis (TK) and preoperative supine TK, and these changes were measured over the overall thoracic spine and the fused portion of the thoracic spine (i.e., TK fused). A case-control analysis was performed to compare thoracic flexibility between patients with PJK and those without (no PJK). The cohort was also stratified into three groups based on thoracic flexibility: kyphotic change (increased TK), lordotic change (decreased TK), and no change. The PJK rate was compared between the cohorts. RESULTS A total of 101 patients (mean 63 years old, 82.2% female, mean BMI 27.4 kg/m2) were included. Preoperative Scoliosis Research Society–Schwab ASD classification showed moderate preoperative deformity (pelvic tilt 27.7% [score ++]; pelvic incidence–lumbar lordosis mismatch 44.6% [score ++]; sagittal vertical axis 42.6% [score ++]). Postoperatively, the average offset from age-adjusted alignment goals demonstrated slight overcorrection in the study sample (−8.5° ± 15.6° pelvic incidence–lumbar lordosis mismatch, −29.2 ± 53.1 mm sagittal vertical axis, −5.4 ± 10.8 pelvic tilt, and −7.6 ± 11.7 T1 pelvic angle). TK decreased between standing and supine radiographs and increased postoperatively (TK fused: −25.3° vs −19.6° vs −29.9°; all p < 0.001). The overall rate of radiographic PJK was 23.8%. Comparisons between PJK and no PJK demonstrated that offsets from age-adjusted alignment goals were similar (p > 0.05 for all). There was a significant difference in the PJK rate when stratified by thoracic flexibility cohorts (kyphotic: 0.0% vs no change: 18.4% vs lordotic: 35.0%; p = 0.049). Logistic regression revealed thoracic flexibility (p = 0.045) as the only independent correlate of PJK. CONCLUSIONS Half of patients with ASD experienced significant changes in TK during supine positioning, a quality that may influence surgical strategy. Increased thoracic flexibility is associated with PJK, possibly secondary to fusing the patient’s spine in a flattened position intraoperatively.

scholarly journals The Pelvic Incidence Stratified Sagittal Spinopelvic Alignment in Asymptomatic Chinese Population With Different Age Groups

2021 ◽  
pp. 219256822198964
Author(s):  
Siyu Zhou ◽  
Zhuoran Sun ◽  
Wei Li ◽  
Da Zou ◽  
Weishi Li
Keyword(s):  
Chinese Population ◽  
Pelvic Incidence ◽  
Sagittal Alignment ◽  
Age Groups ◽  
Vertical Axis ◽  
Elderly Subjects ◽  
Sagittal Vertical Axis ◽  
Cross Sectional ◽  
Sagittal Parameters ◽  
Very High

Study Design: Cross-sectional study. Objective: To provide the age- and pelvic incidence-related variations of sagittal alignment in asymptomatic Chinese population. Methods: This study recruited asymptomatic adult subjects. All subjects undertook the standing whole spinal radiograph and the sagittal parameters were measured: sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI) and pelvic tilt (PT). All subjects were divided into young, middle aged and elderly groups, then each age group was further divided into 5 subgroups (very low, low, average, high and very high) based on PI values. The relations between PI, age and other parameters were evaluated. The differences in sagittal parameters of each PI subgroup were compared. Results: 546 subjects were included with an average age of 38.6 years (18 to 81). The number of subjects over 70 years and with very low PI was relatively small. The average of PI, TPA, PT and LL were 45.9° ± 8.4°, 6.4° ± 6.2°, 11.9° ± 6.6° and 49.2° ± 10.1°, respectively. SVA, TPA, TK and PT increased with age ( P < 0.05), while SVA, TPA, PT, PI-LL also increased with PI ( P < 0.05). LL, PT, TPA, PI-LL and LL-TK were different among the 5 PI subgroups ( P < 0.05). However, the values of LL in elderly subjects with high and very high PI were similar. Conclusion: The age- and PI-related variations in sagittal alignment of Chinese population were provided. The sagittal parameters were significantly influenced by age and PI. The individual pelvic morphology should be carefully considered during the assessment and restoration of sagittal balance.

scholarly journals Normal Age-Adjusted Sagittal Spinal Alignment Is Achieved with Surgical Correction in Adolescent Idiopathic Scoliosis

2017 ◽  
Vol 11 (5) ◽  
pp. 770-779 ◽  
Author(s):  
Subaraman Ramchandran ◽  
Norah Foster ◽  
Akhila Sure ◽  
Thomas J. Errico ◽  
Aaron J. Buckland
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Incidence ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Surgical Correction ◽  
Sagittal Vertical Axis

<sec><title>Study Design</title><p>Retrospective analysis.</p></sec><sec><title>Purpose</title><p>Our hypothesis is that the surgical correction of adolescent idiopathic scoliosis (AIS) maintains normal sagittal alignment as compared to age-matched normative adolescent population.</p></sec><sec><title>Overview of Literature</title><p>Sagittal spino-pelvic alignment in AIS has been reported, however, whether corrective spinal fusion surgery re-establishes normal alignment remains unverified.</p></sec><sec><title>Methods</title><p>Sagittal profiles and spino-pelvic parameters of thirty-eight postsurgical correction AIS patients ≤21 years old without prior fusion from a single institution database were compared to previously published normative age-matched data. Coronal and sagittal measurements including structural coronal Cobb angle, pelvic incidence, pelvic tilt, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, C2–C7 cervical lordosis, C2–C7 sagittal vertical axis, and T1 pelvic angles were measured on standing full-body stereoradiographs using validated software to compare preoperative and 6 months postoperative changes with previously published adolescent norms. A sub-group analysis of patients with type 1 Lenke curves was performed comparing preoperative to postoperative alignment and also comparing this with previously published normative values.</p></sec><sec><title>Results</title><p>The mean coronal curve of the 38 AIS patients (mean age, 16±2.2 years; 76.3% female) was corrected from 53.6° to 9.6° (80.9%, <italic>p</italic>&lt;0.01). None of the thoracic and spino-pelvic sagittal parameters changed significantly after surgery in previously hypo- and normo-kyphotic patients. In hyper-kyphotic patients, thoracic kyphosis decreased (<italic>p</italic>=0.003) with a reciprocal decrease in lumbar lordosis (<italic>p</italic>=0.01), thus lowering pelvic incidence-lumbar lordosis mismatch mismatch (<italic>p</italic>=0.009). Structural thoracic scoliosis patients had slightly more thoracic kyphosis than age-matched patients at baseline and surgical correction of the coronal plane of their scoliosis preserved normal sagittal alignment postoperatively. A sub-analysis of Lenke curve type 1 patients (n=24) demonstrated no statistically significant changes in the sagittal alignment postoperatively despite adequate coronal correction.</p></sec><sec><title>Conclusions</title><p>Surgical correction of the coronal plane in AIS patients preserves sagittal and spino-pelvic alignment as compared to age-matched asymptomatic adolescents.</p></sec>

scholarly journals Revision Strategies for Harrington Rod Instrumentation: Radiographic Outcomes and Complications

2020 ◽  
pp. 219256822096075
Author(s):  
Philip K. Louie ◽  
Sravisht Iyer ◽  
Krishn Khanna ◽  
Garrett K. Harada ◽  
Alina Khalid ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Revision Surgery ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Radiographic Outcomes ◽  
Harrington Rod

Study Design: Retrospective case series. Objective: The purpose of this study is to evaluate the clinical and radiographic outcomes following revision surgery following Harrington rod instrumentation. Methods: Patients who underwent revision surgery with a minimum of 1-year follow-up for flatback syndrome following Harrington rod instrumentation for adolescent idiopathic scoliosis were identified from a multicenter dataset. Baseline demographics and intraoperative information were obtained. Preoperative, initial postoperative, and most recent spinopelvic parameters were compared. Postoperative complications and reoperations were subsequently evaluated. Results: A total of 41 patients met the inclusion criteria with an average follow-up of 27.7 months. Overall, 14 patients (34.1%) underwent a combined anterior-posterior fusion, and 27 (65.9%) underwent an osteotomy for correction. Preoperatively, the most common lower instrumented vertebra (LIV) was at L3 and L4 (61%), whereas 85% had a LIV to the pelvis after revision. The mean preoperative pelvic incidence–lumbar lordosis mismatch and C7 sagittal vertical axis were 23.7° and 89.6 mm. This was corrected to 8.1° and 28.9 mm and maintained to 9.04° and 34.4 mm at latest follow-up. Complications included deep wound infection (12.2%), durotomy (14.6%), implant related failures (14.6%), and temporary neurologic deficits (22.0%). Eight patients underwent further revision surgery at an average of 7.4 months after initial revision. Conclusions: There are multiple surgical techniques to address symptomatic flatback syndrome in patients with previous Harrington rod instrumentation for adolescent idiopathic scoliosis. At an average of 27.7 months follow-up, pelvic incidence–lumbar lordosis mismatch and C7 sagittal vertical axis can be successfully corrected and maintained. However, complication and reoperation rates remain high.

Posterior Cervical Fusion Using Cervical Interfacet Spacers in Patients With Symptomatic Cervical Pseudarthrosis

Neurosurgery ◽  
2015 ◽  
Vol 78 (5) ◽  
pp. 661-668 ◽  
Author(s):  
Manish K. Kasliwal ◽  
Jacquelyn A. Corley ◽  
Vincent C. Traynelis
Keyword(s):  
Neck Pain ◽  
Outcome Measures ◽  
Vertical Axis ◽  
Mean Difference ◽  
Cervical Fusion ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
Arm Pain ◽  
Vas Score ◽  
Posterior Cervical Fusion

Abstract BACKGROUND: Posterior cervical fusion with cervical interfacet spacer (CIS) is a novel allograft technology offering the potential to provide indirect neuroforaminal decompression while simultaneously enhancing fusion by placing the allograft in compression. OBJECTIVE: To analyze the clinical and radiological outcomes after posterior cervical fusion with CIS in patients with symptomatic anterior cervical pseudarthroses. METHODS: Medical records of patients who underwent posterior cervical fusion with CIS for symptomatic pseudarthrosis after anterior cervical diskectomy and fusion were reviewed. Standardized outcome measures such as visual analog scale (VAS) score for neck and arm pain, Neck Disability Index (NDI), and upright lateral cervical radiographs were reviewed. RESULTS: There were 19 patients with symptomatic cervical pseudarthrosis. Preoperative symptoms included refractory neck or arm pain. The average follow-up was 20 months (range, 12-56 months). There was improvement in VAS score for neck pain (P &lt; .004), radicular arm pain (P &lt; .007), and NDI score (P &lt; .06) after surgery, with 83%, 72%, and 67% of patients showing improvement in their VAS neck pain, VAS arm pain, and NDI scores, respectively. Fusion rate was high, with fusion occurring at all levels treated for pseudarthrosis. There was a small improvement in cervical lordosis (mean difference, 2 ± 5.17°; P = .09) and slight worsening of C2-7 sagittal vertical axis after surgery (mean difference, 1.89 ± 7.87 mm; P = .43). CONCLUSION: CIS provides an important fusion technique, allowing placement of an allograft in compression for posterior cervical fusion in patients with anterior cervical pseudarthroses. Although there was improvement in clinical outcome measures after surgery, placement of CIS had no clinically significant impact on cervical lordosis and C2-7 sagittal vertical axis.

scholarly journals Increasing pelvic incidence is associated with more global sagittal imbalance in ankylosing spondylitis with thoracolumbar kyphosis

2019 ◽  
Author(s):  
Diyu Song ◽  
Guoquan Zheng ◽  
Tianhao Wang ◽  
Dengbin Qi ◽  
Yan Wang
Keyword(s):  
Ankylosing Spondylitis ◽  
Pelvic Incidence ◽  
Vertical Axis ◽  
Control Group ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Thoracolumbar Kyphosis ◽  
Spinopelvic Parameters ◽  
Sagittal Vertical Axis ◽  
The Relationship

Abstract Background: Ankylosing spondylitis (AS) patients with kyphosis have an abnormal spinopelvic alignment and pelvic morphology. Most of them focus on the relationship of pelvic tilt (PT) or sacral slope (SS) and deformity, and relatively few studies have addressed the relationship between pelvic incidence (PI) and kyphosis in AS patients. The purpose of this study is to analyze the correlation between pelvic incidence (PI) and the spinopelvic parameters describing local deformity or global sagittal balance in AS patients with thoracolumbar kyphosis. Methods: A total of 94 patients with AS (91 males and 3 females) and 30 controls were reviewed. Sagittal spinopelvic parameters, including PI, PT, SS, thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis(LL), sagittal vertical axis(SVA), T1 pelvic angle(TPA), spinosacral angle(SSA) and spinopelvic angle(SPA) were measured. Statistical analysis was performed to identify the correlation of PI with other parameters. Results: Compared with the control group, the AS patients had significantly higher PI(47.4˚ vs. 43.2˚, P<0.001). PI in AS patients was found to be significantly positively correlated with TPA(r=0.533, R 2 =0.284, P<0.001), and negatively correlated with SPA(r=-0.504, R 2 =0.254, P<0.001). However, no correlations were found between PI and SVA, SSA, TK, TLK or LL in AS patients. Conclusion: The value of PI in AS patients with kyphosis was significantly higher than that of controls. Correlation analysis revealed that increasing PI was significantly correlated with more global sagittal imbalance, not with the local deformity in AS patients with thoracolumbar kyphosis.

scholarly journals Effect of sagittal imbalance on functional disability in patients with degenerative spondylolisthesis

2019 ◽  
Vol 6 (1) ◽  
pp. 31
Author(s):  
Ramdas Maloth
Keyword(s):  
Functional Disability ◽  
Pelvic Incidence ◽  
Sagittal Plane ◽  
Degenerative Spondylolisthesis ◽  
Vertical Axis ◽  
P Value ◽  
Sagittal Imbalance ◽  
Sagittal Vertical Axis ◽  
Cross Sectional ◽  
Digital Radiograph

<p class="abstract"><strong>Background:</strong> Deformity of spine in sagittal plane is a major cause of pain and disability among patients presenting with low back pain to spine clinic. We have studied the effect of spinal sagittal imbalance on functional disability in these patients.</p><p class="abstract"><strong>Methods:</strong> Cross sectional observational study in 50 patients with degenerative spondylolisthesis of more than 45 years age group study done in period of1 years. Subjects underwent standing lateral radiographs of the spine in a relaxed position, facing forward, with their knees maximally extended and their arms raised horizontally forward resting on a support. 2 radiographic films are stitched at baseline using digital radiograph operating console (DROC) software.</p><p class="abstract"><strong>Results: </strong>In our study out of 50 patients we observed female preponderance, female:male 3:1, degenerative spondylolisthesis more commonly involves L4-L5 level (46 patients). 58% of patients with severe degenerative spondylolisthesis. There is significant correlation between sagittal vertical axis (SVA) and severity (p=0.015) in both grade 1 and grade 2 DS, there is significant correlation between pi and functional disability (p=0.001 and 0.010 respectively) it is found that pelvic tilt with p=0.02 and sagittal vertical axis with p value 0.036 are the two most significant variables at the end of backward elimination analysis.</p><p class="abstract"><strong>Conclusions:</strong> Sagittal imbalance is seen in degenerative spondylolisthesis which needs further evaluation with spinopelvic parameters. Pelvic incidence and sagittal vertebral axis are important determinants of functional disability in patients with degenerative spondylolisthesis. Individuals with high pelvic incidence and more lumbo pelvic kyphosis showed more functional disability compared to others.</p>

Association of findings on preoperative extension lateral cervical radiography with osteotomy type, approach, and postoperative cervical alignment after cervical deformity surgery

2021 ◽  
pp. 1-6
Author(s):  
Hai V. Le ◽  
Joseph B. Wick ◽  
Renaud Lafage ◽  
Gregory M. Mundis ◽  
Robert K. Eastlack ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Approach ◽  
Vertical Axis ◽  
Spine Deformity ◽  
Lower Grade ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
T1 Slope ◽  
Radiographic Parameters ◽  
Cervical Spine Radiography

OBJECTIVE The authors’ objective was to determine whether preoperative lateral extension cervical spine radiography can be used to predict osteotomy type and postoperative alignment parameters after cervical spine deformity surgery. METHODS A total of 106 patients with cervical spine deformity were reviewed. Radiographic parameters on preoperative cervical neutral and extension lateral radiography were compared with 3-month postoperative radiographic alignment parameters. The parameters included T1 slope, C2 slope, C2–7 cervical lordosis, cervical sagittal vertical axis, and T1 slope minus cervical lordosis. Associations of radiographic parameters with osteotomy type and surgical approach were also assessed. RESULTS On extension lateral radiography, patients who underwent lower grade osteotomy had significantly lower T1 slope, T1 slope minus cervical lordosis, cervical sagittal vertical axis, and C2 slope. Patients who achieved more normal parameters on extension lateral radiography were more likely to undergo surgery via an anterior approach. Although baseline parameters were significantly different between neutral lateral and extension lateral radiographs, 3-month postoperative lateral and preoperative extension lateral radiographs were statistically similar for T1 slope minus cervical lordosis and C2 slope. CONCLUSIONS Radiographic parameters on preoperative extension lateral radiography were significantly associated with surgical approach and osteotomy grade and were similar to those on 3-month postoperative lateral radiography. These results demonstrated that extension lateral radiography is useful for preoperative planning and predicting postoperative alignment.

scholarly journals Association between bicortical screw fixation at upper instrumented vertebra and risk for upper instrumented vertebra fracture

2017 ◽  
Vol 26 (5) ◽  
pp. 638-644 ◽  
Author(s):  
Young-Seop Park ◽  
Seung-Jae Hyun ◽  
Ho Yong Choi ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng
Keyword(s):  
Spinal Deformity ◽  
Pelvic Incidence ◽  
Screw Fixation ◽  
Adult Spinal Deformity ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
The Mean ◽  
Upper Instrumented Vertebra ◽  
Bicortical Screw

OBJECTIVEThe aim of this study was to investigate the risk of upper instrumented vertebra (UIV) fractures associated with UIV screw fixation (unicortical vs bicortical) and polymethylmethacrylate (PMMA) augmentation after adult spinal deformity surgery.METHODSA single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥ 4 levels (that is, the lower instrumented vertebra at the sacrum or pelvis and the UIV of the thoracolumbar spine [T9–L2]) were retrospectively reviewed. Age, sex, follow-up duration, sagittal UIV angle immediately postoperatively including several balance-related parameters (lumbar lordosis [LL], pelvic incidence, and sagittal vertical axis), bone mineral density, UIV screw fixation type, UIV PMMA augmentation, and UIV fracture were evaluated. Patients were divided into 3 groups: Group U, 15 patients with unicortical screw fixation at the UIV; Group P, 16 with bicortical screw fixation and PMMA augmentation at the UIV; and Group B, 21 with bicortical screw fixation without PMMA augmentation at the UIV.RESULTSThe mean number of levels fused was 6.5 ± 2.5, 7.5 ± 2.5, and 6.5 ± 2.5; the median age was 50 ± 29, 72 ± 6, and 59 ± 24 years; and the mean follow-up was 31.5 ± 23.5, 13 ± 6, and 24 ± 17.5 months in Groups U, P, and B, respectively (p > 0.05). There were no significant differences in balance-related parameters (LL, sagittal vertical axis, pelvic incidence–LL, and so on) among the groups. UIV fracture rates in Groups U (0%), P (31.3%), and B (42.9%) increased in sequence by group (p = 0.006). UIV bicortical screw fixation increased the risk for UIV fracture (OR 5.39; p = 0.02).CONCLUSIONSBicortical screw fixation at the UIV is a major risk factor for early UIV compression fracture, regardless of whether a thoracolumbosacral orthosis is used. To reduce the proximal junctional failure, unicortical screw fixation at the UIV is essential in adult spinal deformity correction surgery.

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