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Risk factors for distal junctional failure in long-construct instrumentation for adult spinal deformity

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Abstract

Purpose

The aim of this study is to identify risk factors associated with postoperative DJF in long constructs for ASD.

Methods

A retrospective review was performed at a tertiary referral spine centre from 01/01/2007 to 31/12/2016. Demographic, clinical and radiographic parameters were collated for patients with DJF in the postoperative period and compared to those without DJF. Survival analyses were performed using univariate logistic regression to identify variables with a p value < 0.05 for inclusion in multivariate analysis. Spearman’s correlations were performed where applicable.

Results

One hundred two patients were identified. 41 (40.2%) suffered DJF in the postoperative period, with rod fracture being the most common sign of DJF (13/65; 20.0%). Mean time to failure was 32.4 months. On univariate analysis, pedicle subtraction osteotomy (p = 0.03), transforaminal lumbar interbody fusion (p < 0.001), pre-op LL (p < 0.01), pre-op SVA (p < 0.01), pre-op SS (p = 0.02), postop LL (p = 0.03), postop SVA (p = 0.01), postop PI/LL (p < 0.001), LL correction (p < 0.001), SVA correction (p < 0.001), PT correction (p = 0.03), PI/LL correction (p < 0.001), SS correction (p = 0.03) all proved significant. On multivariate analysis, pedicle subtraction osteotomy (OR 27.3; p = 0.03), postop SVA (p < 0.01) and LL correction (p = 0.02) remained statistically significant as independent risk factors for DJF.

Conclusion

Recently, DJF has received recognition as its own entity due to a notable postoperative incidence. Few studies to date have evaluated risk factors for DJF. The results of our study highlight that pedicle subtraction osteotomy, poor correction of lumbar lordosis, and sagittal vertical axis are significantly associated with postoperative occurrence of DJF.

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Authors and Affiliations

  1. Royal College of Surgeons in Ireland, Dublin, Ireland

    Jake M. McDonnell

  2. National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland

    Jake M. McDonnell, Daniel P. Ahern, Gráinne Cunniffe & Joseph S. Butler

  3. School of Medicine, University College Dublin, Dublin, Ireland

    Shane R. Evans & Joseph S. Butler

  4. Department of Orthopaedics, Thomas Jefferson University Hospital, Philadelphia, USA

    Christopher Kepler, Alexander Vaccaro & Ian D. Kaye

  5. Department of Orthopaedics, Naval Medical Center, San Diego, USA

    Patrick B. Morrissey

  6. Department of Orthopaedics, Walter Reed National Military Medical Center, Washington, DC, USA

    Scott C. Wagner

  7. Department of Orthopaedics, Mayo Hospital, Rochester, USA

    Arjun Sebastian

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  1. Jake M. McDonnell
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Correspondence to Jake M. McDonnell.

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McDonnell, J.M., Evans, S.R., Ahern, D.P. et al. Risk factors for distal junctional failure in long-construct instrumentation for adult spinal deformity. Eur Spine J 31, 3654–3661 (2022). https://doi.org/10.1007/s00586-022-07396-4

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  • DOI: https://doi.org/10.1007/s00586-022-07396-4

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