ArticleOrthopaedic surgery2023
Risk Factors for Distal Junctional Problems Following Long Instrumented Fusion for Degenerative Lumbar Scoliosis: Are they Related to the Paraspinal Muscles.
Article in Orthopaedic surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.
- Distal junctional failure in posterior cervical and cervicothoracic fusion: A systematic review and meta-analysis of associated factors.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Pooled it
- Role of paraspinal muscle fatty infiltration in predicting adjacent segment disease after lumbar spinal fusion: a systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Review
- Relationship between global muscle atrophy and sagittal imbalance in patients with degenerative lumbar scoliosis: a study based on three-dimensional reconstruction.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Characteristic of Paraspinal Muscle Change in Coronal Sub-type of Degenerative Lumbar Scoliosis and its Potential Clinical Significance.Orthopaedic surgery · 2024Article
- Bilateral Spondylolysis of Lumbar Vertebra Secondary to Long Spinal Fusion for Idiopathic Scoliosis: A Case Report and Review of Literature.Orthopaedic surgery · 2024Review
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Authors and funding
4 authors at 1 institution in 1 country.
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Abstract
purposeAlthough the incidence of distal junctional problems (DJPs) following long construct-based treatment for degenerative lumbar scoliosis (DLS) is lower, affected patients are more likely to require revision surgery when they occur. So the aim of this study is to identify risk factors associated with DJPs to avoid its occurrence by at least 1-year follow-up.
methodsA total of 182 DLS patients undergoing long instrumented fusion surgery (≥4 levels) between February 2011 and March 2022 were retrospectively analyzed. Patients were placed into the DJP group if a DJP occurred at the final follow-up; patients without mechanical complications were matched 1:2 according to age, sex and BMI as the control group. Patient characteristics, surgical variables, radiographic parameters, lumbar muscularity and fatty degeneration were analyzed statistically. The statistical differences in the results between the two groups (p values <0.05) and other variables selected by experts were entered into a multivariate logistic regression model, and the forwards likelihood ratio method was used to analyze the independent risk factors for DJPs.
resultsTwenty-four (13.2%) patients suffered a DJP in the postoperative period and the reoperation rate was 8.8%. On univariate analysis, the lowest instrumented vertebra (LIV) CT value (p = 0.042); instrumented levels (p = 0.030); preoperative coronal vertical axis (CVA) (p = 0.046), thoracolumbar kyphosis (TLK) (p = 0.006), L4-S1 lordosis (p = 0.013), sacral slop (SS) (p = 0.030), pelvic tilt (PT) classification (p = 0.004), and sagittal vertical axis (SVA) (p = 0.021); TLK correction (p = 0.049); post-operative CVA (p = 0.029); Overall, There was no significant difference in the paraspinal muscle parameters between the two groups. On multivariate analysis, instrumented levels (OR = 1.595; p = 0.035), preoperative SVA (OR = 1.016; p = 0.022) and preoperative PT (OR = 0.873; p = 0.001) were identified as significant independent risk factors for DJP.
conclusionLonger instrumented levels, a greater preoperative SVA and a smaller PT were found to be strongly associated with the presence of DJPs in patients treated for DLS. The degeneration of the paraspinal muscles may not be related to the occurrence of DJPs. For DLS patients, the occurrence of DJP can be reduced by selecting reasonable fusion segments and evaluating the patient's sagittal balance and spino-pelvic parameters before operation.
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