ArticleSpine deformity2026
Lower instrumented vertebra distal to both sagittal stable and end vertebrae is associated with reduced distal junctional kyphosis after short-segment three-column osteotomy for osteoporotic kyphosis.
Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo investigate the association between lower instrumented vertebra (LIV) position relative to the sagittal stable vertebra (SSV) and end vertebra (EV) and the risk of distal junctional kyphosis (DJK) after short-segment three-column osteotomy (3CO) for osteoporotic kyphosis, and to explore a simple, hypothesis-generating strategy for LIV selection.
methodsWe retrospectively reviewed 34 consecutive patients with osteoporotic thoracolumbar kyphotic deformity who underwent floating 3CO with short posterior fusion at a single institution. Demographic data, bone mineral density, surgical variables, and pre- and postoperative spinopelvic parameters were collected. DJK at the motion segment below the LIV was assessed on standing lateral radiographs at a minimum follow-up of 2 years. LIV position was categorized relative to the SSV and EV, and its relationship with DJK was evaluated. Multivariable logistic regression was used to explore factors associated with DJK, and the sensitivity and specificity of different LIV selection rules (based on SSV alone, EV alone, or both) were calculated.
resultsDJK developed in 12 of 34 patients (35.3%), and 9 required revision surgery. Patients without DJK more frequently had the LIV placed distal to both the SSV and EV than those with DJK (77.3% vs 16.7%). In multivariable analysis, an LIV distal to both SSV and EV was associated with a lower risk of DJK after adjustment for potential confounders. As a decision rule, choosing an LIV at or distal to both SSV and EV provided the highest sensitivity (83%) with acceptable specificity (73%) for avoiding DJK, compared with strategies based on SSV or EV alone.
conclusionIn short-segment 3CO for osteoporotic kyphosis, placing the LIV distal to both the sagittal stable vertebra and end vertebra was associated with a lower incidence of distal junctional kyphosis and captured most cases at risk. This simple, radiographically based concept for LIV selection is hypothesis-generating and warrants validation in larger multicenter studies.
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