Osteoporosis is a Risk Factor for Proximal Junctional Failure Following Long Spinal Fusion for Adult Spinal Deformity

Authors: Sharath Mohanty, MD, Amol Gupta, MD, MBA, Harold Fogal, MD, Daniel Tobert, MD, Stuart Hershman, MD

Published: 31 January 2025

Open Access

Abstract

With a globally aging population, the prevalence of adult spinal deformity (ASD) is rising. Since 2005, rates as high as 63% have been reported in geriatric patients, affecting quality of life of over 28 million elderly individuals. The rate of corrective surgery for ASD, aimed at preventing progressive deformity, relieving pain, improving self-image, addressing cardiopulmonary comorbidities, and decompressing neurologic elements, increased by 141% since the early 2000s. This rise was predominantly driven by a 460% rise in the incidence of long-segment deformity correction in the elderly subgroup. Despite advancements in the safety of deformity correction, complications following adult spinal deformity correction are common. Among these complications, proximal junctional failure (PJF) has emerged as a critical modifiable risk factor. We hypothesized that osteoporosis is a significant risk factor for PJF in patients undergoing long spinal fusion for ASD.

Keywords

• Osteoporosis
• Proximal Junctional Failure
• Long Spinal Fusion
• Adult Spinal Deformity

Introduction

With a globally aging population, the prevalence of adult spinal deformity (ASD) is rising. Since 2005, rates as high as 63% have been reported in geriatric patients, affecting quality of life of over 28 million elderly individuals. The rate of corrective surgery for ASD, aimed at preventing progressive deformity, relieving pain, improving self-image, addressing cardiopulmonary comorbidities, and decompressing neurologic elements, increased by 141% since the early 2000s. This rise was predominantly driven by a 460% rise in the incidence of long-segment deformity correction in the elderly subgroup. Despite advancements in the safety of deformity correction, complications following adult spinal deformity correction are common. Among these complications, proximal junctional failure (PJF) has emerged as a critical modifiable risk factor. We hypothesized that osteoporosis is a significant risk factor for PJF in patients undergoing long spinal fusion for ASD.

DATA COLLECTION

Patients with adult spinal deformity (ASD) with a diagnosis of degenerative lumbar stenosis or degenerative lumbar scoliosis were included in the following radiographic and clinical parameters: pelvic incidence minus lumbar lordosis (PI-LL) ≥20°, T1 Pelvic Angle (TPA) ≥20°. Sagittal Vertical Axis (SVA) ≥4 cm, scoliosis ≥50°, global coronal malalignment ≥2 cm, undergoing a three-column osteotomy, or spinal fusion involving at least spine tumors or infections, signed informed consent was obtained at the surgeon’s discretion.

RESULTS

Similarly, osteoporosis patients exhibited higher incidence of construct failure/pseudarthrosis than non-osteoporotic patients (18.1% vs 6.7%, p<0.0001). However, the incidence of construct failure/pseudarthrosis and infection did not differ significantly between groups (11.5% vs. 15.7%, p=0.578; 4.6% vs. 3.7%, p=0.6849, respectively). Complications attributed to other causes were rare in both groups, accounting for 4.6% in osteoporotic and 1.9% in non-osteoporotic patients.

Finally, complications were stratified by time to occurrence, with construct failure being most common in the first year following surgery. Infection is a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK, however osteoporosis as a risk factor for PJF but not PJK.

Limitations

Our study concluded that there was no difference in incidence of PJF between osteoporotic and non-osteoporotic patients. This may be due to the limited number of patients included in the study. Further studies are needed to evaluate PJF in patients undergoing long spinal fusion for ASD.

The manuscript submitted has been reviewed and approved by the authors. The authors declare that there is no conflict of interest.

References

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