Risk Factors for Proximal Junctional Fracture Following Fusion Surgery for Osteoporotic Vertebral Collapse with Delayed Neurological Deficits: A Retrospective Cohort Study of 403 Patients
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- Tamai Koji
- Department of Orthopaedic Surgery, Osaka City University
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- Terai Hidetomi
- Department of Orthopaedic Surgery, Osaka City University
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- Suzuki Akinobu
- Department of Orthopaedic Surgery, Osaka City University
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- Nakamura Hiroaki
- Department of Orthopaedic Surgery, Osaka City University
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- Watanabe Kei
- Department of Orthopaedic Surgery, Niigata University
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- Katsumi Keiichi
- Department of Orthopaedic Surgery, Niigata University
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- Ohashi Masayuki
- Department of Orthopaedic Surgery, Niigata University
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- Shibuya Yohei
- Department of Orthopaedic Surgery, Niigata University
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- Izumi Tomohiro
- Department of Orthopaedic Surgery, Niigata University
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- Hirano Toru
- Department of Orthopaedic Surgery, Niigata University
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- Kaito Takashi
- Department of Orthopaedic Surgery, Osaka University
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- Yamashita Tomoya
- Department of Orthopaedic Surgery, Osaka University
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- Fujiwara Hiroyasu
- Department of Orthopaedic Surgery, Osaka University
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- Nagamoto Yukitaka
- Department of Orthopaedic Surgery, Osaka University
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- Matsuoka Yuji
- Department of Orthopaedic Surgery, Tokyo Medical University
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- Suzuki Hidekazu
- Department of Orthopaedic Surgery, Tokyo Medical University
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- Nishimura Hirosuke
- Department of Orthopaedic Surgery, Tokyo Medical University
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- Tagami Atsushi
- Department of Orthopaedic Surgery, Nagasaki University
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- Yamada Syuta
- Department of Orthopaedic Surgery, Nagasaki University
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- Adachi Shinji
- Department of Orthopaedic Surgery, Nagasaki University
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- Yoshii Toshitaka
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University
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- Ushio Shuta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University
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- Harimaya Katsumi
- Department of Orthopaedic Surgery, Kyushu University
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- Kawaguchi Kenichi
- Department of Orthopaedic Surgery, Kyushu University
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- Yokoyama Nobuhiko
- Department of Orthopaedic Surgery, Kyushu University
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- Oishi Hidekazu
- Department of Orthopaedic Surgery, Kyushu University
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- Doi Toshiro
- Department of Orthopaedic Surgery, Kyushu University
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- Kimura Atsushi
- Department of Orthopaedic Surgery, Jichi Medical University
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- Inoue Hirokazu
- Department of Orthopaedic Surgery, Jichi Medical University
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- Inoue Gen
- Department of Orthopaedic Surgery, Kitasato University
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- Miyagi Masayuki
- Department of Orthopaedic Surgery, Kitasato University
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- Saito Wataru
- Department of Orthopaedic Surgery, Kitasato University
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- Nakano Atsushi
- Department of Orthopaedic Surgery, Osaka Medical College
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- Sakai Daisuke
- Department of Orthopaedic Surgery, Tokai University
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- Nukaga Tadashi
- Department of Orthopaedic Surgery, Tokai University
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- Ikegami Shota
- Department of Orthopaedic Surgery, Shinshu University
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- Shimizu Masayuki
- Department of Orthopaedic Surgery, Shinshu University
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- Futatsugi Toshimasa
- Department of Orthopaedic Surgery, Shinshu University
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- Ohtori Seiji
- Department of Orthopaedic Surgery, Chiba University
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- Furuya Takeo
- Department of Orthopaedic Surgery, Chiba University
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- Orita Sumihisa
- Department of Orthopaedic Surgery, Chiba University
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- Imagama Shiro
- Department of Orthopaedic Surgery, Nagoya University
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- Ando Kei
- Department of Orthopaedic Surgery, Nagoya University
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- Kobayashi Kazuyoshi
- Department of Orthopaedic Surgery, Nagoya University
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- Kiyasu Katsuhito
- Department of Orthopaedic Surgery, Kochi University
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- Murakami Hideki
- Department of Orthopaedic Surgery, Kanazawa University
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- Yoshioka Katsuhito
- Department of Orthopaedic Surgery, Kanazawa University
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- Seki Shoji
- Department of Orthopaedic Surgery, University of Toyama
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- Hongo Michio
- Department of Orthopaedic Surgery, Akita University
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- Kakutani Kenichiro
- Department of Orthopaedic Surgery, Kobe University
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- Yurube Takashi
- Department of Orthopaedic Surgery, Kobe University
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- Aoki Yasuchika
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center
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- Oshima Masashi
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital
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- Takahata Masahiko
- Department of Orthopaedic Surgery, Hokkaido University
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- Iwata Akira
- Department of Orthopaedic Surgery, Hokkaido University
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- Endo Hirooki
- Department of Orthopaedic Surgery, Iwate Medical University
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- Abe Tetsuya
- Department of Orthopaedic Surgery, University of Tsukuba
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- Tsukanishi Toshinori
- Department of Orthopaedic Surgery, University of Tsukuba
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- Nakanishi Kazuyoshi
- Department of Orthopaedic Surgery, Hiroshima University
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- Watanabe Kota
- Department of Orthopaedic Surgery, Keio University
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- Hikata Tomohiro
- Department of Orthopaedic Surgery, Keio University
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- Suzuki Satoshi
- Department of Orthopaedic Surgery, Keio University
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- Isogai Norihiro
- Department of Orthopaedic Surgery, Keio University
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- Okada Eijiro
- Department of Orthopaedic Surgery, Keio University
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- Funao Haruki
- Department of Orthopaedic Surgery, Keio University Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare
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- Ueda Seiji
- Department of Orthopaedic Surgery, Keio University
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- Shiono Yuta
- Department of Orthopaedic Surgery, Keio University
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- Nojiri Kenya
- Department of Orthopaedic Surgery, Keio University
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- Hosogane Naobumi
- Department of Orthopaedic Surgery, National Defense Medical College Department of Orthopaedic Surgery, Keio University
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- Ishii Ken
- Department of Orthopaedic Surgery, Keio University Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare
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Abstract
<p>Introduction: Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC.</p><p>Methods: This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for ≥2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis.</p><p>Results: Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm2 (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228).</p><p>Conclusions: PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm2 may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.</p>
Journal
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- Spine Surgery and Related Research
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Spine Surgery and Related Research 3 (2), 171-177, 2019-04-27
The Japanese Society for Spine Surgery and Related Research
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Details 詳細情報について
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- CRID
- 1390001288133796480
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- NII Article ID
- 130007639216
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- ISSN
- 2432261X
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- HANDLE
- 20.500.14094/90005958
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- Text Lang
- en
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- Data Source
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- JaLC
- IRDB
- Crossref
- CiNii Articles
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- Abstract License Flag
- Disallowed