Introduction
To identify the risk factors for distal junctional failure (DJF) in patients treated for adult spine deformity with fusion to L5 and to highlight the significance of preoperative assessment, surgical decision-making, and postoperative care.
Methods
This is a retrospective study of data collected prospectively on the local institutional spine surgery registry (2016-2021). All patients older than 18 years, with a diagnosis of adult spine deformity who underwent long posterior instrumentation to L5 and had a minimum follow-up of 2 years were included in the study. Included patients were divided into two groups, according to whether or not they had developed a DJF. Demographic and radiographic data, corrective strategy, preoperative level of degeneration at L5/S1 and GAP score were compared between the two groups.
Results
Forty-eight patients (n=48) underwent adult deformity surgical correction and long fusion to L5 and satisfied eligibility criteria. At two years follow-up, nine patients (18,7%) developed a DJF that required surgical revision. Thirty-nine patients did not present distal junctional complications. Patients with or without DJF showed significant differences in terms of preoperative spinopelvic parameters (PT: 28°± 6° vs. 23°± 9°, p-value 0.05; DJF group vs. not DJF) and degeneration of L5-S1 (Pfirmann grade L5-S1 disc 3.7±1.0 vs. 2.6±0.8, p-value 0.001; DJF group vs. not DJF) (L5-S1 Facet joint Osteoarthritis 3.1±0.8 vs.2.4±0.8, p-value 0.023; DJF group vs. not DJF).
Discussion
DJF following spinal deformity correction surgery is influenced by a combination of patient-related, surgical and implant-related factors. Fusion construct length, preoperative and postoperative sagittal alignment and the grade of degeneration of the distal disc have been identified as significant risk factors. Surgeons should carefully evaluate these factors and employ appropriate strategies.