This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research article
Shibao Lu
Xuanwu Hospital of Capital Medical University
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background. The mechanisms and risk factors for proximal junctional kyphosis of elderly patients may differ from those of non-elderly patients. The risk factors for PJK in the elderly population remain unclear.
Methods. The present study enrolled elderly DSD patients over 65 years of age who underwent thoracolumbar fusion with no less than 3 levels fused. All patients underwent CT and MRI scans preoperatively, and full spine standing X-ray preoperatively, postoperatively and during follow-up with a minimum follow-up of 18 month. Paraspinal muscle cross-sectional area(CSA) and paraspinal muscle fatty infiltration(FI) of erector spinae(ES) and multifidus muscle(MF), LL, PI, PT, SS, PI-LL and vertebra CT HU value were measured. Radiological PJK was defined as a sagittal Cobb angle between the UIV and the two levels above the UIV (UIV+2) of 10° or greater and at least 10° greater than the preoperative measurement. Parameters were compared between PJK and Non-PJK patients.
Result. A total of 259 patients were enrolled. The prevalence of PJK was 35.9%. Compared with Non-PJK group, PJK group had significantly older age at surgery, greater BMI, lower vertebra CT value and greater PI and a larger PI-LL mismatch. Both erector spinae(ES) and multifidus muscle(MF) relative cross-sectional area(rCSA) of PJK patients were significantly smaller, the ES and MF fatty infiltration(FI) were significantly greater than the Non-PJK patients. Older age at surgery, greater BMI, greater PI, smaller MF rCSA, greater ES and MF FI and smaller CT value were independent risk factors for PJK in elderly patient population.
Conclusions. For elderly patients with DSD, PJK is a commonly seen complication. Higher age at surgery, larger BMI, significant paraspinal muscle degeneration and low bone mineral density are risk factors for PJK. Appropriate preoperative and postoperative measures are beneficial for reducing the risk of PJK in the elderly.
Keywords
cross-sectional area(CSA), fatty infiltration(FI), erector spinae(ES), multifidus muscle(MF)
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CURRENT STATUS: Under Review
Version 1
Posted 16 Feb, 2021
No community comments so far
Review #3 received
Received 30 Mar, 2021
Editorial decision: Major revision
On 30 Mar, 2021
Review #1 received
Received 27 Mar, 2021
Review #2 received
Received 21 Mar, 2021
Reviewer #3 agreed
On 17 Mar, 2021
Reviewer #2 agreed
On 15 Mar, 2021
Reviewer #1 agreed
On 09 Mar, 2021
Reviewers invited
Invitations sent on 08 Mar, 2021
Editor assigned
On 09 Feb, 2021
Submission checks complete
On 09 Feb, 2021
Editor invited
On 09 Feb, 2021
First submitted
On 25 Jan, 2021
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Subject Areas
Orthopedics
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This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Shibao Lu
Xuanwu Hospital of Capital Medical University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 16 Feb, 2021
No community comments so far
Review #3 received
Received 30 Mar, 2021
Editorial decision: Major revision
On 30 Mar, 2021
Review #1 received
Received 27 Mar, 2021
Review #2 received
Received 21 Mar, 2021
Reviewer #3 agreed
On 17 Mar, 2021
Reviewer #2 agreed
On 15 Mar, 2021
Reviewer #1 agreed
On 09 Mar, 2021
Reviewers invited
Invitations sent on 08 Mar, 2021
Editor assigned
On 09 Feb, 2021
Submission checks complete
On 09 Feb, 2021
Editor invited
On 09 Feb, 2021
First submitted
On 25 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background. The mechanisms and risk factors for proximal junctional kyphosis of elderly patients may differ from those of non-elderly patients. The risk factors for PJK in the elderly population remain unclear.
Methods. The present study enrolled elderly DSD patients over 65 years of age who underwent thoracolumbar fusion with no less than 3 levels fused. All patients underwent CT and MRI scans preoperatively, and full spine standing X-ray preoperatively, postoperatively and during follow-up with a minimum follow-up of 18 month. Paraspinal muscle cross-sectional area(CSA) and paraspinal muscle fatty infiltration(FI) of erector spinae(ES) and multifidus muscle(MF), LL, PI, PT, SS, PI-LL and vertebra CT HU value were measured. Radiological PJK was defined as a sagittal Cobb angle between the UIV and the two levels above the UIV (UIV+2) of 10° or greater and at least 10° greater than the preoperative measurement. Parameters were compared between PJK and Non-PJK patients.
Result. A total of 259 patients were enrolled. The prevalence of PJK was 35.9%. Compared with Non-PJK group, PJK group had significantly older age at surgery, greater BMI, lower vertebra CT value and greater PI and a larger PI-LL mismatch. Both erector spinae(ES) and multifidus muscle(MF) relative cross-sectional area(rCSA) of PJK patients were significantly smaller, the ES and MF fatty infiltration(FI) were significantly greater than the Non-PJK patients. Older age at surgery, greater BMI, greater PI, smaller MF rCSA, greater ES and MF FI and smaller CT value were independent risk factors for PJK in elderly patient population.
Conclusions. For elderly patients with DSD, PJK is a commonly seen complication. Higher age at surgery, larger BMI, significant paraspinal muscle degeneration and low bone mineral density are risk factors for PJK. Appropriate preoperative and postoperative measures are beneficial for reducing the risk of PJK in the elderly.
Figure 1
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