129. Is it possible to recover from distal junctional kyphosis occurrence and reoperation?

Abstract

<h3>BACKGROUND CONTEXT</h3> Distal junctional kyphosis (DJK) remains a primary concern for surgeons performing cervical deformity (CD) surgery. Postoperative complications from CD surgeries often render patients with worse recovery profiles which require reoperation. It is paramount to understand possible DJK recovery profiles for various types of surgical patients. <h3>PURPOSE</h3> Identify if DJK patients successfully recover from treatment/reoperation. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected database. <h3>PATIENT SAMPLE</h3> This study included 145 cervical deformity (CD) patients with baseline and 1-year follow-up. <h3>OUTCOME MEASURES</h3> Complications;reoperations; HRQL, alignment. <h3>Methods</h3> CD patients(patients) were identified if they developed DJK. DJK angle (DJKA) was defined as >10° change in kyphosis between LIV and LIV-2 and a >10° index angle. Patients were stratified into two groups: 1) those who received a reoperation for DJK (Reop DJK) and those that did not have DJK (no DJK). Normalized HRQL scores at baseline and follow-up intervals (3 months, 6 months, 1 year, 2 years) were generated. Normalized HRQLs were plotted and area under the curve was calculated, generating one number describing overall recovery (Integrated Health State [IHS]). <h3>Results</h3> A total of 145 CD patients included. Of these patients, 32% developed DJK postop (56 years, 28.5kg/m2, 53% Female) with 12.8% of these cases being severe. By DJK occurrence: 24.2% within 3 months, 45.4% at 6 months, 31.4% by 1 year. Of these DJK patients, 25.5% received a reoperation. Upon presentation, Reop DJK patients had a worse PI-LL (-11.0 vs .11), worse NSR-Neck (8.7 vs 6.9), and a worse NDI (65.7 vs 53.9; all p<0.05). After receiving operation for their DJK, these patients displayed a worse pain recovery profile identified by their IHS-adjusted score when compared to No DJK patients for NRS-Neck between baseline to 3 months (19.7 vs 11.5; p<0.05). If these patients remain hyperkyphotic (T1-T12) postop, the IHS-adjust scores identified worse long-term recovery (3 months to 2 years) as identified by their EQ5D (52.5 vs 57.5; p<0.05). However, if reop DJK patients are matched according to their age-adjusted SVA (Lafage et al), they were identified to have better short-term recovery than DJK reop patients who were not matched by their NSR-Neck (7.0 vs 11; p<0.05) and then eventually normalizes with the latter's recovery course (p>0.05). Having DJK and not receiving a reop did not have much of an effect on recovery despite DJK angle, however; when compared to DJK reop, when nonop DJK angle was greater than 20°, the IHS-score mJOA adjusted resulted in greater long-term recovery (nonReop:59.9 vs Reop: 48.4; p<0.05). <h3>Conclusions</h3> Of the total DJK patients in this study, 25.5% received a reoperation. These patients had a worse pain recovery profile than non-DJK patients. However; when matched to their age-adjusted SVA, reop DJK patients were shown to have an improved short-term recovery than if they went unmatched according to their IHS-adjusted NSR-Neck. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.