Prediction of Post-Operative PJK After Thoracolumbar Fusion by Evaluating the Cervical Inclination Angle (CIA).

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

SB

Stéphane Bourret, n/a

Clinical Research Associate - PhD
Polyclinique Bordeaux Nord Aquitaine
Bordeaux, France

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EQ

Emanuele Quarto, n/a

M.D.
Università degli studi di Genova
Genoa, Italy
LB

Lisa Boue, n/a

Polyclinique Bordeaux Nord Aquitaine
Bordeaux, France
TC

Thibault CLOCHE, n/a

M.D.
VERTEBRA Institute - Polyclinique Bordeaux Nord Aquitaine
Bordeaux, France
WT

Wendy Thompson, n/a

M.D.
VERTEBRA Institute - Polyclinique Bordeaux Nord Aquitaine
Bordeaux, France
LB

Laurent Balabaud, n/a

M.D.
VERTEBRA Institute - Polyclinique Bordeaux Nord Aquitaine
Bordeaux, France

Presenting Author (Person doing the Podium Present(s)

JL

Jean Charles Le Huec, n/a

MD, PhD
VERTEBRA Institute - Polyclinique Bordeaux Nord Aquitaine
Bordeaux, France

Submitter(s)

SB

Stéphane Bourret, n/a

Clinical Research Associate - PhD
Polyclinique Bordeaux Nord Aquitaine
Bordeaux, France

View E-Poster

Disclosure(s):

Stéphane Bourret, n/a: No financial relationships to disclose

Introduction: Cervical Inclination Angle (CIA) has been recently introduced as a key sagittal parameter which will play an important role in the evaluation of the sagittal balance. Recent study described that it remains constant over the ages until the age of 60 years old and its normal values in an asymptomatic population are between 70° and 80° depending on the vertebra of interest. Due to its close correlation with other sagittal parameters (Roussouly type, Thoracic kyphosis, C7 slope and OD-HA), CIA was assumed to be a useful tool to assess the lever arm on the thoracic spine after an ASD surgery and could predict the occurrence of a proximal junctional kyphosis (PJK) when its value is less than 65°.
Aims/

Objective: The aim of this preliminary evaluation is to apply the Cervical Inclination Angle in a symptomatic population to predict the occurrence of PJK or PJF after long segment spinal fusion.

Methods: Sagittal full-spine EOS acquisitions from patients who underwent a posterior thoracolumbar fusion including T12 to S1 were analyzed individually. CIA of the upper instrumented vertebra (UIV) as well as the distance of the UIV form the C2-plumbline were measured on preoperative and immediate post-operative (before discharge) EOS acquisitions. Measurements were performed byone observer who was not aware about the clinical or radiological patient’s condition. Based on the differences between pre and immediate post-operative values, the observer has predicted the risk of PJK as poor, low, high or severe.

Results: Based on the changes in the CIA values, patients were predicted to have a low (n=5) or high (n=3) or severe (n=2) risk of PJK. Among the 10 predictions, 9 were right (the last one was biased due to patient malposition during the EOS acquisition).

Conclusions: Even if these results need to be confirmed on a larger cohort, they demonstrate that the CIA could help in the prediction of the occurrence of PJK after thoracolumbar spinal fusion.