• Robert Hart, Ian McCarthy, Michael Oʼbrien, Shay Bess, Brett Line, Oheneba Boachie Adjei, Doug Burton, Munish Gupta, Christopher Ames, Vedat Deviren, Khaled Kebaish, Christopher Shaffrey, Kirkham Wood, Richard Hostin, and International Spine Study Group.
• *Oregon Health Sciences University, Portland, OR †Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX; and ‡Southern Methodist University, Dallas, TX; §Baylor Scoliosis Center, Plano, TX ¶Rocky Mountain Scoliosis and Spine, Denver, CO ‖Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY **Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS ††Department of Orthopedic Surgery, University of California Davis, Sacramento, CA ‡‡Department of Neurological Surgery, University of California San Francisco, San Francisco, CA §§Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA; ¶¶Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD ‖‖Department of Neurological Surgery, University of Virginia, Charlottesville, VA ***Massachusetts General Hospital, Boston, MA; and †††Denver, CO.
• Spine. 2013 Sep 1;38(19):E1223-7.

Study DesignMulticenter, retrospective, consecutive case series.ObjectiveThis study aims to identify demographic and radiographical characteristics that influence the decision to perform revision surgery among patients with proximal junctional failure (PJF).Summary Of Background DataRevision rates after PJF remain relatively high, yet the decision criteria for performing revision surgical procedures are not uniform and vary by surgeon. A better understanding of the factors that impact the decision to perform revision surgery is important in order to improve efficiency of surgical treatment of adult spinal deformity.MethodsA cohort of 57 patients with PJF was identified retrospectively from 1218 consecutive patients with adult spinal deformity. PJF was identified on the basis of 10° postoperative increase in kyphosis between upper instrumented vertebra (UIV) and UIV +2, along with 1 or more of the following: fracture of the vertebral body of UIV or UIV +1, posterior osseoligamentous disruption, or pullout of instrumentation at the UIV. Univariate statistical analysis was performed using t tests and Fisher exact tests. Multivariate analysis was performed using logistic regression.ResultsTwenty-seven (47.4%) patients underwent revision surgery within 6 months of the index operation. Regression results revealed that patients with combined posterior/anterior approaches at index were significantly more likely to undergo revision (P = 0.001) as were patients with more extreme proximal junctional kyphosis angulation (P = 0.034). Patients sustaining trauma were also significantly more likely to undergo revision (P = 0.019). Variables approaching but not reaching significance as predictors of revision included female sex (P = 0.066) and higher sagittal vertical axis (SVA) (P = 0.090).ConclusionThe decision to perform revision surgery is complicated and varies by surgeon. Factors that seem to influence this decision include traumatic etiology of PJF, severity of proximal junctional kyphosis angulation, higher SVA, and female sex. Factors that were expected to influence revision but had no statistical effect included soft tissue versus bony mode of failure, age, levels fused, and upper thoracic versus thoracolumbar proximal junction.

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