Distal junctional failure in posterior thoracolumbar surgery: an analysis of spinopelvic alignment and surgical outcomes

OpenAlex İngilizce

AIM: To evaluate the incidence, risk factors, and spinopelvic alignment parameters associated with distal junctional failure (DJF) following posterior thoracolumbar stabilization surgery. MATERIAL AND METHODS: This retrospective cohort study included 40 patients who underwent thoracolumbar stabilization between 2018 and 2024. Patients were divided into two groups: those who developed DJF (n=20) and those who did not (n=20, control group). Radiographic evaluations, including pre- and postoperative lateral radiographs, were used to assess spinopelvic parameters such as lumbar lordosis (LL), pelvic incidence (PI), and PI-LL mismatch. Statistical analyses were conducted to examine the correlation between these parameters and DJF occurrence. RESULTS: The DJF group exhibited a significant postoperative reduction in LL and an increase in PI-LL mismatch compared to the control group, which maintained better sagittal alignment postoperatively (p < 0.05). Patients with higher preoperative PI-LL mismatch were more likely to develop DJF, highlighting the importance of preoperative planning and correction to prevent this complication. CONCLUSION: Optimizing spinopelvic alignment, particularly LL and PI-LL mismatch, is crucial for reducing the risk of DJF after thoracolumbar stabilization surgery. Future studies should aim to refine surgical techniques and strategies to enhance postoperative outcomes and minimize complications.