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. 2023 Oct 1;48(19):1348-1353.
doi: 10.1097/BRS.0000000000004719. Epub 2023 May 12.

Impact of Frailty on the Development of Proximal Junctional Failure: Does Frailty Supersede Achieving Optimal Realignment?

Oscar Krol  1 , Kimberly McFarland  1 , Stephane Owusu-Sarpong  2 , Navraj Sagoo  3 , Tyler Williamson  1 , Rachel Joujon-Roche  1 , Peter Tretiakov  1 , Bailey Imbo  1 , Pooja Dave  1 , Jamshaid Mir  1 , Jordan Lebovic  2 , Oluwatobi O Onafowokan  4 , Andrew J Schoenfeld  5 , Rafael De la Garza Ramos  3   6 , Muhammad Burhan Janjua  7 , Daniel M Sciubba  8 , Bassel G Diebo  9 , Shaleen Vira  3 , Justin S Smith  10 , Virginie Lafage  11 , Renaud Lafage  11 , Peter G Passias  1
Affiliations

Impact of Frailty on the Development of Proximal Junctional Failure: Does Frailty Supersede Achieving Optimal Realignment?

Oscar Krol et al. Spine (Phila Pa 1976). .

Abstract

Background: Patients undergoing surgery for adult spinal deformity (ASD) are often elderly, frail, and at elevated risk of adverse events perioperatively, with proximal junctional failure (PJF) occurring relatively frequently. Currently, the specific role of frailty in potentiating this outcome is poorly defined.

Purpose: To determine if the benefits of optimal realignment in ASD, with respect to the development of PJF, can be offset by increasing frailty.

Study design: Retrospective cohort.

Materials and methods: Operative ASD patients (scoliosis >20°, SVA>5 cm, pelvic tilt>25°, or TK>60°) fused to the pelvis or below with available baseline and 2-year (2Y) radiographic and HRQL data were included. The Miller Frailty Index (FI) was used to stratify patients into 2 categories: Not Frail (FI <3) and Frail (>3). Proximal Junctional Failure (PJF) was defined using the Lafage criteria. "Matched" and "unmatched" refers to ideal age-adjusted alignment postoperatively. Multivariable regression determined the impact of frailty on the development of PJF.

Results: Two hundred eighty-four ASD patients met inclusion criteria [62.2yrs±9.9, 81%F, BMI: 27.5 kg/m 2 ±5.3, ASD-FI: 3.4±1.5, Charlson Comorbidity Index (CCI): 1.7±1.6]. Forty-three percent of patients were characterized as Not Frail (NF) and 57% were characterized as Frail (F). PJF development was lower in the NF group compared with the F group (7% vs . 18%; P =0.002). F patients had 3.2 × higher risk of PJF development compared to NF patients (OR: 3.2, 95% CI: 1.3-7.3, P =0.009). Controlling for baseline factors, F unmatched patients had a higher degree of PJF (OR: 1.4, 95% CI:1.02-1.8, P =0.03); however, with prophylaxis, there was no increased risk. Adjusted analysis shows F patients, when matched postoperatively in PI-LL, had no significantly higher risk of PJF.

Conclusions: An increasingly frail state is significantly associated with the development of PJF after corrective surgery for ASD. Optimal realignment may mitigate the impact of frailty on eventual PJF. Prophylaxis should be considered in frail patients who do not reach ideal alignment goals.

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Conflict of interest statement

A.J. S.: AAOS: board or committee member. Journal of Bone and Joint Surgery —American: Editorial or governing board. North American Spine Society: board or committee member. Spine: Editorial or governing board. Springer: Publishing royalties, financial or material support. Wolters Kluwer Health - Lippincott Williams & Wilkins: publishing royalties, financial or material support. D.S.: Baxter: paid consultant. DePuy, A Johnson & Johnson Company: paid consultant. K2M: paid consultant. Medtronic: paid consultant. Nuvasive: paid consultant. Stryker: paid consultant. J.S.S.: Alphatec Spine: stock or stock options. Carlsmed: paid consultant. Cerapedics: paid consultant. DePuy: research support. DePuy, A Johnson & Johnson Company: paid consultant. Journal of Neurosurgery Spine: editorial or governing board. Neurosurgery: editorial or governing board. Nuvasive: IP royalties; paid consultant; research support; stock or stock options. Operative Neurosurgery: editorial or governing board. Scoliosis Research Society: board or committee member. SeaSpine: paid consultant. Spine Deformity: editorial or governing board. Stryker: paid consultant. Thieme: publishing royalties, financial or material support. Zimmer: IP royalties; paid consultant. R.L.: Carlsmed: paid consultant. V.L.: Alphatec Spine: paid consultant. DePuy, A Johnson & Johnson Company: paid presenter or speaker. European Spine Journal: editorial or governing board. Globus Medical: paid consultant. International Spine Study Group: board or committee member. Nuvasive: IP royalties. Scoliosis Research Society: board or committee member. Stryker: paid presenter or speaker. P.G.P.: Cerapedics: other financial or material support. Cervical Scoliosis Research Society: research support. Globus Medical: paid presenter or speaker. Medtronic: paid consultant. Royal Biologics: paid consultant. Spine: editorial or governing board. Spinevision: other financial or material support. SpineWave: paid consultant. Terumo: paid consultant. The remaining authors report no conflicts of interest.

References

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