UIVにおけるフレキシブルスクリューの使用はPJFを予防できるか？―成人脊柱変形手術の新たな可能性
はじめに：成人脊柱変形（ASD）術後PJK予防におけるUIVでのsagittal flexible screw（SFS）の有用性を検証した．対象及び方法：2023年以降当院においてASDに対してLLIFおよびPPSを用いたcMISを施行し1年以上経過観察可能であった患者を対象とした．UIVにSFSを用いたS群（11名）と用いていないNS群（10名）2群において脊柱骨盤パラメーター，rod contour angle（RCA），pedicle screw angle（PSA），rod screw angle（RSA），PJK/PJF発生率，UIV/UIV-1 angle（UIVA），坐位仰臥位で...
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| Published in | Journal of Spine Research Vol. 16; no. 7; pp. 982 - 988 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脊椎脊髄病学会
20.07.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1884-7137 2435-1563 |
| DOI | 10.34371/jspineres.2025-3024 |
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| Abstract | はじめに：成人脊柱変形（ASD）術後PJK予防におけるUIVでのsagittal flexible screw（SFS）の有用性を検証した．対象及び方法：2023年以降当院においてASDに対してLLIFおよびPPSを用いたcMISを施行し1年以上経過観察可能であった患者を対象とした．UIVにSFSを用いたS群（11名）と用いていないNS群（10名）2群において脊柱骨盤パラメーター，rod contour angle（RCA），pedicle screw angle（PSA），rod screw angle（RSA），PJK/PJF発生率，UIV/UIV-1 angle（UIVA），坐位仰臥位でのUIVAの差（UIVM）を評価した．UIVAはUIV頭側終板とUIV-1の尾側終板とのなす角度，RCAはUIVからL1までのrodの後弯角，PSAはUIVにおける頭側終板とスクリューとのなす角度，RSAはUIVにおけるrodとscrewのなす角度とした．結果：二群間で患者背景，ODI，HU，脊柱骨盤パラメーターにおいて有意差はなかった．またRCA，PSA，RSAにおいても有意差はなかった．術後UIVAにおいて有意差はないもののUIVMはS群2.2°，NS群0.5°であり有意差を認めた．PJFr発生率はS群10％，NS群20％であり有意差はなかった．Screw looseningはS群18％，NS群40％であった．結語：本結果よりSFSは術後UIVの動きを許容でき，固定部から非固定部にかけてのgradual transitionが実現している可能性が示された．本結果からPJK発生率において有意差は無いもののこの固定椎から非固定椎にかけてのgradual transition効果が長期の隣接椎間の変性予防に有用である可能性が示唆された． |
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| AbstractList | はじめに：成人脊柱変形（ASD）術後PJK予防におけるUIVでのsagittal flexible screw（SFS）の有用性を検証した．対象及び方法：2023年以降当院においてASDに対してLLIFおよびPPSを用いたcMISを施行し1年以上経過観察可能であった患者を対象とした．UIVにSFSを用いたS群（11名）と用いていないNS群（10名）2群において脊柱骨盤パラメーター，rod contour angle（RCA），pedicle screw angle（PSA），rod screw angle（RSA），PJK/PJF発生率，UIV/UIV-1 angle（UIVA），坐位仰臥位でのUIVAの差（UIVM）を評価した．UIVAはUIV頭側終板とUIV-1の尾側終板とのなす角度，RCAはUIVからL1までのrodの後弯角，PSAはUIVにおける頭側終板とスクリューとのなす角度，RSAはUIVにおけるrodとscrewのなす角度とした．結果：二群間で患者背景，ODI，HU，脊柱骨盤パラメーターにおいて有意差はなかった．またRCA，PSA，RSAにおいても有意差はなかった．術後UIVAにおいて有意差はないもののUIVMはS群2.2°，NS群0.5°であり有意差を認めた．PJFr発生率はS群10％，NS群20％であり有意差はなかった．Screw looseningはS群18％，NS群40％であった．結語：本結果よりSFSは術後UIVの動きを許容でき，固定部から非固定部にかけてのgradual transitionが実現している可能性が示された．本結果からPJK発生率において有意差は無いもののこの固定椎から非固定椎にかけてのgradual transition効果が長期の隣接椎間の変性予防に有用である可能性が示唆された． |
| Author | 朴 正旭 谷口 愼一郎 谷 陽一 中 信裕 小野 直登 安藤 宗治 足立 崇 石原 昌幸 齋藤 貴徳 川島 康輝 |
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| References | 9) Faulks CR, Biddau DT, Munday NR, et al: Patient-specific spinal rods in adult spinal deformity surgery reduce proximal junctional failure: a review of patient outcomes and surgical technique in a prospective observational cohort. J Spine Surg. 2023; 9 (4): 409-421 10) Ishihara M, Taniguchi S, Kawashima K, et al: Bone fusion morphology after circumferential minimally invasive spine surgery using lateral lumbar interbody fusion and percuta neous pedicle screws without bone grafting in the thoracic spine: a retrospective study. Medicina (Kaunas). 2022; 58: 496 8) Line BG, Bess S, Lafage R, et al: Effective Prevention of Proximal Junctional Failure in Adult Spinal Deformity Surgery Requires a Combination of Surgical Implant Prophylaxis and Avoidance of Sagittal Alignment Overcorrection. Spine (Phila Pa 1976). 2020; 45 (4): 258-267 11) Schreiber JJ, Anderson PA, Rosas HG, et al: Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011; 93 (11): 1057-1063 6) Ishihara M, Taniguchi S, Adachi T, et al: Rod contour and overcorrection are risk factors of proximal junctional kyphosis after adult spinal deformity correction surgery. Eur Spine J. 2021; 30 (5): 1208-1214 14) Lee KY, Lee JH, Kang KC: Preliminary report on the flexible rod technique for prevention of proximal junctional kyphosis following long-segment fusion to the sacrum in adult spinal deformity. J Neurosurg Spine. 2019; 31 (5): 703-710 1) Bess S., Protopsaltis T. S., Lafage V, et al: Clinical and radiographic evaluation of adult spinal deformity. Clin. Spine Surg. 2016; 29: 6-16 13) Vercoulen TFG, Doodkorte RJP, Roth A, et al: Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies. Global Spine J. 2022; 12 (6): 1282-1296 4) Hyun SJ, Kim YJ, Rhim SC, et al: Patients with proximal junctional kyphosis after stopping at thoracolumbar junction have lower muscularity, fatty degeneration at the thoracolumbar area. Spine J. 2016; 16 (9): 1095-1101 16) Eguchi Y, Orita S, Yamada H, et al: Pilot study of oblique lumbar interbody fusion using mobile percutaneous pedicle screw and validation by a three-dimensional finite element assessment. J Clin Neurosci. 2020; 76: 74-80 17) Paholpak P, Shah I, Acevedo-Moreno LA, et al: Thoracic spine disc degeneration, translation, and angular motion: An analysis using thoracic spine kinematic MRI (kMRI). J Clin Neurosci. 2019; 66: 113-120 3) Djurasovic M., Glassman S. D.: Correlation of radiographic and clinical findings in spinal deformities. Neurosurg. Clin. N. Am. 2007; 18: 223-227 15) Cahill PJ, Wang W, Asghar J, et al: The use of a transition rod may prevent proximal junctional kyphosis in the thoracic spine after scoliosis surgery: a finite element analysis. Spine (Phila Pa 1976). 2012; 37: E687-E695 2) Acaroglu E., Yavuz A. C., Guler U. O, et al: A decision analysis to identify the ideal treatment for adult spinal deformity: Is surgery better than nonsurgical treatment in improving health-related quality of life and decreasing the disease burden? Eur. Spine J. 2016; 25: 2390-2400 5) Yagi M, Rahm M, Gaines R, et al: Characterization and surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity. Spine (Phila Pa 1976). 2014; 39: E607-E614 7) Yagi M, Ohne H, Konomi T, et al: Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity. Osteoporos Int. 2016; 27 (12): 3495-3502 12) Hiyama A, Sakai D, Katoh H, et al: Comparative Analysis of Hounsfield Units and Vertebral Bone Quality Scores for Predicting Proximal Junctional Failure in Female Adult Spinal Deformity Patients Undergoing Planned 2-Stage Corrective Surgery with Lateral Lumbar Interbody Fusion. World Neurosurg. 2023; S1878-8750 |
| References_xml | – reference: 8) Line BG, Bess S, Lafage R, et al: Effective Prevention of Proximal Junctional Failure in Adult Spinal Deformity Surgery Requires a Combination of Surgical Implant Prophylaxis and Avoidance of Sagittal Alignment Overcorrection. Spine (Phila Pa 1976). 2020; 45 (4): 258-267 – reference: 4) Hyun SJ, Kim YJ, Rhim SC, et al: Patients with proximal junctional kyphosis after stopping at thoracolumbar junction have lower muscularity, fatty degeneration at the thoracolumbar area. Spine J. 2016; 16 (9): 1095-1101 – reference: 11) Schreiber JJ, Anderson PA, Rosas HG, et al: Hounsfield units for assessing bone mineral density and strength: a tool for osteoporosis management. J Bone Joint Surg Am. 2011; 93 (11): 1057-1063 – reference: 1) Bess S., Protopsaltis T. S., Lafage V, et al: Clinical and radiographic evaluation of adult spinal deformity. Clin. Spine Surg. 2016; 29: 6-16 – reference: 2) Acaroglu E., Yavuz A. C., Guler U. O, et al: A decision analysis to identify the ideal treatment for adult spinal deformity: Is surgery better than nonsurgical treatment in improving health-related quality of life and decreasing the disease burden? Eur. Spine J. 2016; 25: 2390-2400 – reference: 13) Vercoulen TFG, Doodkorte RJP, Roth A, et al: Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies. Global Spine J. 2022; 12 (6): 1282-1296 – reference: 6) Ishihara M, Taniguchi S, Adachi T, et al: Rod contour and overcorrection are risk factors of proximal junctional kyphosis after adult spinal deformity correction surgery. Eur Spine J. 2021; 30 (5): 1208-1214 – reference: 9) Faulks CR, Biddau DT, Munday NR, et al: Patient-specific spinal rods in adult spinal deformity surgery reduce proximal junctional failure: a review of patient outcomes and surgical technique in a prospective observational cohort. J Spine Surg. 2023; 9 (4): 409-421 – reference: 10) Ishihara M, Taniguchi S, Kawashima K, et al: Bone fusion morphology after circumferential minimally invasive spine surgery using lateral lumbar interbody fusion and percuta neous pedicle screws without bone grafting in the thoracic spine: a retrospective study. Medicina (Kaunas). 2022; 58: 496 – reference: 15) Cahill PJ, Wang W, Asghar J, et al: The use of a transition rod may prevent proximal junctional kyphosis in the thoracic spine after scoliosis surgery: a finite element analysis. Spine (Phila Pa 1976). 2012; 37: E687-E695 – reference: 16) Eguchi Y, Orita S, Yamada H, et al: Pilot study of oblique lumbar interbody fusion using mobile percutaneous pedicle screw and validation by a three-dimensional finite element assessment. J Clin Neurosci. 2020; 76: 74-80 – reference: 14) Lee KY, Lee JH, Kang KC: Preliminary report on the flexible rod technique for prevention of proximal junctional kyphosis following long-segment fusion to the sacrum in adult spinal deformity. J Neurosurg Spine. 2019; 31 (5): 703-710 – reference: 7) Yagi M, Ohne H, Konomi T, et al: Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity. Osteoporos Int. 2016; 27 (12): 3495-3502 – reference: 5) Yagi M, Rahm M, Gaines R, et al: Characterization and surgical outcomes of proximal junctional failure in surgically treated patients with adult spinal deformity. Spine (Phila Pa 1976). 2014; 39: E607-E614 – reference: 12) Hiyama A, Sakai D, Katoh H, et al: Comparative Analysis of Hounsfield Units and Vertebral Bone Quality Scores for Predicting Proximal Junctional Failure in Female Adult Spinal Deformity Patients Undergoing Planned 2-Stage Corrective Surgery with Lateral Lumbar Interbody Fusion. World Neurosurg. 2023; S1878-8750 – reference: 17) Paholpak P, Shah I, Acevedo-Moreno LA, et al: Thoracic spine disc degeneration, translation, and angular motion: An analysis using thoracic spine kinematic MRI (kMRI). J Clin Neurosci. 2019; 66: 113-120 – reference: 3) Djurasovic M., Glassman S. D.: Correlation of radiographic and clinical findings in spinal deformities. Neurosurg. Clin. N. Am. 2007; 18: 223-227 |
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| Title | UIVにおけるフレキシブルスクリューの使用はPJFを予防できるか？―成人脊柱変形手術の新たな可能性 |
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