The Association of Bone Mineral Density with Distal Junctional Kyphosis and Distal Junctional Failure after Multilevel Spine Fusions: A Systematic Review and Meta-Analysis

Zeyad Daher; Luke L Jouppi; Bryan G Anderson; Clifford Pierre; Donald David Davis; Neel Patel; Julius Gerstmeyer; Gautam Rao; Daniel Norvell; Giorgio Cracchiolo; Amir Abdul-Jabbar; Rod Oskouian; Jens R Chapman

doi:10.1016/j.wneu.2024.123598

The Association of Bone Mineral Density with Distal Junctional Kyphosis and Distal Junctional Failure after Multilevel Spine Fusions: A Systematic Review and Meta-Analysis

World Neurosurg. 2024 Dec 20:123598. doi: 10.1016/j.wneu.2024.123598. Online ahead of print.

Affiliations

¹ Seattle Science Foundation, Seattle, WA.
² Seattle Science Foundation, Seattle, WA; Swedish Neuroscience Institute, Seattle, WA. Electronic address: luke.l.jouppi@gmail.com.
³ Seattle Science Foundation, Seattle, WA; Swedish Neuroscience Institute, Seattle, WA.
⁴ Seattle Science Foundation, Seattle, WA; Swedish Neuroscience Institute, Seattle, WA; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr, University Bochum, Burkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
⁵ Spectrum Research Inc., Steilacoom, WA.

PMID: 39710200
DOI: 10.1016/j.wneu.2024.123598

Abstract

Introduction: Distal junctional kyphosis (DJK) and distal junctional failure (DJF) are known complications of adult multilevel spinal fusion surgery. Previous literature has extensively investigated proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), but DJK and DJF are relatively under-studied. This study investigates the association between bone mineral density (BMD) and DJK/DJF via a Systematic Review (SR) and Meta-Analysis (MA).

Methods: A literature search was conducted across PubMed, Cochrane, Web of Science, Embase, and Scopus to find studies reporting DJK, DJF, and BMD. A 12-month minimum follow-up and radiographic biomarker for BMD (Hounsfield units {HU} or a T-score) individually reported for each patient type were required for inclusion. Studies that did not report individualized biomarkers but provided averaged estimates of the effect of BMD on DJK/DJF development were used for SR.

Results: Our search yielded 12 unique studies with 1,094 patients, of which five studies with a total of 519 patients were suitable for comparison by MA. Patients who developed DJK/DJF had significantly lower HUs (113.17 ± 33.86) than patients who did not develop DJK/DJF (142.51 ± 41.39). No significant difference was found with regards to DEXA measurements, age, or BMI between patients who did and did not develop DJK/DJF.

Conclusions: Patients who developed DJK/DJF had significantly lower CT-measured HU as compared to those without DJK/DJF. Our findings highlight the potential importance of BMD evaluation with CT prior to multilevel spine fusion surgery, though further research would be helpful to evaluate the significance of DEXA-based BMD measurements on DJK/DJF development.

Keywords: Bone Mineral Density; DEXA; Distal Junctional Failure; Distal Junctional Kyphosis; Distal Junctional Problems; Hounsfield Units; Multilevel Spine Fusion.