Proximal junctional kyphosis in adult spinal deformity: a novel predictive index

2018 ◽  
Vol 27 (9) ◽  
pp. 2303-2311 ◽  
Author(s):  
Jian Zhao ◽  
Mingyuan Yang ◽  
Yilin Yang ◽  
Xin Yin ◽  
Changwei Yang ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Proximal Junctional Kyphosis ◽  
Predictive Index ◽  
Junctional Kyphosis

scholarly journals Proximal Junctional Kyphosis and Proximal Junctional Failure Following Adult Spinal Deformity Surgery

2017 ◽  
Vol 14 (4) ◽  
pp. 126-132 ◽  
Author(s):  
Seung-Jae Hyun ◽  
Byoung Hun Lee ◽  
Jong-Hwa Park ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Proximal Junctional Kyphosis ◽  
Spinal Deformity Surgery ◽  
Proximal Junctional Failure ◽  
Junctional Kyphosis

Proximal Junctional Kyphosis in Adult Spinal Deformity After Segmental Posterior Spinal Instrumentation and Fusion

Spine ◽  
2008 ◽  
Vol 33 (20) ◽  
pp. 2179-2184 ◽  
Author(s):  
Yongjung J. Kim ◽  
Keith H. Bridwell ◽  
Lawrence G. Lenke ◽  
Chris R. Glattes ◽  
Seungchul Rhim ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Spinal Instrumentation ◽  
Proximal Junctional Kyphosis ◽  
Junctional Kyphosis

scholarly journals Posterior Ligamentous Reinforcement of the Upper Instrumented Vertebrae +1 Does Not Decrease Proximal Junctional Kyphosis in Adult Spinal Deformity

2019 ◽  
Vol 10 (6) ◽  
pp. 692-699
Author(s):  
Sravisht Iyer ◽  
Francis Lovecchio ◽  
Jonathan Charles Elysée ◽  
Renaud Lafage ◽  
Michael Steinhaus ◽  
...  
Keyword(s):  
Cohort Study ◽  
Spinal Deformity ◽  
Soft Tissues ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Proximal Junctional Kyphosis ◽  
Propensity Matching ◽  
Surgical Data ◽  
Junctional Kyphosis

Study Design: Retrospective cohort study. Objectives: Violation of the posterior soft tissues is believed to contribute to the development of proximal junctional kyphosis (PJK). Biomechanical and clinical studies suggest that augmentation of the posterior ligamentous structures (PLS) may help prevent PJK. The purpose of this study was to evaluate the effect of PLS augmentation on the rate of PJK at 1 year. Methods: A retrospective single-surgeon cohort study was performed of 108 adult spinal deformity patients who underwent 5 level fusions to the pelvis. Patients were divided into 2 groups: PLS+ patients had reconstruction of the PLS between upper instrumented vertebrae +1 (UIV+1) and UIV−1 with a surgical nylon tape while PLS− patients did not. Demographics, surgical data, and sagittal alignment parameters were compared between the cohorts. The primary outcome of interest was the development of PJK at final follow-up. A subgroup propensity match and logistic regression model were utilized to control for differences in the cohorts. Results: A total of 108 patients met final criteria, 31 patients (28.7%) were PLS+. There were no differences with regard to preoperative or final sagittal alignment parameters, number of levels fused, rates of 3-column osteotomies, and body mass index ( P > .05), though the PLS+ cohort was older and had larger initial sagittal corrections ( P < .05). The rates of PJK for PLS+ (27.3%) and PLS− (28.6%) were similar ( P = .827). After controlling for sagittal correction via propensity matching, PLS+ had no impact on PJK (29% vs 38.7%, P = .367). In our multivariate analysis, only increased sagittal malalignment and failure to restore sagittal balance were retained as significant predictors of PJK. Conclusion: Even after controlling for extent of correction and preoperative sagittal alignment, PLS reinforcement at UIV+1 using a hand-tensioned nylon tape does not reduce the incidence of PJK at 1 year.

Incidence of Acute, Progressive, and Delayed Proximal Junctional Kyphosis Over an 8-Year Period in Adult Spinal Deformity Patients

2019 ◽  
Vol 18 (1) ◽  
pp. 75-82 ◽  
Author(s):  
Frank A Segreto ◽  
Peter G Passias ◽  
Renaud Lafage ◽  
Virginie Lafage ◽  
Justin S Smith ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Management Strategies ◽  
Progressive Increase ◽  
Small Sample ◽  
Annual Incidence ◽  
Proximal Junctional Kyphosis ◽  
Chi Square Analysis ◽  
Junctional Kyphosis

Abstract BACKGROUND Proximal junctional kyphosis (PJK) is a common radiographic complication of adult spinal deformity (ASD) corrective surgery. Although previous literature has reported a 5 to 61% incidence of PJK, these studies are limited by small sample sizes and short-term follow-up. OBJECTIVE To assess the incidence of PJK utilizing a high-powered ASD database. METHODS Retrospective review of a prospective multicenter ASD database. Operative ASD patients &gt; 18 yr old from 2009 to 2017 were included. PJK was defined as ≥ 10° for the sagittal Cobb angle between the inferior upper instrumented vertebra (UIV) endplate and the superior endplate of the UIV + 2. Chi-square analysis and post hoc testing assessed annual and overall incidence of acute (6-wk follow-up [f/u]), progressive (increase in degree of PJK from 6 wk to 1 yr), and delayed (1-yr, 2-yr, and 3-yr f/u) PJK development. RESULTS A total of 1005 patients were included (age: 59.3; 73.5% F; body mass index: 27.99). Overall PJK incidence was 69.4%. Overall incidence of acute PJK was 48.0%. Annual incidence of acute PJK has decreased from 53.7% in 2012 to 31.6% in 2017 (P = .038). Overall incidence of progressive PJK was 35.0%, with stable rates observed from 2009 to 2016 (P = .297). Overall incidence of 1-yr-delayed PJK was 9.3%. Annual incidence of 1-yr-delayed PJK has decreased from 9.2% in 2009 to 3.2% in 2016 (P &lt; .001). Overall incidence of 2-yr-delayed PJK development was 4.3%. Annual incidence of 2-yr-delayed PJK has decreased from 7.3% in 2009 to 0.9% in 2015 (P &lt; .05). Overall incidence of 3-yr-delayed PJK was 1.8%, with stable rates observed from 2009 to 2014 (P = .594). CONCLUSION Although progressive PJK has remained a challenge for physicians over time, significantly lower incidences of acute and delayed PJK in recent years may indicate improving operative decision-making and management strategies.

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