Distal Junctional Kyphosis after Posterior Spinal Fusion in Lenke 1 and 2 Adolescent Idiopathic Scoliosis-Exploring Detailed Features of the Sagittal Stable Vertebra Concept

Study Design: A retrospective cohort study. Objective: To investigate the factors contributing to the development of postoperative distal junctional kyphosis (DJK) in adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusion (PSF) with lowest instrumented vertebrae (LIV) at or above L1. Methods: Patients with Lenke type 1 or 2 curves who underwent PSF with LIV at or above L1 with a minimum follow-up of 2 years were evaluated. The primary outcome measure was the occurrence of postoperative DJK. Radiographic parameters of sagittal alignment and inclusion/exclusion of sagittal stable vertebra (SSV) in PSF were analyzed to determine their associations with the occurrence of postoperative DJK. Results: Overall, 122 patients (mean age: 15.1 ± 3.2 years) were included. The overall incidence of postoperative DJK was 6.6%. DJK was observed in 19.0% (8/42) of patients whose SSV was not included in PSF and not in patients with SSV included in PSF (n = 80). In the SSV-excluded group, univariate analysis found two significant risk factors for DJK: postoperative thoracic kyphosis (TK, T5-12) and postoperative thoracolumbar kyphosis (TLK, T11-L2). The ROC curve revealed that postoperative TK ≥ 25° and TLK ≥ 10° best predicted the occurrence of postoperative DJK in the SSV-excluded group. The incidence was significantly higher in cases with postoperative TK ≥ 25° or TLK ≥ 10° (7/13 = 53.8%) than in those with postoperative TK < 25° and TLK < 10° (1/29 = 3.4%). Conclusions: The current study revealed that postoperative TK ≥ 25° or postoperative TLK ≥ 10° with SSV excluded from PSF were related to DJK after PSF for Lenke type 1 and type 2 AIS. When the SSV is intended to be spared from PSF to save more motion segments, TK and TLK should be carefully evaluated and attained in a lesser magnitude (TK < 25°, TLK < 10°) after surgery.

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Commentary on “The Incidence of Adding-On or Distal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Treated by Anterior Spinal Fusion to L3 Was Significantly Higher Than by Posterior Spinal Fusion to L3”

Neurospine ◽

10.14245/ns.2142658.329 ◽

2021 ◽

Vol 18 (3) ◽

pp. 464-466

Author(s):

Morio Matsumoto

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Anterior Spinal Fusion ◽

Distal Junctional Kyphosis ◽

Junctional Kyphosis

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The Prevalence of Adding-On or Distal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Treated By Anterior Spinal Fusion to L3 was Significantly Higher Than By Posterior Spinal Fusion to L3

Neurospine ◽

10.14245/ns.2142182.091 ◽

2021 ◽

Author(s):

Seung-Jae Hyun ◽

Lawrence G Lenke ◽

Yongjung Kim ◽

Keith H Bridwell ◽

Meghan Cerpa ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Anterior Spinal Fusion ◽

Distal Junctional Kyphosis ◽

Junctional Kyphosis

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P76. Selection of the lowest instrumented vertebra in thoracic adolescent idiopathic scoliosis Lenke type 1 and 2 following segmental posterior spinal fusion

The Spine Journal ◽

10.1016/j.spinee.2004.05.147 ◽

2004 ◽

Vol 4 (5) ◽

pp. S74 ◽

Cited By ~ 2

Author(s):

Lawrence Lenke ◽

Yong-Jung Kim ◽

Keith Bridwell ◽

Junghoon Kim ◽

Samuel Cho

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Lowest Instrumented Vertebra ◽

Selection Of

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Prediction of Spontaneous Lumbar Curve Correction After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Lenke Type 1 Curves

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000736 ◽

2019 ◽

Vol 32 (2) ◽

pp. E112-E116

Author(s):

Masashi Uehara ◽

Jun Takahashi ◽

Shota Ikegami ◽

Shugo Kuraishi ◽

Toshimasa Futatsugi ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Lumbar Curve ◽

Curve Correction

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Assessment of Proximal Junctional Kyphosis and Shoulder Balance With Proximal Screws versus Hooks in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Spine ◽

10.1097/brs.0000000000002700 ◽

2018 ◽

Vol 43 (22) ◽

pp. E1322-E1328 ◽

Cited By ~ 5

Author(s):

Joshua M. Pahys ◽

Andrew C. Vivas ◽

Amer F. Samdani ◽

Gregory Cunn ◽

Randal R. Betz ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion ◽

Proximal Junctional Kyphosis ◽

Shoulder Balance ◽

Junctional Kyphosis

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Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Global Spine Journal ◽

10.1177/2192568220935107 ◽

2020 ◽

pp. 219256822093510

Author(s):

Yoji Ogura ◽

Steven D. Glassman ◽

Daniel Sucato ◽

M. Timothy Hresko ◽

Leah Y. Carreon

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Pedicle Screw ◽

Standard Procedure ◽

Pedicle Screws ◽

Posterior Spinal Fusion ◽

Proximal Junctional Kyphosis ◽

The Impact ◽

Junctional Kyphosis

Study Design: Longitudinal cohort. Objectives: Posterior spinal fusion (PSF) using all-pedicle screw constructs has become the standard procedure in the treatment of adolescent idiopathic scoliosis (AIS). However, there have been several reports that all-pedicle screw constructs or the use of pedicle screws at the upper instrumented vertebrae (UIV) increases the incidence of proximal junctional kyphosis (PJK). We aimed to evaluate the impact of instrumentation type on the incidence of PJK following PSF for AIS. Methods: We performed a stratified random sampling from 3654 patients enrolled in a multicenter database of surgically treated AIS to obtain a representative sample from all Lenke types. Patients were then allocated into 3 groups based on the instrumentation type: all-pedicle screw (PS), hook at UIV with pedicle screws distally (HT), and hybrid constructs (HB). We measured proximal junctional angle (PJA) and defined PJK as PJA ≥ 10° and PJA progression of >10° at the final follow-up. Results: Fifteen (4.3%) of 345 cases had PJK. PJK was significantly more common in PS (11%) compared with HB (1%) and HT (0%) ( P < .001). PJK patients were similar to non-PJK patients regarding age, sex, curve type, UIV, and preoperative coronal Cobb angle. Thoracic kyphosis was significantly higher in the PJK group before surgery. Patients who developed PJK had a statistically significantly larger negative sagittal balance compared with the non-PJK group. Conclusion: The incidence of PJK was 4.3% and was more common in all-pedicle screw constructs. Using hooks at UIV might be a treatment strategy to limit PJK.

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Residual thoracolumbar/lumbar curve is related to self-image after posterior spinal fusion for Lenke 1 and 2 curves in adolescent idiopathic scoliosis patients

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.2.peds19656 ◽

2020 ◽

Vol 26 (2) ◽

pp. 211-216

Author(s):

Tetsuhiko Mimura ◽

Shota Ikegami ◽

Shugo Kuraishi ◽

Masashi Uehara ◽

Hiroki Oba ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Spinal Fusion ◽

Linear Models ◽

Univariate Analysis ◽

Posterior Spinal Fusion ◽

Research Society ◽

Scoliosis Research Society ◽

Self Image

OBJECTIVEAlthough it is well known that major curve severity in adolescent idiopathic scoliosis (AIS) is inversely related to self-image, surgeons often encounter patients who complain of low self-image with preoperatively mild curves or postoperatively well-corrected main curves, suggesting the presence of other factors. This study examined factors contributing to self-image in AIS.METHODSA total of 86 consecutive patients who underwent posterior spinal fusion for AIS Lenke 1 or 2 curves and were followed for a minimum of 2 years were included in this study of patient self-image based on data that included scores reported on the Scoliosis Research Society survey (SRS-22r). The authors evaluated sex, BMI, Risser grade, age, angle of trunk rotation, Cobb angle of the main thoracic (MT) curve, Cobb angle of the thoracolumbar/lumbar (TL/L) curve, apical vertebral translation (AVT), T5–12 kyphotic angle, and clavicular angle. Univariate and multivariate general linear models were employed to identify preoperative and 2-year postoperative factors that impact self-image.RESULTSUnivariate analysis revealed no significant correlation between preoperative MT curve Cobb angle and SRS-22r self-image score (p = 0.51), although patients with a higher MT curve AVT had a significantly worse preoperative self-image (p < 0.01). Two years postoperatively, larger Cobb angle of the TL/L curve (p = 0.01) and higher Risser grade (p = 0.03) resulted in significantly lower self-image scores. In multivariate testing, preoperative MT curve AVT remained significantly related to diminished self-image (p < 0.01). Two years later, higher TL/L curve (p < 0.01), Risser grade (p = 0.03), and MT curve AVT (p = 0.03) had significant associations with lower self-image scores.CONCLUSIONSPreoperative MT curve AVT appears more strongly related to self-image than does Cobb angle. Two years postoperatively, persistent TL/L region curvature and high Risser grade may also be associated with diminished patient self-image.

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