scholarly journals Incidence and Radiological Risk Factors of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Following Pedicle Screw Instrumentation with Rod Derotation and Direct Vertebral Rotation: A Minimum 5-Year Follow-Up Study

2021 ◽  
Vol 10 (22) ◽  
pp. 5351
Author(s):  
Hong Jin Kim ◽  
Jae Hyuk Yang ◽  
Dong-Gune Chang ◽  
Se-Il Suk ◽  
Seung Woo Suh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Deformity Correction ◽  
Vertebral Rotation ◽  
Proximal Junctional Kyphosis ◽  
Pedicle Screw Instrumentation ◽  
Junctional Kyphosis

Several studies have reported incidence and risk factors for the development of proximal junctional kyphosis (PJK) in patients with adolescent idiopathic scoliosis (AIS). However, there is little information regarding long-term follow-up after pedicle screw instrumentation (PSI) with rod derotation (RD) and direct vertebral rotation (DVR). Sixty-nine AIS patients who underwent deformity correction using PSI with RD and DVR were retrospectively analyzed in two groups according to the occurrence of PJK, with a minimum five-year follow-up, including a non-PJK group (n = 62) and PJK group (n = 7). Radiological parameters were evaluated at preoperative, postoperative, and last follow-up. Incidence for PJK was 10.1% (7/69 patients), with a mean 9.4-year follow-up period. The thoracolumbar/lumbar curve (TL/L curve) was proportionally higher in the PJK group. The proximal compensatory curve was significantly lower in the PJK group than in the non-PJK group preoperatively (p = 0.027), postoperatively (p = 0.001), and at last follow-up (p = 0.041). The development of PJK was associated with the TL/L curve pattern, lower preoperative proximal compensatory curve, and over-correction of the proximal curve for PSI with RD and DVR. Therefore, careful evaluation of compensatory curves as well as of the main curve is important to prevent the development of PJK in the treatment of AIS.

scholarly journals Impact of Pregnancy on Loss of Deformity Correction After Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis

2020 ◽  
Vol 139 ◽  
pp. e121-e126 ◽  
Author(s):  
Pawel Grabala ◽  
Ilkka Helenius ◽  
Suken A. Shah ◽  
A. Noelle Larson ◽  
Jacob M. Buchowski ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Deformity Correction ◽  
Pedicle Screw Instrumentation

Evaluation of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Following Pedicle Screw, Hook, or Hybrid Instrumentation

Spine ◽  
2010 ◽  
Vol 35 (2) ◽  
pp. 177-181 ◽  
Author(s):  
Melvin D. Helgeson ◽  
Suken A. Shah ◽  
Peter O. Newton ◽  
David H. Clements ◽  
Randal R. Betz ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Proximal Junctional Kyphosis ◽  
Hybrid Instrumentation ◽  
Junctional Kyphosis

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

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.

scholarly journals Large Difference between Proximal Junctional Angle and Rod Contouring Angle is a Risk Factor for Proximal Junctional Kyphosis

2019 ◽  
Author(s):  
Jie Wang ◽  
Ningning Yang ◽  
Ming Luo ◽  
Ning Li ◽  
Yonggang Fan ◽  
...  
Keyword(s):  
Risk Factor ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pearson Correlation ◽  
Spinal Instrumentation ◽  
Proximal Junctional Kyphosis ◽  
Single Institution ◽  
Junctional Kyphosis

Abstract Background: There are several risk factors for proximal junctional kyphosis (PJK) in adolescent idiopathic scoliosis (AIS) surgery. Decreased rod contouring angle (RCA) has been proposed as a risk factor for PJK, but the role of difference between proximal junctional angle (PJA) and RCA (PJA-RCA) has not been fully investigated. The aim of this study was to assess the role of PJA-RCA for the development of postoperative PJK in AIS. Methods: We performed a retrospective analysis of 96 AIS patients who underwent posterior segmental spinal instrumentation and fusion between the years 2012 and 2018 (minimum 1.5-year and average 2-year follow-up) at a single institution. Each patient was measured on preoperative, postoperative and final follow-up long-cassette standing radiographs. The PJA-RCA was regarded as a new definition that reflects the match degree between proximal rod contouring and vertebra curvature, and radiographic parameters were compared between PJK and non-PJK group. Results : Among the 96 patients with a mean age of 14.00 years (± 0.82), the overall incidence of PJK was 22%. PJK group showed a significantly greater preoperative SVA (P = 0.032) and larger correction of SVA (P = 0.007) than non-PJK group. At the last follow-up, PJK patients had significantly greater LL (P = 0.046). Patients in the PJK group had significantly greater preoperative PJA-RCA than the non-PJK group (4.07±3.30 vs. 1.42±4.28, P = 0.024). However, RCA was not significantly different between two groups (3.88 ± 4.34 vs. 2.86 ± 3.36, P = 0.405). In addition, Pearson correlation coefficient showed a significant correlation between the change of SVA and the last follow-up PJA (r = -0.208, P = 0.042). Preoperative PJA-RCA and postoperative PJA-RCA demonstrated similar results which showed a strong correlation with the last follow-up PJA (r = 0.528 and r = 0.532 respectively, P < 0.000). Conclusions: As a new reflex of improper rod contouring, large PJA-RCA is a risk factor for PJK in AIS, and PJK might be a compensation mechanism rather than complication when spine is shifted and overcorrected. Keywords: adolescent idiopathic scoliosis, proximal junctional kyphosis, proximal junctional angle, rod contouring angle.

Postoperative proximal junctional kyphosis in Lenke 5C adolescent idiopathic scoliosis following posterior surgery: extending fusion versus thoracolumbar/lumbar fusion

2020 ◽  
Author(s):  
Bowen Hu ◽  
Linnan Wang ◽  
Xin He ◽  
Yueming Song ◽  
Xi Yang ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Lumbar Fusion ◽  
Posterior Fusion ◽  
Proximal Junctional Kyphosis ◽  
Thoracic Inlet ◽  
Posterior Surgery ◽  
Increased Risk ◽  
Junctional Kyphosis

Abstract Background: Proximal junctional kyphosis is a common complication after posterior fusion in adolescent idiopathic scoliosis patients, and was correlated with postoperative change of thoracic kyphosis. However, no previous literature has evaluated the correlation of PJK with thoracervical parameters in the AIS patients. Methods: Data from 61 patients who underwent posterior fusion for Lenke 5C AIS and had 2 years of follow-up were retrospectively reviewed. Patients were fused higher than two levels above the upper-end-vertebra in the extended fusion group (n=32), whereas they were fused below or at UEV+2 in the TL/L fusion group (n=29). Results: During an average follow-up of 32.5 months, 14/61 patients had PJK. The extended fusion group had a greater incidence of PJK than the TL/L fusion group did (11/32 vs. 3/29,P = 0.03) and a significant more decrease of TK than the TL/L group(p<0.01). Patients with PJK had a significantly larger Thoracic inlet angle(TIA) than those without PJK (P <0.01). Multivariate analysis revealed a greater preoperative TIA to be a positive predictor for PJK (p = 0.015). TIA >72° with extended fusion was a risk factor for PJK at final follow-up. The SRS-22 score did not significantly differ between the extended fusion and TL/L fusion groups. Conclusions: TIA could be a predictor of PJK. In Lenke 5C AIS patients, those with TIA >72° were more likely to develop PJK. And extended fusion in patients with Lenke 5C adolescent idiopathic scoliosis may be at an increased risk of proximal junctional kyphosis.

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