Incidence and risk factors for proximal junctional kyphosis: a meta-analysis

Liu, Fengyu; Wang, Tao; Yang, Sidong; Wang, Hui; Yang, Dalong; Ding, Wenyuan

doi:10.1007/s00586-016-4534-0

Cited by 115 publications

(89 citation statements)

References 39 publications

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“…18,19 The incidence ranges between 10-40%, with reported risk factors including advanced age at surgery, fusion to sacrum, thoracic kyphosis >40˚, low T-score, larger amount of correction, and sagittal vertical axis (SVA) difference >5 cm. 20 However, our findings indicated that proximal and distal junctional kyphosis occurred more frequently in the CoCr group than in the Ti group. The Young's modulus of cortical or cancellous bone ranges from 10.4 GPa-20.7 GPa-much lower than that of Ti or CoCr-and the elastic modulus of CoCr is superior to that of Ti.…”

Section: ‫ܫ‬ = ߨ݀ ସ 64mentioning

confidence: 51%

Comparative Study Between Cobalt Chrome and Titanium Alloy Rods for Multilevel Spinal Fusion: Proximal Junctional Kyphosis More Frequently Occurred in Patients Having Cobalt Chrome Rods

et al. 2017

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Section: ‫ܫ‬ = ߨ݀ ସ 64mentioning

confidence: 51%

Comparative Study Between Cobalt Chrome and Titanium Alloy Rods for Multilevel Spinal Fusion: Proximal Junctional Kyphosis More Frequently Occurred in Patients Having Cobalt Chrome Rods

et al. 2017

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“…To allocate a maximum of 9 points for the quality of selection, exposure, comparability, and results for study participants, this scale for nonrandomized case-controlled studies and cohort studies was applied. [29] …”

Section: Methodsmentioning

confidence: 99%

“…Heterogeneity was analyzed with I 2 test, in which I 2 > 50% implies heterogeneity. [29] All statistical analyses were conducted by using RevMan 5.3 (The Cochrane Collaboration, Oxford, UK) and STATA 12.0 (Stata Corporation, College Station, TX). Sensitivity analysis was conducted to examine the influence of excluding each study.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for dysphagia after anterior cervical spine surgery

et al. 2017

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Background:Dysphagia is a well-known complication following anterior cervical spine surgery. Although risk factors for dysphagia have been reported in the literature, they still remain controversial. This study aims to investigate the risk factors associated with dysphagia following anterior cervical spinal surgery.Methods:PubMed, EMBASE, and The Cochrane Library were searched up to June 2016 for studies examining dysphagia following anterior cervical spinal surgery. Risk factors associated with dysphagia were extracted. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for outcomes. Data analysis was conducted with RevMan 5.3 and STATA 12.0.Results:The final analysis includes a total of 18 distinct studies. The pooled analysis reveals that there are significant differences in female gender (OR = 2.30, 95% CI: 1.76–2.99, P < 0.001), the use of anterior cervical plate (OR = 1.66, 95% CI: 1.05–2.62, P = 0.03), more than 1 surgical level (OR = 2.07, 95% CI: 1.62–2.66, P < 0.001), the upper surgical level at C3/4 (OR = 3.08, 95% CI: 1.44–6.55, P = 0.004), and the use of bone morphogenetic protein-2 (rhBMP-2) (OR = 5.52, 95% CI: 2.16–14.10, P < 0.001). However, no significant difference is found in revision surgery (OR = 1.67, 95% CI: 0.60–4.68, P = 0.33), the type of fusion (OR = 1.02, 95% CI: 0.62–1.67, P = 0.95), and cervical disc arthroplasty (OR = 1.37, 95% CI: 0.75–2.51, P = 0.30).Conclusion:Female gender, the use of anterior cervical plate, more than 1 surgical level, the upper surgical level at C3/4, and the use of rhBMP-2 are the risk factors for dysphagia following anterior cervical spinal surgery. However, revision surgery, the type of fusion, and cervical disc arthroplasty are unassociated with dysphagia. Considering the limited number of studies, this conclusion should be interpreted cautiously, and larger scale studies are required.

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“…Additionally, the development of PJK has been suggested to be associated with patient demographics. 6,10,11 These risk factors were recently identified and studied in a systematic literature review and meta-analysis. The results reported are extensive and demonstrate the relationship between more than 20 risk factors and PJK development.…”

Section: Introductionmentioning

confidence: 99%

Risk Factor Analysis for Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery: A New Simple Scoring System to Identify High-Risk Patients

Lafage

Beyer

Schwab

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: Develop a simple scoring system to estimate proximal junctional kyphosis (PJK) risk. Methods: A total of 417 adult spinal deformity (ASD) patients (80% females, 57.8 years) with 2-year follow-up were included. PJK was defined as a >10° kyphotic angle between the upper-most instrumented vertebra (UIV) and the vertebrae 2 levels above the UIV (UIV+2). Based on a previous literature review, the following point score was attributed to parameters likely to impact PJK development: age >55 years (1 point), fusion to S1/ilium (1 point), UIV in the upper thoracic spine (UIV-UT: 1 point), UIV in the lower thoracic region (UIV-LT: 2 points), flattening of the thoracic kyphosis (TK) relative to the lumbar lordosis (LL; ie, ▵LL − ▵TK) greater than 10° (1 point). Results: At 2 years, the overall PJK rate was 43%. The odds ratios for each risk factor were the following: age >55 years (2.52), fusion to S1/ilium (5.17), UIV-UT (6.63), UIV-LT (8.24), and ▵LL − ▵TK >10° (1.59). Analysis by risk factor revealed a significant impact on PJK (no PJK vs PJK): age >55 years (28% vs 51%, P < .001), LIV S1/ilium (16.3% vs 51.4%, P < .001), UIV in lower thoracic spine (12.0% vs 38.7% vs 52.9%, P < .001), and a >10° surgical reduction in TK relative to LL increase (40.0% vs 51.5%, P < .001). The PJK rate by point score was as follows: 1 = 17%, 2 = 29%, 3 = 40%, 4 = 53%, and 5 = 69%. Conclusion: A pragmatic scoring system was developed that is tied to the increasing risk of PJK. These findings are helpful for surgical planning and preoperative counseling.

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Incidence and risk factors for proximal junctional kyphosis: a meta-analysis

Cited by 115 publications

References 39 publications

Comparative Study Between Cobalt Chrome and Titanium Alloy Rods for Multilevel Spinal Fusion: Proximal Junctional Kyphosis More Frequently Occurred in Patients Having Cobalt Chrome Rods

Comparative Study Between Cobalt Chrome and Titanium Alloy Rods for Multilevel Spinal Fusion: Proximal Junctional Kyphosis More Frequently Occurred in Patients Having Cobalt Chrome Rods

Risk factors for dysphagia after anterior cervical spine surgery

Risk Factor Analysis for Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery: A New Simple Scoring System to Identify High-Risk Patients

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