Mismatch Between Proximal Rod Contouring and Proximal Junctional Angle

Peng, Yan; Bao, Hongda; Qiu, Yong; Bao, Mike; Varghese, Jeffrey; Sun, Xu; Liu, Zhen; Zhu, Zezhang; Qian, Bangping; Zheng, Minghao; Zhu, Feng

doi:10.1097/brs.0000000000001883

Cited by 47 publications

(20 citation statements)

References 28 publications

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“…Both over- and undercorrection of SVA and PI-LL mismatch have been proposed as potential risk factors leading to the development of PJK. Yan et al 13 have suggested that in patients who undergo extensive corrective surgery with sagittal overcorrection, postoperative alignment might not be sustainable, as the body tends to balance itself. For instance, they proposed that patients with an overcorrected sagittal profile would unconsciously generate compensatory mechanisms to realign and correct sagittal balance, commonly via the unfused segments and pelvic compensation.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, they proposed that patients with an overcorrected sagittal profile would unconsciously generate compensatory mechanisms to realign and correct sagittal balance, commonly via the unfused segments and pelvic compensation. 13 Additionally, in patients who undergo aggressive correction, the development of PJK may be influenced by surgical technique. Mauro et al 10 predicted that when rod cantilever techniques with multiple Smith-Peterson osteotomies were used, this could lead to significant stresses at the proximal adjacent disc and vertebrae, which may lead to PJK.…”

Section: Discussionmentioning

confidence: 99%

“…PJK has a multifactorial etiology, with proposed mechanisms, including extensive paraspinal muscle dissection, disruption of the posterior ligamentous tension band, UIV selection, choice of surgical approach, proximal disc degeneration, degree of correction, compression fracture at or around the UIV, facet violation, and patient factors such as age, body mass index (BMI), and the presence of osteoporosis. 1,4,6-14 To our knowledge, only one prior study has performed a systematic review or meta-analysis on the risk factors for PJK. 15 The purpose of this article was to perform a meta-analysis to analyze the surgical, radiographic, and patient-related risk factors associated with PJK and PJF.…”

Section: Introductionmentioning

confidence: 99%

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Surgical, Radiographic, and Patient-Related Risk Factors for Proximal Junctional Kyphosis: A Meta-Analysis

Kim

Phan

Cheung

et al. 2018

Global Spine Journal

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Study Design:Meta-analysis.Objective:Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity with a multifactorial etiology. Many risk factors are controversial and their relative importance are not fully understood. We aimed to identify the surgical, radiographic, and patient-related risk factors associated with PJK and proximal junctional failure (PJF).Methods:A systematic literature search was performed using PubMed, Cochrane Database of Systematic Reviews, and EMBASE. The inclusion criteria included prospective randomized control trials and prospective/retrospective cohort studies of adult patients with radiographic evidence of PJK, which was defined as a proximal junctional sagittal Cobb angle ≥10° and at least 10° greater than the preoperative measurement. Studies required a minimum of 10 patients and 12 months of follow-up.Results:A total of 14 unique studies, including 1908 patients were included. The pooled analysis showed significant differences between the PJK and non-PJK groups in age (weighted mean difference [WMD] −3.80; P = .03), prevalence of osteopenia/osteoporosis (odds ratio [OR] 1.99; P = .0004), preoperative sagittal vertical axis (SVA) (WMD −17.52; P = .02), preoperative lumbar lordosis (LL) (WMD −1.22; P = .002), pedicle screw instrumentation at the upper instrumented vertebra (UIV) (OR 1.67; P = .02), change in SVA (WMD −11.87; P = .01), fusion to sacrum/pelvis/ilium (OR 2.14; P < .00 001), change in LL (WMD −5.61; P = .01), and postoperative SVA (WMD −7.79; P = .008).Conclusions:Our meta-analysis suggests that age, osteopenia/osteoporosis, high preoperative SVA, high postoperative SVA, low preoperative LL, use of pedicle screws at the UIV, SVA change/correction, LL change/correction, and fusion to sacrum/pelvis/iliac region are risk factors for PJK.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical, Radiographic, and Patient-Related Risk Factors for Proximal Junctional Kyphosis: A Meta-Analysis

Kim

Phan

Cheung

et al. 2018

Global Spine Journal

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“…[6,13,14] In addition, it was recently shown that two interesting parameters representing the spine's sagittal alignment at the proximal part of the instrumentation, namely the rod contouring angle (RCA) and its mismatch with the proximal junctional angle (PJA), are associated with the occurrence of PJK. [15,16] Decreased RCA, representing the amount of kyphotic curvature bent into the rod, has been suggested to be a risk factor for PJK, but the importance of a mismatch between PJA and RCA (PJA-RCA) has not been fully understood and has rarely been studied in AIS. [15] Furthermore, spinous processes are often sacrificed during posterior surgery harvesting cancellous bony material for spondylodesis.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis – the Spinous Processes and Proximal Rod Contouring

Boeckenfoerde¹,

Boevingloh²,

Gosheger³

et al. 2022

Preprint

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Proximal Junctional Kyphosis (PJK) as one of the most discussed problems after corrective surgery in adolescent idiopathic scoliosis (AIS), is still not fully clarified and seems to be multifactorial. Biome-chanical and few clinical studies have shown the influence of destruction of posterior ligaments by re-section of spinous processes and some parameters concerning rod contouring as risk factors for PJK. To verify these results 192 patients with AIS and corrective surgery via posterior approach between 2009 and 2017 were included. Radiographic parameters were analyzed preoperatively (preOP), postoperatively (postOP), and with a mean follow up (FU) of 27 months. The participants were divided into two groups (PJK group and non-PJK group). The incidence of PJK was 15.6%. Contrary to the results of biomechanical studies, we could not find any significant influence of the spinous process resection. However, the PJK group had significantly larger preOP T4-T12 kyphosis (31.1°±13.93° vs. 23.3°±14.93°, p=.016). Furthermore, the PJK group showed a significantly larger rod contour angle (RCA) (8.0°±4.44° vs. 5.9°±3.28°, p=.003) and mismatch of postOP proximal junctional angle (PJA) and RCA (3.5°±5.72° vs. 0.9°±4.86°, p=.010) compared to the non-PJK group. An increase of the mismatch of postOP PJA and RCA (OR=1.14, p=.008) and a high RCA are risk factors for PJK and need to be focused on by surgeons.

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“…2,4,5 There are surgical, radiographic, and patient-specific risk factors that may lead to the development of PJK. 2,3,[6][7][8][9][10] Fracture at the upper instrumented vertebrae is the most common mechanism for the development of PJK. 2,7 Proximal junction failure (PJF) generally refers to radiographic findings of PJK coupled with adverse clinical symptoms that can include increasing pain, functional impairment, and even neurologic deficits in severe cases.…”

Section: Introductionmentioning

confidence: 99%

Transpedicular-Transdiscal Cement Augmentation Treatment of Thoracolumbar Fusion Proximal Junctional Failure

et al. 2019

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Background: Long instrumented fusions for adult deformity have a proximal junction kyphosis rate between 20% and 40%. When symptomatic, proximal junctional failure (PJF) often requires revision surgery and is associated with significant morbidity. Vertebral cement augmentation (VCA) has been used for prophylaxis against PJF but has not been previously described as treatment after onset of PJF has occurred. We describe a series of patients with PJF of long posterior spinal fusions that were treated at our institution using a novel VCA technique. Methods: Three patients with PJF above thoracolumbopelvic fusions were retrospectively reviewed following treatment with transpedicular-transdiscal VCA. The medical record was reviewed for demographic data, outcomes scores, and radiographic images. Results: Mean age was 69.3 years. Mean follow-up was 13.3 months. Mean preprocedure visual analog scale score was 8.67, and postprocedure visual analog scale score was 4.00. Mean preprocedure sagittal balance was 9.7 cm, and postprocedure sagittal balance was 5.8 cm. No patients required revision surgery for PJF in the follow-up period. Conclusions: Transpedicular-transdiscal VCA treatment for PJF is safe and may have the potential to prevent the need for revision surgery. Level of Evidence: 4.

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Mismatch Between Proximal Rod Contouring and Proximal Junctional Angle

Abstract: 4.

Cited by 47 publications

References 28 publications

Surgical, Radiographic, and Patient-Related Risk Factors for Proximal Junctional Kyphosis: A Meta-Analysis

Surgical, Radiographic, and Patient-Related Risk Factors for Proximal Junctional Kyphosis: A Meta-Analysis

Risk Factors of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis – the Spinous Processes and Proximal Rod Contouring

Transpedicular-Transdiscal Cement Augmentation Treatment of Thoracolumbar Fusion Proximal Junctional Failure

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