Proximal junctional kyphosis in adult scoliosis: comparison of four radiological predictor models

Sebaaly, Amer; Riouallon, Guillaume; Obeid, Ibrahim; Grobost, Pierre; Rizkallah, Maroun; Laouissat, Féthi; Charles, Yann-Phillippe; Roussouly, Pierre

doi:10.1007/s00586-017-5172-x

Cited by 74 publications

(52 citation statements)

References 25 publications

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“…We have found an incidence of 18.4% of PJK in this population similar to that reported in the literature [17]. In a recent evaluation of a large database of adult deformity patients, restoring the sagittal apex of the lordosis and its effects on the incidence of PJK was analyzed [13]. When postoperative sagittal apex of the lumbar curve was identical to the theoretical apex, PJK occurred in 13.5% of the cases, whereas it occurred in 41.4% in cases where the theoretical and actual apex were different (p = 0.01) with an OR = 4.6.…”

Section: Discussionsupporting

confidence: 85%

“…In the recent available medical literature, there are no clear guidelines for ASD correction as PI-LL formula yielded unacceptably high rates of mechanical complications and the updated age specific goals are yet to yield definitive guidelines [12]. Moreover, it has recently been published that restoring the apex of the lordosis to the levels corresponding to the Roussouly classification would reduce the risk of PJK by a ratio of 4.6 [13]. Based on the fact that identification of the correspondence between pelvic incidence and spinal degenerative shape would allow recognizing the original "normal" shape, the proposed algorithm is to restore the low-pelvic-incidence patients to type 1 or type 2 while restoring higher-pelvic-incidence patients to type 3 and type 4.…”

Section: Introductionmentioning

confidence: 99%

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Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

et al. 2019

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Purpose To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. Methods This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. Results A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5-4.3; p < 0.001) Conclusion In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. Level of evidence IV cross-sectional observational study. Graphic abstractThese slides can be retrieved under Electronic Supplementary Material. Sebaaly AY, Gehrchen M, Silvestre C, Kharrat KE, Bari TJ, Kreichati G, Rizkallah M, Roussouly P (2019) Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J;

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

et al. 2019

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“…In our study, the occurrences of PJK were very high when apexes of sagittal lordosis were not at their theoretical position compared to when they're positioned at their theoretical position. These findings are similar to what has been reported in the literature by other scholars (18).…”

Section: Formulasupporting

confidence: 93%

“…Yagi et al (2) in their retrospective review of 157 cases, they found that more than 80% of patient with non-ideal global sagittal alignment (GSA> 45 0 ) developed PJK, and the OR for these patients was 29. Sebaaly et al (18) in their retrospective study of 250 cases of adult idiopathic scoliosis from a multicentric database, found that GSA >45 0 was associated with the occurrences of PJK, with OR 1.7. in this study we also found that GSA> 45 0 is highly associated with occurrences of PJK, with OR 2.5. This might be explained by the reason that increased GSA results in the positive (SVA) and increases the stress for the proximal and distal junctions of instrumentation that lead to the development of PJK (19).…”

Section: Formulamentioning

confidence: 99%

Proximal junction kyphosis in adult scoliosis. best post-operative radiological predictors. Retrospective cohort study.

Manini

Zhang

Wang

et al. 2020

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Background: Proximal junction kyphosis is the post-surgical radiographic event seen in the surgical plane after the fusion of spinal deformity. No common agreement on direct postoperative radiographic prognostic criteria for occurrences of proximal junctional kyphosis that justify close monitoring for the patients. The purpose of this study is to assess which immediate post-surgical radiographic variable is best in forecasting the occurrences of proximal junction kyphosis. Methods: Data for adult scoliosis patients who underwent curve correction were extracted from the hospital database. Pelvic and spinal parameters were measured, Fisher exact test was performed for continuous variables and the Chi-square test was used for noncontinuous variables to compare four immediate post-surgical radiographic variables for occurrences of proximal junctional kyphosis. These variables were; Restoration of hypothetical values of lumbar lordosis and thoracic kyphosis according to pelvic incidence, evaluation of global sagittal alignment. Restoration of the apex of lumbar lordosis to its hypothetical position according to the spine shape and evaluation of positive-sum and negative-sum of lumbar lordosis and thoracic kyphosis. Results: The excellent predictor for occurrences of proximal junctional kyphosis was restoration of the apex of lumbar lordosis to its hypothetical position according to the spine shape. The second good predictor for occurrences of proximal junctional kyphosis was evaluation of global sagittal alignment. The Restoration of hypothetical values of lumbar lordosis and thoracic kyphosis according to pelvic incidence and evaluation of positive-sum and negative-sum of lumbar lordosis and thoracic kyphosis were both poor predictors for occurrences of proximal junction kyphosis. Conclusion: Among the four proposed formulae for predicting occurrences of proximal junctional kyphosis, the position of the sagittal apex of lumbar lordosis is an excellent predictor for the development of proximal junctional kyphosis followed by global sagittal alignment. Therefore, during scoliosis deformity correction hypothetical position of the sagittal apex of lumbar lordosis should be used to decide the level of pedicle subtraction osteotomy or a suitable place to put lordotic cages to reduce the risk of the future occurrences of proximal junctional kyphosis.

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“…Many risk factors have been identified to be associated with the development of PJK� however, development of prediction models is still in early stages with individual precise prediction remaining difficult so far [30].…”

Section: Discussionmentioning

confidence: 99%

Is Sacral Extension a Risk Factor for Early Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery?

et al. 2020

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Study Design: Retrospective cohort study.Purpose: To investigate the role of sacral extension (SE) for the development of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery.Overview of Literature: The development of PJK is multifactorial and different risk factors have been identified. Of these, there is some evidence that SE also affects the development of PJK, but data are insufficient. Methods: Using a combined database comprising two propensity-matched groups of fusions following ASD surgery, one with fixation to S1 or S1 and the ilium (SE) and one without SE but with a lower instrumented vertebra of L5 or higher (lumbar fixation, LF), PJK and the role of further parameters were analyzed. The propensity-matched variables included age, the upper-most instrumented vertebra (UIV), preoperative sagittal alignment, and the baseline to one year change of the sagittal alignment.Results: Propensity matching led to two groups of 89 patients each. The UIV, pelvic incidence minus lumbar lordosis, sagittal vertical axis, pelvic tilt, age, and body mass index were similar in both groups (p >0.05). The incidence of PJK at postoperative one year was similar for SE (30.3%) and LF (22.5%) groups (p =0.207). The PJK angle was comparable (p =0.963) with a change of −8.2° (SE) and −8.3° (LF) from the preoperative measures (p =0.954). A higher rate of PJK after SE (p =0.026) was found only in the subgroup of patients with UIV levels between T9 and T12.Conclusions: Instrumentation to the sacrum with or without iliac extension did not increase the overall risk of PJK. However, an increased risk for PJK was found after SE with UIV levels between T9 and T12.

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Proximal junctional kyphosis in adult scoliosis: comparison of four radiological predictor models

Abstract: Level IV.

Cited by 74 publications

References 25 publications

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Proximal junction kyphosis in adult scoliosis. best post-operative radiological predictors. Retrospective cohort study.

Is Sacral Extension a Risk Factor for Early Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery?

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