Proximal Junctional Kyphosis or Failure After Adult Spinal Deformity Surgery - Review of Risk Factors and Its Prevention

Abstract

Proximal junction kyphosis (PJK) is a common imaging finding after long-level fusion, and proximal junctional failure (PJF) is an aggravated form of the progressive disease spectrum of PJK. This includes vertebral fracture of upper instrumented vertebra (UIV) or UIV+1, instability between UIV and UIV+1, neurological deterioration requiring surgery. Many studies have reported on PJK and PJF after long segment instrumentation for adult spinal deformity (ASD). In particular, for spine deformity surgeons, risk factors and prevention strategies of PJK and PJF are very important to minimize reoperation. Therefore, this review aims to help reduce the occurrence of PJK and PJF by updating the latest contents of PJK and PJF by 2023, focusing on the risk factors and prevention strategies of PJK and PJF. We conducted a search on multiple database for articles published until February 2023 using the search keywords “proximal junctional kyphosis,” “proximal junctional failure,” “proximal junctional disease,” and “adult spinal deformity.” Finally, 103 papers were included in this study. Numerous factors have been suggested as potential risks for the development of PJK and PJF, including a high body mass index, inadequate postoperative sagittal balance and overcorrection, advanced age, pelvic instrumentation, and osteoporosis. Recently, with the increasing elderly population, sarcopenia has been emphasized. The quality and quantity of muscle in the surgical site have been suggested as new risk factor. Therefore, spine surgeon should understand the pathophysiology of PJK and PJF, as well as individual risk factors, in order to develop appropriate prevention strategies for each patient.

Autism Spectrum Disorder: Brain Areas Involved, Neurobiological Mechanisms, Diagnoses and Therapies

“…The frequency of ADS in adult patients has been found to be close to the frequency in children just mentioned (2.2%) [1]. Consequences of aging are structural alterations often resulting from the progressive degenerations of abnormal spinal curvature due to the progressive alteration of its elements [11][12][13][14]. These conditions often require minimally invasive surgery of the spinal curvature taking place upon the accurate preparation and recognition of risk factors: pain, loss of function, fatigue and many others [11,14].…”

“…These conditions often require minimally invasive surgery of the spinal curvature taking place upon the accurate preparation and recognition of risk factors: pain, loss of function, fatigue and many others [11,14]. In a minor number of these patients, surgeries need to be repeated [12,13]. In other adult patients, ASD lesions take place in the heart, affected by congenital atrial septal defects, and others take place in the bones [15,16].…”

Re-Evaluating the Long-Term Efficacy of Semi-Rigid Fixation Using a Nitinol Spring Rod in Lumbar Surgery: A Retrospective Study on an Effective Alternative for Reducing Adjacent Segment Disease

“…It also decreases screw loading at the UIV, which can reduce the occurrence of proximal junctional kyphosis. In the context of long-level fusion surgery, some surgeons have employed soft-landing techniques using hooks or bandages to prevent proximal junctional failure and similar issues [17,[28][29][30]. We suggest that these mechanisms may have contributed to our study's observation of a 16.9% incidence rate of radiologic ASD.…”