Risk Factors of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis—The Pelvis and Other Considerations

Lonner, Baron S.; Ren, Yuan; Newton, Peter O.; Shah, Suken A.; Samdani, Amer F.; Shufflebarger, Harry L.; Asghar, Jahangir; Sponseller, Paul D.; Betz, Randal R.; Yaszay, Burt

doi:10.1016/j.jspd.2016.10.003

Cited by 77 publications

(86 citation statements)

References 11 publications

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“…Kim [1]and Wang [2] defined PJK in AIS patients as both an increase of > 10° in kyphosis between the UIV and the UIV + 2 and the final PJA greater than or equal to 10°, which was widely used in AIS patients [1,2,4,5] and was chosen in our study. Previous studies have reported incidences of PJK after surgery for Lenke 5C AIS of 8.49% [4]. Sun et al [3] reported that an increase of PJK larger than 10°o ccurred after selective fusion in 17.1% of patients with Lenke 5C AIS at 2 years postoperatively, which is comparable to the PJK incidence found in the present study (23.0%).…”

Section: Proximal Junctional Kyphosis and Extendned Fusionmentioning

confidence: 99%

“…To reduce the incidence of PJK, it is critical to restore and maintain normal TK [1,2,3,5]. Important risk factors for PJK in AIS include reduction of TK and large preoperative TK [2,4,5].…”

Section: Proximal Junctional Kyphosis and Extendned Fusionmentioning

confidence: 99%

“…PJK is a common complication after posterior fusion in patients with Lenke 5C adolescent idiopathic scoliosis (AIS) [1][2][3][4]. Multiple studies have reported that the risk factors for PJK are a large lumbar lordosis (LL) angle, large sagittal vertical axis (SVA), and low pelvic incidence (PI) [1][2][3][4]. Other factors strongly associated with PJK are a large preoperative TK and large immediately postoperative TK in AIS [2,4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Multiple studies have reported that the risk factors for PJK are a large lumbar lordosis (LL) angle, large sagittal vertical axis (SVA), and low pelvic incidence (PI) [1][2][3][4]. Other factors strongly associated with PJK are a large preoperative TK and large immediately postoperative TK in AIS [2,4,5]. Previous study indicated that the thoracic inlet angle (TIA) was strongly associated with TK, global TK, and cervical kyphosis in AIS patients [6][7][8], and that the TIA is a constant morphological parameter that is not changed by the patient's position or any other conditions.…”

Section: Introductionmentioning

confidence: 99%

“…The choose of upper instrumented vertebra may also be associated with the incidence of PJK in Lenke 5c patients [4]. Posterior thoracolumbar/lumbar (TL/L) fusion is commonly used for Lenke 5C (AIS) [9,10].…”

Section: Introductionmentioning

confidence: 99%

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

Wang

et al. 2020

Preprint

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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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