The Long-term Fate of Asymptomatic Proximal Junctional Kyphosis Following Long Instrumented Fusion in Elderly Patients with Sagittal Imbalance

Park, Se-Jun; Park, Jin-Sung; Nam, Yunjin; Choi, Yoon‐Ho; Lee, Chong-Suh

doi:10.1097/brs.0000000000004027

Cited by 15 publications

(18 citation statements)

References 25 publications

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“…Park et al compared patients who experienced PJK with those who did not and found no differences between the two groups in SVA. 21 To examine the impact of UIV on postoperative evolution, patients were stratified into those with UT and LT proximal fusion levels. Prior work comparing upper and lower thoracic UIV gives no definitive answers with regard to optimal approach.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Evolution of Sagittal Parameters Over Time Does Not Differ by Upper Instrumented Vertebra

Steinhaus

Lafage

Alluri

et al. 2021

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Study Design. Retrospective cohort study.Objectives. The aim of this study was to examine sagittal alignment over time in adult spinal deformity (ASD) and to understand whether these changes vary by choice of upper instrumented vertebra (UIV). Summary of Background Data. Recent ASD literature has focused on specific alignment goals. Less is known about how sagittal parameters evolve over time after surgical correction and whether these changes differ by choice of UIV. Methods. This was a retrospective review of ASD patients from a single institution. Routine 36 00 sagittal x-rays were obtained preoperatively, before hospital discharge, and at 6 months, 1 year, and 2 years and sagittal parameters were measured. Patients with UIV T6 and above were classified as upper thoracic (UT) and T7 and below as lower thoracic (LT). Results. A total of 102 patients with mean age 66.0 years (AE7.7) were included in the analysis (49 UT, 53 LT). All sagittal and coronal alignment parameters demonstrated significant improvement from preoperatively to any postoperative time point. Although multiple parameters maintained correction over time, others (TK, TPA, and PT) demonstrated significant increase from discharge to 2 years postoperatively, with changes occurring relatively early after surgery, whereas overall global alignment was maintained. Both UT/LT groups demonstrated significantly greater TK from preoperatively to discharge to 6 months (P < 0.05), stabilizing at that time point out to 2 years, whereas TLK preferentially increased in the LT group. There was significant improvement in sagittal vertical axis after surgery, which was maintained out to 2years of follow-up (P > 0.05). Conclusions. Our data suggest that although several key parameters are maintained over time out to 2years postoperatively, TK tends to worsen over time for all patients, whereas TLK preferentially increases in the LT group. Nevertheless, despite these trends, compensatory changes are seen in PT such that global alignment is relatively maintained.

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Section: Discussionmentioning

confidence: 99%

“…This phenomenon holds true even in the setting of proximal junctional kyphosis. Park et al compared patients who experienced PJK with those who did not and found no differences between the two groups in SVA 21 …”

Section: Discussionmentioning

confidence: 99%

Postoperative Evolution of Sagittal Parameters Over Time Does Not Differ by Upper Instrumented Vertebra

Steinhaus

Lafage

Alluri

et al. 2021

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“…All patients met at least 1 or more of the following radiographic criteria: (1) sagittal vertical axis (SVA) ≥50 mm; (2) pelvic incidence (PI)-lumbar lordosis (LL) >10°; and (3) pelvic tilt (PT) >25°. 18,20,21 To eliminate the distal fusion segment-related bias to the SRFD, we only included patients who had their sacrum fused. In 2011, we created the Specific Functional Disability Index (SFDI), a measure for assessing daily specific functional disabilities after long segmented fusion (Table 1).…”

Section: Study Populationmentioning

confidence: 99%

“…9,[13][14][15][16] When looking at the time trends of change in postoperative outcomes after long segmental fusion for ASD, it has been wellknown that radiographic parameters and clinical outcomes can change over time. [17][18][19] In a similar way, we supposed that SRFD may not be a static concept and could change over time after surgery. There are infrequent studies about the time-dependent change in SRFD after long segmental spinal fusion.…”

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confidence: 99%

Time-Dependent Changes in Stiffness-Related Functional Disability After Long Segmental Fusion in Elderly Patients With Adult Spinal Deformity—Minimum 2-Year Follow-up Results

et al. 2023

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BACKGROUND: Although several studies were performed to measure stiffness-related functional disability (SRFD) after long segmental fusion for adult spinal deformity, the evaluation of SRFD was done at a single point in time. We do not know whether the disability will stay the same, worsen, or improve over time. OBJECTIVE: To evaluate the time-dependent changes of SRFD and any factors affecting these changes. METHODS: Patients who had ≥4-segment fusion with the sacrum were reviewed retrospectively. Specific Functional Disability Index (SFDI), consisting of a 12-item tool with 4 categories (sitting on the floor, sanitation activities, lower body activities, and moving activities), was used to assess the severity of SRFD. The SFDI taken at 3 months, 1 year, and 2 years postoperatively and at the last follow-up were used for evaluating the changes in SRFD. The presumed factors affecting these changes were analyzed. RESULTS: This study included 116 patients. Total SFDI scores significantly improved from 3-month to the last follow-up. Among the 4-category of SFDI, sitting on the floor showed the highest scores followed by lower body activities, sanitation activities, and moving activities at all time points. All categories except for sitting on the floor showed significant improvement from 3 months until the last follow-up. This improvement was most pronounced between 3 months and 1 year. American Society of Anaesthesiologists grade was identified as the only factor affecting time-dependent changes. CONCLUSION: SRFD was highest at 3 months, but it improved over time except for sitting on the floor. The improvement was observed greatest between 3 months and 1 year. Patients with less American Society of Anaesthesiologists grade experienced more improvement in SRFD.

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“…Large series have demonstrated similar Scoliosis Research Society (SRS)-24 scores in patients with and without PJK 2,3. Furthermore, radiographic PJK does not herald a need for revision surgery: rates of revision for PJK are as low as one-tenth the incidence of the radiographic finding 4,5. To rectify this issue, investigators have proposed increasing the PJA threshold to 20° or using classification schemes that take into account factors other than the PJA 6–8.…”

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confidence: 99%

Optimizing the Definition of Proximal Junctional Kyphosis: A Sensitivity Analysis

Lovecchio

Lafage

Line

et al. 2022

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Study Design. Diagnostic binary threshold analysis. Objective. (1) Perform a sensitivity analysis demonstrating the test performance metrics for any combination of proximal junctional angle (PJA) magnitude and change; (2) Propose a new proximal junctional kyphosis (PJK) criteria. Summary of Background Data. Previous definitions of PJK have been arbitrarily selected and then tested through retrospective case series, often showing little correlation with clinical outcomes. Materials and Methods. Surgically treated adult spinal deformity patients (≥4 levels fused) enrolled into a prospective, multicenter database were evaluated at a minimum 2-year follow-up for proximal junctional failure (PJF). Using PJF as the outcome of interest, test performance metrics including sensitivity, positive predictive value, and F1 metrics (harmonic mean of precision and recall) were calculated for all combinations of PJA magnitude and change using different combinations of perijunctional vertebrae. The combination with the highest F1 score was selected as the new PJK criteria. Performance metrics of previous PJK definitions and the new PJK definition were compared. Results. Of the total, 669 patients were reviewed. PJF rate was 10%. Overall, the highest F1 scores were achieved when the upper instrumented vertebrae −1 (UIV−1)/UIV+2 angle was measured. For lower thoracic cases, out of all the PJA and magnitude/change combinations tested, a UIV−1/UIV+2 magnitude of −28° and a change of −20° was associated with the highest F1 score. For upper thoracic cases, a UIV−1/UIV+2 magnitude of −30° and a change of −24° were associated with the highest F1 score. Using PJF as the outcome, patients meeting this new criterion (11.5%) at 6 weeks had the lowest survival rate (74.7%) at 2 years postoperative, compared with Glattes (84.4%) and Bridwell (77.4%). Conclusions. Out of all possible PJA magnitude and change combinations, without stratifying by upper thoracic versus lower thoracic fusions, a magnitude of ≤−28° and a change of ≤−22° provide the best test performance metrics for predicting PJF.

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The Long-term Fate of Asymptomatic Proximal Junctional Kyphosis Following Long Instrumented Fusion in Elderly Patients with Sagittal Imbalance

Cited by 15 publications

References 25 publications

Postoperative Evolution of Sagittal Parameters Over Time Does Not Differ by Upper Instrumented Vertebra

Postoperative Evolution of Sagittal Parameters Over Time Does Not Differ by Upper Instrumented Vertebra

Time-Dependent Changes in Stiffness-Related Functional Disability After Long Segmental Fusion in Elderly Patients With Adult Spinal Deformity—Minimum 2-Year Follow-up Results

Optimizing the Definition of Proximal Junctional Kyphosis: A Sensitivity Analysis

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