A Patient-specific Approach to Alignment and Proximal Junctional Kyphosis Risk Assessment in Adult Spinal Deformity Surgery

2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jeffrey M. Hills ◽  
Benjamin M. Weisenthal ◽  
John P. Wanner ◽  
Rishabh Gupta ◽  
Anthony Steinle ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Patient Specific ◽  
Proximal Junctional Kyphosis ◽  
Specific Approach ◽  
Spinal Deformity Surgery ◽  
Junctional Kyphosis

scholarly journals Proximal Junctional Kyphosis and Proximal Junctional Failure Following Adult Spinal Deformity Surgery

2017 ◽  
Vol 14 (4) ◽  
pp. 126-132 ◽  
Author(s):  
Seung-Jae Hyun ◽  
Byoung Hun Lee ◽  
Jong-Hwa Park ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Proximal Junctional Kyphosis ◽  
Spinal Deformity Surgery ◽  
Proximal Junctional Failure ◽  
Junctional Kyphosis

scholarly journals Risk Factor Analysis for Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery: A New Simple Scoring System to Identify High-Risk Patients

2019 ◽  
Vol 10 (7) ◽  
pp. 863-870
Author(s):  
Renaud Lafage ◽  
George Beyer ◽  
Frank Schwab ◽  
Eric Klineberg ◽  
Douglas Burton ◽  
...  
Keyword(s):  
Risk Factor ◽  
Thoracic Spine ◽  
Spinal Deformity ◽  
Scoring System ◽  
Adult Spinal Deformity ◽  
Proximal Junctional Kyphosis ◽  
Point Score ◽  
Spinal Deformity Surgery ◽  
Upper Thoracic ◽  
Junctional Kyphosis

Study Design: Retrospective cohort study. Objective: Develop a simple scoring system to estimate proximal junctional kyphosis (PJK) risk. Methods: A total of 417 adult spinal deformity (ASD) patients (80% females, 57.8 years) with 2-year follow-up were included. PJK was defined as a >10° kyphotic angle between the upper-most instrumented vertebra (UIV) and the vertebrae 2 levels above the UIV (UIV+2). Based on a previous literature review, the following point score was attributed to parameters likely to impact PJK development: age >55 years (1 point), fusion to S1/ilium (1 point), UIV in the upper thoracic spine (UIV-UT: 1 point), UIV in the lower thoracic region (UIV-LT: 2 points), flattening of the thoracic kyphosis (TK) relative to the lumbar lordosis (LL; ie, ▵LL − ▵TK) greater than 10° (1 point). Results: At 2 years, the overall PJK rate was 43%. The odds ratios for each risk factor were the following: age >55 years (2.52), fusion to S1/ilium (5.17), UIV-UT (6.63), UIV-LT (8.24), and ▵LL − ▵TK >10° (1.59). Analysis by risk factor revealed a significant impact on PJK (no PJK vs PJK): age >55 years (28% vs 51%, P < .001), LIV S1/ilium (16.3% vs 51.4%, P < .001), UIV in lower thoracic spine (12.0% vs 38.7% vs 52.9%, P < .001), and a >10° surgical reduction in TK relative to LL increase (40.0% vs 51.5%, P < .001). The PJK rate by point score was as follows: 1 = 17%, 2 = 29%, 3 = 40%, 4 = 53%, and 5 = 69%. Conclusion: A pragmatic scoring system was developed that is tied to the increasing risk of PJK. These findings are helpful for surgical planning and preoperative counseling.

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