Incidence, Risk Factors, and Prevention Strategy for Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery

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  • Sakuma Tsuyoshi
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
  • Kotani Toshiaki
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
  • Akazawa Tsutomu
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital Department of Orthopaedic Surgery, St. Marianna University School of Medicine
  • Nakayama Keita
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
  • Iijima Yasushi
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
  • Shiratani Yuki
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital Department of Orthopedic Surgery, Teikyo University Chiba Medical Center
  • Kishida Shunji
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
  • Muramatsu Yuta
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
  • Sasaki Yu
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
  • Ueno Keisuke
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital
  • Ohtori Seiji
    Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University
  • Minami Shohei
    Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital

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<p>Introduction: Proximal junctional kyphosis (PJK) is an acute complication of adult spinal deformity (ASD) surgery and may require re-operation because of proximal junctional failure (PJF). PJK causes and prevention strategies remain unknown. This study aimed to investigate the differences in the backgrounds of patients with PJK, compared to those without PJK, in ASD surgery.</p><p>Methods: We included data from 86 patients who underwent ASD surgery between 2012 and 2018. There were 40 patients (46.5%) with PJK; 46 patients did not have PJK until the last follow-up. We evaluated patient demographics, clinical outcomes, and radiographic parameters, such as Cobb angle and spinopelvic parameters on standing X-ray films, in each group.</p><p>Results: There was no significant difference in patient demographics, clinical outcomes, or preoperative radiographic parameters. Postoperative pelvic incidence minus lumbar lordosis (PI-LL) and pelvic tilt (PT) were significantly lower in the PJK group, and thoracic kyphosis (TK) was higher. The cutoff values were 34.5° for TK, 0.5° for PI-LL, and 15.5° for PT. Other radiographic parameters were not significantly different. PJF developed in seven patients (17.5%) in the PJK group. PJF patients had significantly older age, higher postoperative TK, higher postoperative proximal junctional Cobb angle (PJA), more changes between pre- and postoperative PJA, and lower satisfaction scores on the Scoliosis Research Society Outcomes Questionnaire (SRS-22 satisfaction) than non-PJF patients in the PJK group.</p><p>Conclusions: One risk factor for PJK was lower postoperative PI-LL that was 0° or less. In ASD surgery, the most critical factor in a PJK prevention strategy is to obtain a postoperative LL adjusted by PI, which is >0°.</p>

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