19 Harley St, London, W1G 9QJ, UK

Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis

STUDY DESIGN: Retrospective case series of surgically treated adult scoliosis patients. OBJECTIVE: To assess the incidence, risk factors and clinical outcomes of proximal junctional kyphosis (PJK) in a large series of adult idiopathic scoliosis patients undergoing long instrumented spinal fusion (.5 vertebrae). A new classification is also projected. SUMMARY OF BACKGROUND DATA: Maintaining both coronal and sagittal balance is essential in the surgical treatment of adult deformity patients. PJK is a well-recognized postoperative phenomenon in adults and adolescents after scoliosis surgery. Despite recent reports, the prevalence, clinical outcomes, and the risk factors of PJK are still controversial. MATERIALS AND METHODS: This study is a retrospective review of the charts and radiographs of 157 consecutive patients with adult scoliosis treated with long instrumented spinal fusion. PJK was defined by a proximal junctional angle greater than 108 and at least 108 greater than the corresponding preoperative measurement. Radiographic measurements included sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL) and pelvic incidence (PI) on preoperative, immediate postoperative and at follow-up. Bone mineral density (BMD), Body mass index (BMI), age, sex, instrumentation type, surgery type, and fusion to sacrum were reviewed. Postoperative SRS outcome scores and Oswestry Disability Index (ODI) were also evaluated. PJK was graded by the severity and type. Means were compared with Student’s t test and chi2 test. P value of less than 0.05 with confidence interval 95% was considered significant. RESULTS: The average age was 46.9 years (22-81 years) and the average Follow-up was 4.3 years (2-12 years). PJK occurred in 32 patients (20%) and were mostly classified as 1A (Ligamentous & mild) deformity. The SRS outcome scores and ODI did not demonstrate significant differences between PJK group and non-PJK group, four patients had additional surgeries performed for local pain. Fusion to the sacrum and posterior fusion with segmental instrumentation were significant risk for PJK (P = 0.03, P < 0.01). BMD, BMI, age, sex, and instrumentation type showed no difference. Eighty-four percent of PJK group was associated with TK 1 LL 1 PI .458 or preoperation to postoperation SVA more than 50 mm vs. 6.4% of non-PJK group (P < 0.01, P < 0.01). CONCLUSION: Despite the occurrence of PJK in 20% of adult scoliosis patients undergoing long fusion, no significant differences were found in SRS outcome scores and ODI in PJK and non-PJK patients. Fusion to the sacrum and posterior fusion with segmental instrumentation were identified as risk factors. PJK can be minimized by post-operative normalization of global sagittal alignment. A simplified classification based in severity type of PJK showed the majority in class 1A (ligamentous lesion and mild deformity) Keywords : Adolescent,Adult,adverse effects,Aged,Aged,80 and over,Analysis of Variance,Body Mass Index,Chi-Square Distribution,classification,diagnostic imaging,Disability Evaluation,epidemiology,etiology,Female,Humans,Incidence,instrumentation,Japan,Kyphosis,Lordosis,Male,methods,Middle Aged,Pain,Patients,Prevalence,prevention & control,Radiography,Retrospective Studies,Risk,Risk Assessment,Risk Factors,Sacrum,Scoliosis,Severity of Illness Index,Spinal Fusion,surgery,Surveys and Questionnaires,Time Factors,Tokyo,Treatment Outcome,Universities,Young Adult,, Risk,Factors,Classification, facet joint injection cost

Date of Publication : 2011 Jan 1

Authors : Yagi M;Akilah KB;Boachie-Adjei O;

Organisation : Hospital for Special Surgery and National Hospital Organization, Murayama Medical Center, Keio University School of Medicine, Tokyo, Japan

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/21192216

The London Spine Unit : Harley Street UK. Specialists in Cutting Edge Technologies for Spinal Surgery

Make an Appointment 

Trustpilot Reviews
Doctify Reviews
Top Doctor Reviews

Incidence, risk factors and classification of proximal junctional kyphosis surgical outcomes review of adult idiopathic scoliosis | Neck pain clinic london

What our patients say ...

Consultant Spine Surgeon
Consultant Spine Surgeon
Consultant Spine Surgeon

This surgical technique consists of a percutaneous approach for the treatment of small to medium size hernias of the intervertebral disc by laser energy. The main objective is to reduce the intradiscal pressure in the nucleus pulposus

Laser Disc Surgery can be performed under local anaesthetic as a day case at our centre on the prestigious Harley Street.
What is London spine unit and How it Works

The London Spine Unit was established in 2005 and has successfully treated over 5000 patients. All conditions are treated.

treatment of all spinal disorders

The London Spine Unit specialises in Minimally Invasive Treatments allowing rapid recovery and return to normal function

Trusted by patients worldwide

The London Spine Unit provides the highest quality care to all patients and has VIP services for those seeking exceptional services

If you have any emergency Doctor’s need, simply call our 24 hour emergency

Your personal case manager will ensure that you receive the best possible care.

Call Now 

+44 844 589 2020
+44 203 973 8810