Incidence, Risk Factors and Natural Course of Proximal Junctional Kyphosis: Surgical Outcomes Review of Adult Idiopathic Scoliosis. Minimum 5 years Follow-Up.
Spine (Phila Pa 1976). 2012 Feb 21;
Authors: Yagi M, King AB, Boachie-Adjei O
Study Design. Retrospective case series of surgically treated adult scoliosis patients.Objective. The purpose of this study is to evaluate the incidence, risk factors and natural course of proximal junctional kyphosis (PJK) in a long term follow-up of adult idiopathic scoliosis undergoing long instrumented spinal fusion.Summary of Background Data. Although recent reports have showed the prevalence, clinical outcomes and the possible risk factors of PJK, quite a few reports have showed long-term follow-up outcome.Materials and Methods. This is a retrospective review of the charts and x-rays of 76 consecutive patients with adult scoliosis treated with long instrumented spinal fusion. Radiographic measurements and demographic data were reviewed on pre-op, immediate post-op, 2yrs post-op, 5yrs post-op and at follow-up. Postoperative SRS scores and ODI were also evaluated. Means were compared with student’s t test. P value of <0.05 with confidence Interval 95% was considered significant.Results. The mean age was 48.8yrs (23-75yrs) and the average f/u was 7.3yrs (5-14yrs). PJK has been identified in 17pts. The SRS and ODI did not demonstrate significant differences between PJK group and non PJK group, 2pts had additional surgeries performed for local pain. 76% of PJK has been identified within 3months after surgery. Despite 53% of total degree of PJK was progressed within 3 months after surgery, PJK continuously progressed to the final follow-up. Pre-existing low BMD, PSF, fusion to sacrum, inappropriate global spine alignment and greater SVA change were identified as a significant risk for PJK (P = 0.04, P<0.001, P = 0.02, p<0.0001 and p = 0.01).Conclusion. In a long term review of minimum 5 yrs, 76% of PJK occurred within 3 months after surgery. Pre-existing low BMD, PSF, fusion to the sacrum, inappropriate global spine alignment and greater SVA change were significant risk for PJK. Careful long term follow-up should be done for PJK patient.
PMID: 22357097 [PubMed – as supplied by publisher]