INTRODUCTION: Proximal junctional kyphosis (PJK) of the cervicothoracic spine is a deformity that can affect patients who have undergone long thoracolumbar instrumented fusion. Preoperative hyperkyphosis of the thoracic spine and changes of more than 30° in lumbar lordosis are independent risk factors for the onset of PJK. METHODS: When PJK occurs in the cervicothoracic spine, extension of the fusion with eventual application of osteotomy techniques is frequently necessary to treat symptomatic patients or in case a neurological deficit occurs. Ponte osteotomy and pedicle subtraction osteotomy (PSO) are the two most used techniques to restore a good cervicothoracic alignment, although they are still demanding procedures even for expert surgeons. In junctional fractures, a vertebral column resection can be performed to support the anterior column. Ponte osteotomy ideally restores 10° at each treated level, while PSO allows a segmental correction up to 30°-35°. Adequate preoperative planning is fundamental for outlining the correct surgery and choosing the appropriate osteotomy. CONCLUSIONS: The aim of corrective surgery is to restore the cervicothoracic alignment, obtaining an adequate postoperative sagittal balance and decreasing the risk of further complications and new revision surgeries.
INTRODUCTION: Proximal junctional kyphosis (PJK) of the cervicothoracic spine is a deformity that can affect patients who have undergone long thoracolumbar instrumented fusion. Preoperative hyperkyphosis of the thoracic spine and changes of more than 30° in lumbar lordosis are independent risk factors for the onset of PJK. METHODS: When PJK occurs in the cervicothoracic spine, extension of the fusion with eventual application of osteotomy techniques is frequently necessary to treat symptomatic patients or in case a neurological deficit occurs. Ponte osteotomy and pedicle subtraction osteotomy (PSO) are the two most used techniques to restore a good cervicothoracic alignment, although they are still demanding procedures even for expert surgeons. In junctional fractures, a vertebral column resection can be performed to support the anterior column. Ponte osteotomy ideally restores 10° at each treated level, while PSO allows a segmental correction up to 30°-35°. Adequate preoperative planning is fundamental for outlining the correct surgery and choosing the appropriate osteotomy. CONCLUSIONS: The aim of corrective surgery is to restore the cervicothoracic alignment, obtaining an adequate postoperative sagittal balance and decreasing the risk of further complications and new revision surgeries.
Authors: Pedro Berjano; Juan Francisco Blanco; Diego Rendon; Jorge Hugo Villafañe; David Pescador; Carlos Manuel Atienza Journal: Eur Spine J Date: 2015-10-09 Impact factor: 3.134
Authors: Bassel G Diebo; Neil V Shah; Maximillian Solow; Vincent Challier; Carl B Paulino; Peter G Passias; Renaud Lafage; Frank J Schwab; Han Jo Kim; Virginie Lafage Journal: Orthopade Date: 2018-06 Impact factor: 1.087