Frank A Segreto1, Peter G Passias1, Renaud Lafage2, Virginie Lafage2, Justin S Smith3, Breton G Line4, Gregory M Mundis5, Cole A Bortz1, Nicholas D Stekas1, Samantha R Horn1, Bassel G Diebo6, Avery E Brown1, Yael Ihejirika1, Pierce D Nunley7, Alan H Daniels8, Munish C Gupta9, Jeffrey L Gum10, D Kojo Hamilton11, Eric O Klineberg9, Douglas C Burton12, Robert A Hart13, Frank J Schwab2, Shay Bess4, Christopher I Shaffrey3, Christopher P Ames14. 1. Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York. 2. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York. 3. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia. 4. Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado. 5. Department of Orthopedics, San Diego Center for Spinal Disorders, La Jolla, California. 6. Department of Orthopedic Surgery, State University of New York Downstate Medical Center, Brooklyn, New York, New York. 7. Spine Institute of Louisiana, Shreveport, Louisiana. 8. Department of Orthopedics, Alpert Medical School of Brown University, Providence, Rhode Island. 9. Department of Orthopedic Surgery, University of California, Davis, Davis, California. 10. Norton Leatherman Spine Center, Louisville, Kentucky. 11. Department of Neurosurgery, University of Pittsburg School of Medicine, Pittsburgh, Pennsylvania. 12. Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas. 13. Department of Orthopedics, Swedish Neuroscience Institute, Seattle, Washington. 14. Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Abstract
BACKGROUND: Proximal junctional kyphosis (PJK) is a common radiographic complication of adult spinal deformity (ASD) corrective surgery. Although previous literature has reported a 5 to 61% incidence of PJK, these studies are limited by small sample sizes and short-term follow-up. OBJECTIVE: To assess the incidence of PJK utilizing a high-powered ASD database. METHODS: Retrospective review of a prospective multicenter ASD database. Operative ASD patients > 18 yr old from 2009 to 2017 were included. PJK was defined as ≥ 10° for the sagittal Cobb angle between the inferior upper instrumented vertebra (UIV) endplate and the superior endplate of the UIV + 2. Chi-square analysis and post hoc testing assessed annual and overall incidence of acute (6-wk follow-up [f/u]), progressive (increase in degree of PJK from 6 wk to 1 yr), and delayed (1-yr, 2-yr, and 3-yr f/u) PJK development. RESULTS: A total of 1005 patients were included (age: 59.3; 73.5% F; body mass index: 27.99). Overall PJK incidence was 69.4%. Overall incidence of acute PJK was 48.0%. Annual incidence of acute PJK has decreased from 53.7% in 2012 to 31.6% in 2017 (P = .038). Overall incidence of progressive PJK was 35.0%, with stable rates observed from 2009 to 2016 (P = .297). Overall incidence of 1-yr-delayed PJK was 9.3%. Annual incidence of 1-yr-delayed PJK has decreased from 9.2% in 2009 to 3.2% in 2016 (P < .001). Overall incidence of 2-yr-delayed PJK development was 4.3%. Annual incidence of 2-yr-delayed PJK has decreased from 7.3% in 2009 to 0.9% in 2015 (P < .05). Overall incidence of 3-yr-delayed PJK was 1.8%, with stable rates observed from 2009 to 2014 (P = .594). CONCLUSION: Although progressive PJK has remained a challenge for physicians over time, significantly lower incidences of acute and delayed PJK in recent years may indicate improving operative decision-making and management strategies.
BACKGROUND: Proximal junctional kyphosis (PJK) is a common radiographic complication of adult spinal deformity (ASD) corrective surgery. Although previous literature has reported a 5 to 61% incidence of PJK, these studies are limited by small sample sizes and short-term follow-up. OBJECTIVE: To assess the incidence of PJK utilizing a high-powered ASD database. METHODS: Retrospective review of a prospective multicenter ASD database. Operative ASDpatients > 18 yr old from 2009 to 2017 were included. PJK was defined as ≥ 10° for the sagittal Cobb angle between the inferior upper instrumented vertebra (UIV) endplate and the superior endplate of the UIV + 2. Chi-square analysis and post hoc testing assessed annual and overall incidence of acute (6-wk follow-up [f/u]), progressive (increase in degree of PJK from 6 wk to 1 yr), and delayed (1-yr, 2-yr, and 3-yr f/u) PJK development. RESULTS: A total of 1005 patients were included (age: 59.3; 73.5% F; body mass index: 27.99). Overall PJK incidence was 69.4%. Overall incidence of acute PJK was 48.0%. Annual incidence of acute PJK has decreased from 53.7% in 2012 to 31.6% in 2017 (P = .038). Overall incidence of progressive PJK was 35.0%, with stable rates observed from 2009 to 2016 (P = .297). Overall incidence of 1-yr-delayed PJK was 9.3%. Annual incidence of 1-yr-delayed PJK has decreased from 9.2% in 2009 to 3.2% in 2016 (P < .001). Overall incidence of 2-yr-delayed PJK development was 4.3%. Annual incidence of 2-yr-delayed PJK has decreased from 7.3% in 2009 to 0.9% in 2015 (P < .05). Overall incidence of 3-yr-delayed PJK was 1.8%, with stable rates observed from 2009 to 2014 (P = .594). CONCLUSION: Although progressive PJK has remained a challenge for physicians over time, significantly lower incidences of acute and delayed PJK in recent years may indicate improving operative decision-making and management strategies.
Authors: Nathan J Lee; Lawrence G Lenke; Meghan Cerpa; Joseph Lombardi; Alex Ha; Paul Park; Eric Leung; Zeeshan M Sardar; Ronald A Lehman Journal: Global Spine J Date: 2020-09-03