Jean-Luc Clément1, Sebastien Pesenti2, Brice Ilharreborde3, Christian Morin4, Yann-Philippe Charles5, Henri-François Parent6, Philippe Violas7, Marc Szadkowski8, Louis Boissière9, Federico Solla10. 1. Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux Pédiatriques de Nice Chu Lenval, 57 Avenue de la Californie, 06200, Nice, France. clement.jluc@wanadoo.fr. 2. Pediatric Orthopedics, Hôpital Timone Enfants, Aix Marseille Université, 264 rue Saint Pierre, 13005, Marseille, France. 3. Department of Pediatric Orthopedics, CHU Robert Debré, AP-HP, University of Paris, 48 Bd Sérurier, 75019, Paris, France. 4. Department of Pediatric Orthopedics, Institut Calot, rue du Dr Calot, 62600, Berck sur mer, France. 5. Department of Spine Surgery, Fédération de Médecine Translationnelle (FMTS), Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France. 6. Spine Center, 6 rue de Belliniere, 49800, Trelaze, France. 7. Department of Pediatric Surgery, Hôpital Sud, CHU de Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France. 8. Santy Orthopedic Center, 24 avenue Paul Santy, 69008, Lyon, France. 9. Department of Orthopaedic Surgery, Spine Unit, CHU Bordeaux Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France. 10. Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux Pédiatriques de Nice Chu Lenval, 57 Avenue de la Californie, 06200, Nice, France.
Abstract
PURPOSE: Many authors tried to explain proximal junctional kyphosis (PJK) after adolescent idiopathic scoliosis (AIS) surgery by looking for risk factors. Latest publications focus on sagittal alignment. Each healthy adolescent has a specific thoracic kyphosis (TK) depending on their pelvic parameters and lumbar lordosis (LL). The objective of this work is to determine if the difference between TK at follow-up (TKFU) and the patient-specific TK (PSTK) plays a role in PJK occurrence after AIS surgery. The secondary objective was to find other risk factors. METHODS: We analyzed retrospectively 570 thoracic AIS who underwent a posterior thoracic fusion from nine centers. The series was separated in two groups: with and without PJK. PSTK was calculated with the formula PSTK = 2(PT + LL-PI). TK Gap was the difference between TKFU and PSTK. Logistic regression was utilized to test the impact of TK Gap and other known risk factors on PJK occurrence. RESULTS: Univariate analysis showed 15 factors significantly different between the groups. In a multivariate analysis, three factors had a strong significant influence on PJK: TKFU, TK Gain and TK Gap. Four additional factors affected the rate of PJK: Posterior translation on two rods, preoperative TK, preoperative LL and number of instrumented vertebrae. CONCLUSION: PJK is related to the insufficient TK at follow-up, compared to the specific TK that every patient should have according to their pelvic parameters. PJK incidence is significantly reduced by a strong gain in TK and a thoracic selective fusion which leaves the proximal lumbar vertebrae free. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
PURPOSE: Many authors tried to explain proximal junctional kyphosis (PJK) after adolescent idiopathic scoliosis (AIS) surgery by looking for risk factors. Latest publications focus on sagittal alignment. Each healthy adolescent has a specific thoracic kyphosis (TK) depending on their pelvic parameters and lumbar lordosis (LL). The objective of this work is to determine if the difference between TK at follow-up (TKFU) and the patient-specific TK (PSTK) plays a role in PJK occurrence after AIS surgery. The secondary objective was to find other risk factors. METHODS: We analyzed retrospectively 570 thoracic AIS who underwent a posterior thoracic fusion from nine centers. The series was separated in two groups: with and without PJK. PSTK was calculated with the formula PSTK = 2(PT + LL-PI). TK Gap was the difference between TKFU and PSTK. Logistic regression was utilized to test the impact of TK Gap and other known risk factors on PJK occurrence. RESULTS: Univariate analysis showed 15 factors significantly different between the groups. In a multivariate analysis, three factors had a strong significant influence on PJK: TKFU, TK Gain and TK Gap. Four additional factors affected the rate of PJK: Posterior translation on two rods, preoperative TK, preoperative LL and number of instrumented vertebrae. CONCLUSION: PJK is related to the insufficient TK at follow-up, compared to the specific TK that every patient should have according to their pelvic parameters. PJK incidence is significantly reduced by a strong gain in TK and a thoracic selective fusion which leaves the proximal lumbar vertebrae free. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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