TY - JOUR
T1 - Cervical alignment changes in patients developing proximal junctional kyphosis following surgical correction of adult spinal deformity
AU - International Spine Study Group
AU - Passias, Peter G.
AU - Horn, Samantha R.
AU - Jalai, Cyrus M.
AU - Ramchandran, Subaraman
AU - Poorman, Gregory W.
AU - Kim, Han Jo
AU - Smith, Justin S.
AU - Sciubba, Daniel
AU - Soroceanu, Alexandra
AU - Ames, Christopher P.
AU - Kojo Hamilton, D.
AU - Eastlack, Robert
AU - Burton, Douglas
AU - Gupta, Munish
AU - Bess, Shay
AU - Lafage, Virginie
AU - Schwab, Frank
N1 - Funding Information:
This study was supported by a grant received from DePuy Spine to the International Spine Study Group Foundation. Funds were used to pay for
Funding Information:
data-collection support. Disclosures outside of the submitted work: Dr Passias reports Consultancy from Medicrea and Spinewave, Speaking/Teaching arrangements from Zimmer Biomet, and a grant from CSRS. Dr Kim reports Consultancy for Medtronic, Biomet, and K2M, and Speaking/Teaching arrangements from Stryker and DePuy. Dr Smith reports Consultancy from Biomet, Medtronic, and Stryker, and Fellowship Support from NREF and AOSpine. Dr Sciubba reports Consultancy from Medtronic. Dr Ames reports Consultancy for DePuy, Medtronic, and Stryker, and Royalties from Biomet and Stryker. Dr Burton reports Royalties and Consultancy for DePuy Spine. Dr Bess reports personal fees from Pioneer, grants and personal fees from K2M Medical, grants and personal fees from NuVasive, grants and personal fees from Inovasis, personal fees from Allosource, and grants from DePuy Synthes. Dr Lafage reports Speaking/Teaching arrangements/Consultancy from NuVasive, Medicrea, DePuy Spine, Nemaris INC, and Shareholder, Board of Directors for Nemaris INC. Dr Schwab reports grants from NuVasive, DePuy Stryker, and K2M, and Speaking/Teaching arrangements from Medtronic, Zimmer Biomet, Medicrea, NuVasive, and K2M, and Consultancy from Medtronic, Zimmer Biomet, Medicrea, NuVasive, and K2M, and Royalties from MSD and K2M, and Board of Directors/shareholder for Nemaris INC. The International Spine Study Group reports grant from DePuy Spine. Ms Horn, Mr Jalai, Dr Ramchandran, Mr Poorman, Dr Eastlack, Dr Soroceanu, Dr Hamilton, and Dr Gupta have no conflicts of interest to report. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
Publisher Copyright:
© 2017 by the Congress of Neurological Surgeons.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - BACKGROUND: Proximal junctional kyphosis (PJK) following adult spinal deformity (ASD) surgery is a well-documented complication, but associations between radiographic PJK and cervical malalignment onset remain unexplored. OBJECTIVE: To study cervical malalignment in ASD surgical patients that develop PJK. METHODS: Retrospective review of prospective multicenter database. Inclusion: primary ASD patients (≥5 levels fused, upper instrumented vertebra [UIV] at T2 or above, and 1-yr minimum follow-up) without baseline cervical deformity (CD), defined as ≥2 of the following criteria: T1 slope minus cervical lordosis < 20◦, cervical sagittal vertical axis < 4 cm, C2-C7 cervical lordosis < 10◦. PJK presence (<10◦ change in UIV and UIV + 2 kyphosis) and angle were identified 1 yr postoperative. Propensity score matching between PJK and nonPJK groups controlled for baseline alignment. Preoperative and 1-yr postoperative cervical alignment were compared between PJK and nonPJK patients. RESULTS: One hundred sixty-three patients without baseline CD (54.9 yr, 83.9% female) were included. PJK developed in 60 (36.8%) patients, with 27 (45%) having UIV above T7. PJK patients had significantly greater baseline T1 slope in unmatched and propensity score matching comparisons (P < .05). At 1 yr postoperative, PJK patients had significantly higher T1 slope (P < .001), C2-T3 Cobb (P = .04), and C2-T3 sagittal vertical axis (P = .02). New-onset CD rate in PJK patients was 15%, and 16.5% in nonPJK patients (P > .05). Increased PJK magnitude was associated with increasing T1 slope and C2-T3 SVA (P < .05). CONCLUSION: Patients who develop PJK following surgical correction of ASD have a 15% incidence of development of new-onset CD. Patients developing PJK following surgical correction of ASD tend to have an increased preoperative T1 slope. Increased progression of C2-T3 Cobb angle and C2-T3 SVA are associated with development of PJK following surgical correction of thoracolumbar deformity.
AB - BACKGROUND: Proximal junctional kyphosis (PJK) following adult spinal deformity (ASD) surgery is a well-documented complication, but associations between radiographic PJK and cervical malalignment onset remain unexplored. OBJECTIVE: To study cervical malalignment in ASD surgical patients that develop PJK. METHODS: Retrospective review of prospective multicenter database. Inclusion: primary ASD patients (≥5 levels fused, upper instrumented vertebra [UIV] at T2 or above, and 1-yr minimum follow-up) without baseline cervical deformity (CD), defined as ≥2 of the following criteria: T1 slope minus cervical lordosis < 20◦, cervical sagittal vertical axis < 4 cm, C2-C7 cervical lordosis < 10◦. PJK presence (<10◦ change in UIV and UIV + 2 kyphosis) and angle were identified 1 yr postoperative. Propensity score matching between PJK and nonPJK groups controlled for baseline alignment. Preoperative and 1-yr postoperative cervical alignment were compared between PJK and nonPJK patients. RESULTS: One hundred sixty-three patients without baseline CD (54.9 yr, 83.9% female) were included. PJK developed in 60 (36.8%) patients, with 27 (45%) having UIV above T7. PJK patients had significantly greater baseline T1 slope in unmatched and propensity score matching comparisons (P < .05). At 1 yr postoperative, PJK patients had significantly higher T1 slope (P < .001), C2-T3 Cobb (P = .04), and C2-T3 sagittal vertical axis (P = .02). New-onset CD rate in PJK patients was 15%, and 16.5% in nonPJK patients (P > .05). Increased PJK magnitude was associated with increasing T1 slope and C2-T3 SVA (P < .05). CONCLUSION: Patients who develop PJK following surgical correction of ASD have a 15% incidence of development of new-onset CD. Patients developing PJK following surgical correction of ASD tend to have an increased preoperative T1 slope. Increased progression of C2-T3 Cobb angle and C2-T3 SVA are associated with development of PJK following surgical correction of thoracolumbar deformity.
KW - Adult spinal deformity
KW - Cervical sagittal alignment
KW - Cervicothoracic alignment
KW - New-onset cervical deformity
KW - Postoperative alignment
KW - Proximal junctional kyphosis
KW - Thoracolumbar deformity
UR - http://www.scopus.com/inward/record.url?scp=85062008367&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyx479
DO - 10.1093/neuros/nyx479
M3 - Review article
C2 - 29040759
AN - SCOPUS:85062008367
SN - 0148-396X
VL - 83
SP - 675
EP - 682
JO - Clinical Neurosurgery
JF - Clinical Neurosurgery
IS - 4
ER -