TY - JOUR
T1 - Evolution of Proximal Junctional Kyphosis and Proximal Junctional Failure Rates over 10 Years of Enrollment in a Prospective Multicenter Adult Spinal Deformity Database
AU - Alshabab, Basel Sheikh
AU - Lafage, Renaud
AU - Smith, Justin S.
AU - Kim, Han Jo
AU - Mundis, Gregory
AU - Klineberg, Eric
AU - Shaffrey, Christopher
AU - Daniels, Alan
AU - Ames, Christopher
AU - Gupta, Munish
AU - Burton, Douglas
AU - Hostin, Richard
AU - Bess, Shay
AU - Schwab, Frank
AU - Lafage, Virginie
N1 - Funding Information:
Grants, technical support, and corporate support: The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes (current), Nuvasive (current), K2M (present), Innovasis (past), Biomet (past), and individual donations. Funding sources did not play a role in investigation. th
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Study Design. Retrospective cohort study. Objective. The aim of this study was to investigate the evolution of proximal junctional kyphosis (PJK) rate over 10-year enrollment period within a prospective database. Summary of Background Data. PJK is a common complication following adult spinal deformity (ASD) surgery and has been intensively studied over the last decade. Methods. Patients with instrumentation extended to the pelvis and minimum 2-year follow-up were included. To investigate evolution of PJK/proximal junctional failure (PJF) rate, a moving average of 321 patients was calculated across the enrollment period. Logistic regression was used to investigate the association between the date of surgery (DOS) and PJK and/or PJF. Comparison of PJK/PJF rates, demographics, and surgical strategies was performed between the first and second half of the cohort. Results. A total of 641 patients met inclusion criteria (age: 64±10 years, 78.2% female, body mass index: 28.3±5.7). The overall rate of radiographic PJK at 2 years was 47.9%; 12.9% of the patients developed PJF, with 31.3% being revised within 2-year follow-up. Stratification by DOS produced two halves. Between these two periods, rate of PJK and PJF demonstrated nonsignificant decrease (50.3%-45.5%, P=0.22) and (15.0%-10.9%, P=0.12), respectively. Linear interpolation suggested a decrease of 1.2% PJK per year and 1.0% for PJF. Patients enrolled later in the study were older and more likely to be classified as pure sagittal deformity (P<0.001). There was a significant reduction in the use of three-column osteotomies (P<0.001), an increase in anterior longitudinal ligament release (P<0.001), and an increase in the use of PJK prophylaxis (31.3% vs 55.1%). Logistical regression demonstrated no significant association between DOS and radiographic PJK (P=0.19) or PJF (P=0.39). Conclusion. Despite extensive research examining risk factors for PJK/PJF and increasing utilization of intraoperative PJK prophylaxis techniques, the rate of radiographic PJK and/or PJF did not significantly decrease across the 10-year enrollment period of this ASD database.
AB - Study Design. Retrospective cohort study. Objective. The aim of this study was to investigate the evolution of proximal junctional kyphosis (PJK) rate over 10-year enrollment period within a prospective database. Summary of Background Data. PJK is a common complication following adult spinal deformity (ASD) surgery and has been intensively studied over the last decade. Methods. Patients with instrumentation extended to the pelvis and minimum 2-year follow-up were included. To investigate evolution of PJK/proximal junctional failure (PJF) rate, a moving average of 321 patients was calculated across the enrollment period. Logistic regression was used to investigate the association between the date of surgery (DOS) and PJK and/or PJF. Comparison of PJK/PJF rates, demographics, and surgical strategies was performed between the first and second half of the cohort. Results. A total of 641 patients met inclusion criteria (age: 64±10 years, 78.2% female, body mass index: 28.3±5.7). The overall rate of radiographic PJK at 2 years was 47.9%; 12.9% of the patients developed PJF, with 31.3% being revised within 2-year follow-up. Stratification by DOS produced two halves. Between these two periods, rate of PJK and PJF demonstrated nonsignificant decrease (50.3%-45.5%, P=0.22) and (15.0%-10.9%, P=0.12), respectively. Linear interpolation suggested a decrease of 1.2% PJK per year and 1.0% for PJF. Patients enrolled later in the study were older and more likely to be classified as pure sagittal deformity (P<0.001). There was a significant reduction in the use of three-column osteotomies (P<0.001), an increase in anterior longitudinal ligament release (P<0.001), and an increase in the use of PJK prophylaxis (31.3% vs 55.1%). Logistical regression demonstrated no significant association between DOS and radiographic PJK (P=0.19) or PJF (P=0.39). Conclusion. Despite extensive research examining risk factors for PJK/PJF and increasing utilization of intraoperative PJK prophylaxis techniques, the rate of radiographic PJK and/or PJF did not significantly decrease across the 10-year enrollment period of this ASD database.
KW - adult spinal deformity
KW - proximal junctional failure
KW - proximal junctional kyphosis
KW - rate evolution.
UR - http://www.scopus.com/inward/record.url?scp=85134328733&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004364
DO - 10.1097/BRS.0000000000004364
M3 - Article
C2 - 35472089
AN - SCOPUS:85134328733
SN - 0362-2436
VL - 47
SP - 922
EP - 930
JO - Spine
JF - Spine
IS - 13
ER -