Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: Minimum five-year follow-up

Yongjung J. Kim, Keith H. Bridwell, Lawrence G. Lenke, Chris R. Glattes, Seungchul Rhim, Gene Cheh

Research output: Contribution to journalArticlepeer-review

214 Scopus citations

Abstract

Study Design.: A retrospective study. Objective.: To analyze time-dependent change of, prevalence of, and risk factors for proximal junctional kyphosis (PJK) in adult spinal deformity after long (≥5 vertebrae) segmental posterior spinal instrumented fusion with a minimum 5-year postoperative follow-up. Summary of Background Data.: No study has focused on time-dependent long-term proximal junctional change in adult spinal deformity after segmental posterior spinal instrumented fusion with minimum 5-year follow-up. Methods.: Clinical and radiographic data of 161 (140 women/21 men) adult spinal deformity patients with minimum 5-year follow-up (average 7.8 years, range 5-19.8 years) treated with long posterior spinal instrumentation and fusion were analyzed. Radiographic measurements included sagittal Cobb angle at the proximal junction on preoperative, 8-weeks postoperation, 2-year postoperation, and ultimate follow-up (≥5 years). Postoperative SRS outcome scores were also evaluated. Results.: The prevalence of PJK at 7.8 years postoperation was 39% (62/161 patients). The PJK group (n = 62) demonstrated a significant increase in proximal junctional angle at 8 weeks (59%), between 2 years postoperation and ultimate postoperation (35%), and in thoracic kyphosis (T5-T12) at ultimate follow-up (P = 0.001). However, the sagittal vertical axis change at ultimate follow-up did not correlate with PJK (P = 0.53). Older age at surgery >55 years (vs. ≤55 years) and combined anterior and posterior spinal fusion (vs. posterior only) demonstrated significantly higher PJK prevalence (P = 0.001, 0.041, respectively). The SRS outcome scores did not demonstrate significant differences with the exception of the self-image domain when PJK exceeded 20°. Conclusion.: The prevalence of PJK at 7.8 years postoperation was 39%. PJK progressed significantly within 8 weeks postoperation (59%) and between 2 years postoperation and ultimate follow-up (35%). Older age at surgery (>55 years) and combined anterior and posterior spinal fusion were identified as risk factors for developing PJK. The SRS outcome instrument was not adversely affected by PJK, except when PJK exceeded 20°.

Original languageEnglish
Pages (from-to)2179-2184
Number of pages6
JournalSpine
Volume33
Issue number20
DOIs
StatePublished - Sep 15 2008

Keywords

  • Adult spinal deformity
  • Outcomes
  • Proximal junctional change
  • Segmental posterior spinal instrumentation and fusion

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