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Realignment surgery in adult spinal deformity

Prevalence and risk factors for proximal junctional kyphosis

Operative Korrektur von Wirbelsäulendeformitäten des Erwachsenen

Prävalenz und Risikofaktoren der proximalen junktionalen Kyphose

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Abstract

Although surgical techniques pertaining to adult spinal deformity (ASD) have advanced over the last decade, proximal junctional kyphosis (PJK) is still a complication following surgery for ASD that continues to significantly challenge clinicians. This article aimed to report on the prevalence of PJK as well as enhance understanding of surgically modifiable and non-modifiable risk factors of PJK to guide management of this postoperative complication of ASD. As the understanding of the pathogenesis as well as surgical modifications aimed at reducing the incidence of PJK have advanced, so too should clinicians’ ability to implement more patient-specific operative plans and improve outcomes following realignment surgery for ASD.

Zusammenfassung

Obwohl sich die chirurgischen Techniken in Bezug auf die Behandlung von Wirbelsäulendeformitäten des Erwachsenen („adult spinal deformities“, ASD) in den letzten Dekaden weiterentwickelt haben, stellt die proximale junktionale Kyphose (PJK) als Komplikation nach operativer Versorgung der ASD eine große Herausforderung für den Wirbelsäulenchirurgen dar. Ziel dieser Übersichtsarbeit ist es, die Prävalenz der PJK darzustellen und das Verständnis für chirurgisch beeinflussbare sowie chirurgisch nicht beeinflussbare Risikofaktoren der PJK zu erhöhen, damit diese relevante postoperative Komplikation der ASD besser eingeordnet und behandelt werden kann. Da das Verständnis für die Pathogenese der PJK wie auch die chirurgischen Strategien mit dem Ziel, die Häufigkeit der postoperativen PJK zu reduzieren, fortgeschritten sind, muss nun auch die Fähigkeit der Kliniker gefordert werden, die patientenspezifische operative Planung in der Behandlung zu implementieren, um das postoperative Ergebnis nach der Wiederherstellung des sagittalen Profils bei ASD zu verbessern.

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Abbreviations

ASD:

Adult spinal deformity

ASD-FI:

Adult spinal deformity frailty index

BMD:

Bone mineral density

BMI:

Body mass index

CoCrMRC:

Cobalt chromium multi-rod construct

HRT:

Head repositioning test

LL:

Lumbar lordosis

mFI:

Modified frailty index

miniBESTest:

Mini-balance evaluation systems test

NIS:

Nationwide Inpatient Sample

NSQIP:

National surgical quality improvement program

PI:

Pelvic incidence

PI-LL:

Pelvic incidence minus lumbar lordosis

PJF:

Proximal junction failure

PJK:

Proximal junctional kyphosis

PT:

Pelvic tilt

ROM:

Range of motion

SRA:

Scoliosis Research Society

SVA:

Sagittal vertical axis

TiTRC:

Titanium two-rod construct

TK:

Thoracic kyphosis

TUG test:

Timed Up and Go test

UIV:

Upper instrumented vertebra

VAS:

Visual analog scale

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, State University of New York, Downstate Medical Center, 450 Clarkson Ave, Box 30, 11203, Brooklyn, NY, USA

    B. G. Diebo MD, N. V. Shah MD, MS, S. G. Stroud AB & C. B. Paulino MD

  2. Spine Service, Hospital for Special Surgery, New York, NY, USA

    F. J. Schwab MD & V. Lafage PhD

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  1. B. G. Diebo MD
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  2. N. V. Shah MD, MS
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  4. C. B. Paulino MD
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  5. F. J. Schwab MD
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  6. V. Lafage PhD
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Correspondence to B. G. Diebo MD.

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Conflict of interest

C.B. Paulino is a paid presenter or speaker for DePuy, A Johnson & Johnson Company. F.J. Schwab receives research support from DePuy, is a paid consultant, presenter or speaker for K2M, Medicrea, Medtronic, Medtronic Sofamor Danek, Nuvasive, and Zimmer, owns stock or stock options in Nemaris INC, and is a board or committee member of the Scoliosis Research Society, Spine Deformity, and International Spine Society Group (Vice President). V. Lafage is a paid presenter or speaker for DePuy and Medtronic, receives research support from DePuy, is a board or committee member of the International Spine Study Group, Scoliosis Research Society, and Nemaris INC, and owns stock or stock options in Nemaris INC. B.G. Diebo, N.V. Shah and S.G. Stroud declare that they have no competing interests.

This article represents a review of the literature, including original studies of human or animal subjects performed by their respective authors, in order to complete this article. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Where applicable, informed consent was obtained from all individual participants included in the respective studies.

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Diebo, B.G., Shah, N.V., Stroud, S.G. et al. Realignment surgery in adult spinal deformity. Orthopäde 47, 301–309 (2018). https://doi.org/10.1007/s00132-018-3536-5

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