Pediatric Spine Foundation

Title: The Effect of Spinopelvic Parameters on the Development of Proximal Junctional Kyphosis in Early Onset: Mean 4.5-Year Follow-up Publication

Authors: Jaime A. Gomez, Ozren Kubat, Mayra A. Tovar Castro, Regina Hanstein, Tara Flynn, Virginie Lafage, Jennifer K. Hurry, Alexandra Soroceanu, Frank Schwab, David L. Skaggs, Ron El-Hawary, MD, and Pediatric Spine Study Group (PSSG)

Journal: Journal of Pediatric Orthopaedics

Date: July 01, 2020

Excerpt: In EOS patients undergoing growth-friendly surgery for EOS, preoperative TK >50 degrees was associated with increased risk for radiographic PJK. Postoperative PI-LL>20 degrees, PT =30 degrees, and overcorrection of PT and PI-LL increased risk for PJF. Rib-based distraction constructs decreased the risk for radiographic PJK in contrast with the spine-based constructs.

Keywords: spine, early-onset scoliosis, EOS, proximal junctional kyphosis, PJK, growth-friendly surgery, distraction-based growth friendly implants, pelvic tilt, distraction

Summary:

Purpose

Proximal junctional kyphosis (PJK) is a large issue after spinal surgery. It is defined by two things: a deformity angle from the side of the patient that is greater than or equal to 10° and at least 10° greater than the angle before surgery. Proximal junctional failure (PJF) is a more noteworthy complication to a doctor than PJK. The main reason for this study was to review things that causePJK and PJF in patients with early-onset scoliosis (EOS).

Results

  • 135 patients were reviewed in this study. 38% of patients developed PJK and 18% developed proximal junctional failure (PJF).
  • Preoperative Thoracic Kyphosis (TK) > 50 degrees and age at first surgery were possible reasons for the PJK to happen. Children with spine-based devices were more likely to develop PJK compared to children with rib-based treatment (54% vs 31%).
  • Children with high Cobb Angle (CA) after surgery, Pelvic Tilt=30 degrees after surgery, Pelvic Incidence and Lumbar Lordosis >20 degrees, as well as greater changes throughout treatment in Pelvic Tilt, Pelvic Incidence and Pelvic Incidence-Lumbar Lordosis were more likely to develop PJF.

Discussion Points

  • This study suggests that patients who developed PJF underwent many greater changes in alignment and that surgical overcorrection may make PJF more likely.
  • The results from this study show that there are multiple reasons for patients to get PJK and PJF, and to help avoid this from happening, it is important to discuss problems that may occur with your doctor before your surgery.