Correlations of proximal junctional kyphosis with radiographic measurements, spinopelvic parameters, and health-related quality of life in Lenke type V adolescent idiopathic scoliosis

Albay, Cem; Kaygusuz, Mehmet Akif; Kargın, Deniz; Öner, Ali

doi:10.52312/jdrs.2022.497

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…Therefore, 22 studies were analyzed in our meta-analysis. In our systematic review, we included a total of 3922 patients; all were under the age of 18 years and were operated on due to adolescent idiopathic scoliosis [1,4,5,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Figure 1). statistical heterogeneity (α = 0.05), the χ 2 test was employed, and I 2 statistics were used to quantitatively assess heterogeneity.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…PJK after adult corrective deformity surgery is well described, and the risk factors and preventive protocols have been extensively reviewed [27]. There are some recent studies evaluating the incidence, risk factors and preventive techniques of PJK after the correction of adolescent idiopathic scoliosis [8][9][10]12,16,23,26,28,29]. The sagittal balance is a parameter that needs to be evaluated thoroughly within the adolescent population with spinal deformities, as it plays an important role in clinical outcomes [30].…”

Section: Discussionmentioning

confidence: 99%

“…Another sagittal parameter with a significant impact on developing PJK is postoperative high SVA. Of the studies included, 11 mentioned post-operative SVA as a parameter that could be a risk factor for PJK [8,[10][11][12][15][16][17]26] with statistically significant difference (overall effect Z = 24.93, p < 0.00001). Angelliaume et al [38] found that a higher post-operative SVA (SVA posterior shift) leads to an increased chance of PJK in patients with AIS correction.…”

Section: Post-operative Sagittal Parameters Post-operative Thoracic K...mentioning

confidence: 99%

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Sagittal Balance Parameters and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis

Katzouraki,

Vasiliadis,

Kaspiris

et al. 2024

JCM

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Background: To review and evaluate multiple preoperative and postoperative sagittal parameters and their association with the risk of developing proximal junctional kyphosis (PJK) in patients with adolescent idiopathic scoliosis (AIS) who undergo correction surgery. Methods: A systematic search was performed in December 2022 in PubMed, Embase and the Cochrane Library to retrieve all the studies relevant to our research. After the study selection and data extraction following PRISMA guidelines, RevMan 5.3 was used for statistical analysis. All the analyzed factors were evaluated by using odds ratios and weighted mean differences with 95% confidence intervals. Moreover, the meta-analysis of proportions via MedCalc was used for analyzing quantitative data from the studies. Results: A total of 22 studies were included in our meta-analysis. All the available values of sagittal parameters were evaluated. Among all the potential risk factors, higher preoperative thoracic kyphosis (Test for overall effect Z = 11.79, p < 0.00001), higher preoperative sagittal vertical axis (SVA) (test for overall effect Z = 11.19, p < 0.00001), greater thoracic kyphosis change post-op. compared to pre-op. (test for overall effect Z = 6.02, p < 0.00001), increased postoperative lumbar lordosis (test for overall effect Z = 3.65, p = 0.0003), higher post-op. SVA (test for overall effect Z = 24.93, p < 0.00001) and a larger pelvic incidence/lumbar lordosis (PI/LL) mismatch (test for overall effect Z = 20.50, p < 0.00001) were found to be the risk factors for PJK after AIS surgery. Moreover, a decreased rod contour angle (RCA) (test for overall effect Z = 3.79, p < 0.0002) and higher proximal junctional angle–rod contour angle (PJA-RCA) (test for overall effect Z = 39.18, p < 0.00001) play a significant role in the risk of developing PJK after AIS correction. Conclusions: Sagittal balance is of great importance when considering the surgical correction of AIS. Many factors in our meta-analysis were found to increase the incidence for PJK such as higher preoperative thoracic kyphosis and pre-op. SVA. Furthermore, increased thoracic kyphosis change, increased post-operative lumbar lordosis, SVA and PI/LL mismatch are also factors that influence the possibility of post-op. PJK. Lastly, RCA and PJA-RCA are two important factors that need attention during AIS, as over-contouring of the rod could lead to PJK in AIS patients.

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Section: Literature Search Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Post-operative Sagittal Parameters Post-operative Thoracic K...mentioning

confidence: 99%

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Sagittal Balance Parameters and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis

Katzouraki,

Vasiliadis,

Kaspiris

et al. 2024

JCM

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Excessive posterior placement of upper instrumented vertebra relative to lower instrumented vertebra as a predictor of proximal junction kyphosis after selective spinal fusion for adolescent idiopathic scoliosis Lenke type 5C curves

Oba,

Banno,

Ohba

et al. 2024

Eur Spine J

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Simplified S1 vertebral bone quality score independently predicts proximal junctional kyphosis after surgery for degenerative lumbar scoliosis

Deng,

Zhou,

Zhou

et al. 2024

J Orthop Surg Res

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Objective Our study aimed to assess the effectiveness of the simplified S1 vertebral bone quality (VBQ) score in predicting the incidence of proximal junctional kyphosis (PJK) after surgery for degenerative lumbar scoliosis (DLS). Methods We reviewed 122 patients with DLS who underwent posterior lumbar decompression and long-segment fusion surgery in our hospital from January 2016 to December 2020. The patients were classified into PJK group and non-PJK group. S1 VBQ scores are determined by signal intensity measurements taken from the mid-sagittal plane of T1-weighted non-contrast MRI. Logistic regression analysis was used to identify factors associated with PJK. Receiver-operating characteristic curve (ROC) analysis was used to evaluate the value of S1 VBQ score in predicting pedicle PJK after DLS. Results 122 DLS patients (90 females and 32 males) met the inclusion criteria. In addition, 27 patients (22.13%) had PJK at the time of last follow-up. VBQ was higher in PJK patients than non-PJK patients (3.58 ± 0.67 vs. 3.08 ± 0.54, p < 0.001). Preoperatively, patients in the PJK group had a greater TLK than those in the non-PJK group (20.00 ± 6.22 vs. 16.86 ± 5.38, p = 0.011). After surgery, patients in the PJK group had greater TLK (p < 0.001) and PJA (p < 0.001) compared with the non-PJK group. At final FU, patients in the PJK group had greater TK (p = 0.002), TLK (p < 0.001), SVA (p < 0.001), and PJA (p < 0.001) than patients in the non-PJK group (Table 4). In multivariate logistic regression analysis, higher VBQ score (OR 4.565, 95% CI 1.43–14.568, p = 0.010), advanced age (OR 1.119, 95% CI 1.021–1.227, p = 0.016), and larger TLK (OR 1.191, 95% CI 1.041–1.362, p = 0.011) were significant predictors of postoperative PJK in patients with DLS (Table 6). A statistically significant positive correlation existed between VBQ score and PJA change (r = 0.370, p < 0.001). We created ROC curves for VBQ scores as predictors of PJK with a diagnostic accuracy of 72.1% (95% CI 60.15–82.9%.The ideal limit for the VBQ score was 3.205 (sensitivity: 77.8%, specificity: 81.4%). Conclusion To the best of our knowledge, this is the first study to evaluate the effectiveness of the S1 VBQ score in predicting postoperative PJK in DLS. Our study included major risk factors and found that S1 VBQ score was a significant predictor of PJK in patients undergoing DLS surgery. The higher the S1 VBQ score, the higher the probability of PJK.

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Correlations of proximal junctional kyphosis with radiographic measurements, spinopelvic parameters, and health-related quality of life in Lenke type V adolescent idiopathic scoliosis

Cited by 4 publications

References 29 publications

Sagittal Balance Parameters and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis

Sagittal Balance Parameters and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis

Excessive posterior placement of upper instrumented vertebra relative to lower instrumented vertebra as a predictor of proximal junction kyphosis after selective spinal fusion for adolescent idiopathic scoliosis Lenke type 5C curves

Simplified S1 vertebral bone quality score independently predicts proximal junctional kyphosis after surgery for degenerative lumbar scoliosis

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