Proximal Junctional Kyphosis and Proximal Junctional Failure Following Adult Spinal Deformity Surgery

et al. 2020

J Korean Neurosurg Soc

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The purpose of this study was to report the results of pedicle subtraction osteotomy (PSO) for fixed sagittal imbalance with a minimum 2-year follow-up. Besides, authors evaluated the effect of adjunctive multi-level posterior column osteotomy (PCO) on achievement of additional lumbar lordosis (LL) during PSO. Methods : A total of 31 consecutive patients undergoing PSO for fixed sagittal imbalance were enrolled and analyzed. Correction angle of osteotomized vertebra (PSO angle) and other radiographic parameters including pelvic incidence (PI), thoracic kyphosis, LL, and sagittal vertical axis (SVA) were evaluated. Clinical outcomes and surgical complications were also assessed. Results : The mean age was 66.0±9.3 years with a mean follow-up period of 33.2±10.5 months. The mean number of fused segments was 9.6±3.5. The mean operative time and surgical bleeding were 475.9±160.5 minutes and 1406.1±932.1 mL, respectively. The preoperative SRS-22 score was 2.3±0.7 and improved to 3.2±0.8 at the final follow-up. The mean PI was 54.5±9.5°. LL was changed from 7.0±28.9° to-50.2±13.2°. The PSO angle was 33.7±13.5° (15.6±20.1° preoperatively,-16.1±19.4° postoperatively). The difference of correction angle of LL (57.3°) was greater about 23.6° than which of PSO angle (33.7°). SVA was improved from 189.5±93.0 mm, preoperatively to 12.4±40.8 mm, postoperatively. There occurred six, eight, and 14 cases of complications at intraoperative, early (<2 weeks) postoperative, and late (≥2 weeks) postoperative period, respectively. Additional operations were needed in nine patients due to the complications. Conclusion : PSO could provide satisfactory results for patients with fixed sagittal imbalance regarding clinical and radiographic outcomes. Additional correction of LL could be achieved with conduction of adjunctive multi-level PCOs during PSO.

Section: Introductionmentioning

confidence: 96%

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Choi

Hyun

et al. 2020

J Korean Neurosurg Soc

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“…Koda et al 12) suggested that dekyphosis should not be performed after posterior decompression because kyphosis correction may cause instrument failure. Hyun et al 6) also reported instrument failure following dekyphosis for treating adult spinal deformity. But, Zhang et al 27) confirmed by MR image that posterior migration and complete decompression of the spinal cord was possible through posterior approach with kyphosis correction.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes According to Dekyphosis in Patients with Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine

Hyun

et al. 2020

J Korean Neurosurg Soc

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Objective : Ossification of posterior longitudinal ligament (OPLL) in the thoracic spine may cause chronic compressive myelopathy that is usually progressive, and unfavorable by conservative treatment. Although surgical intervention is often needed, the standard surgical method has not been established. Recently, it has been reported that posterior decompression with dekyphosis is effective surgical technique for favorable clinical outcome. The purpose of this study was to evaluate the surgical outcomes in patients with thoracic OPLL according to dekyphosis procedure and to identify predictive factors for the surgical results. Methods : A total of 25 patients with thoracic OPLL who underwent surgery for myelopathy from May 2004 to March 2017, were retrospectively reviewed. Patients with cervical myelopathy were excluded. We assessed the clinical outcomes according to various surgical approaches. The modified Japanese orthopedic association (JOA) scores for the thoracic spine (total, 11 points) and JOA recovery rates were used for investigating surgical outcomes. Results : Of the 25 patients, 10 patients were male and the others were female. The mean JOA score was 6.7±2.3 points preoperatively and 8.8±1.8 points postoperatively, yielding a mean recovery rate of 53.8±31.0%. The mean patients' age at surgery was 52.4 years and mean follow-up period was 40.2 months. According to surgical approaches, seven patients underwent anterior approaches, 13 patients underwent posterior approaches, five patients underwent combined approaches. There was no significant difference of the surgical outcomes related with different surgical approaches. Age (≥55 years) and high signal intensity on preoperative magnetic resonance (MR) image in the thoracic spine were significant predictors of the lower recovery rate after surgery (p<0.05). Posterior decompression with dekyphosis procedure was related to the excellent surgical outcomes (p=0.047). Dekyphosis did not affect the complication rates. Conclusion : In this study, our result elucidated that old age (≥55 years) and presence of intramedullary high signal intensity on preoperative MR images were risk factors related to poor surgical outcomes. In the meanwhile, posterior decompression with dekyphosis affected favorable clinical outcome. Posterior approach with dekyphosis procedure can be a recommendable surgical option for favorable results.

“…The present study aimed to evaluate the natural progression of segmental kyphosis in the thoracic and thoracolumbar spine with age in old, normal asymptomatic men. PJK includes a wide range of symptoms, ranging from a symptomless deformity to severe pain that may require revision surgery [9,10,17]. However, it is fundamentally a radiographic pathologic that develops in the transitional region, usually between the UIV and two levels above the UIV.…”

Section: Discussionmentioning

confidence: 99%

“…Proximal junctional kyphosis (PJK) develops after the surgery for adult spinal deformity, often causing clinical symptoms and needing revision surgery [4][5][6][7][8][9][10]. The selection of the level of the upper instrumented vertebra (UIV) is an important factor for avoiding the development of PJK in the surgery for adult spinal deformity [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Changes in Thoracic Kyphosis and Thoracolumbar Kyphosis in Asymptomatic Korean Male Subjects Aged >50 Years: Do They Progress Above T5, T10, T12, or L2?

et al. 2020

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Study Design: Retrospective analysis of prospectively collected data.Purpose: To evaluate the natural progression of segmental kyphosis in thoracic and thoracolumbar spine with advancing age.Overview of Literature: To our knowledge, the evolution of segmental thoracic kyphosis (TK) in individuals aged >50 years has not been reported.Methods: Total 179 normal, asymptomatic Korean men were divided in to three groups (6th, 7th, and 8th decade) according to their age. Standard sagittal spinopelvic parameters, including TK and thoracolumbar kyphosis, were measured and subdivided into the following four segments: A (C7 upper end plate [UEP]–T5 UEP), B (T5 UEP–T10 UEP), C (T10 UEP–T12 lower end plate [LEP]), and D (T12 LEP–L2 LEP). These segments of the three study groups were analyzed.Results: In segment B, the segmental kyphosis of group 3 (20.2°±8.0°) showed a statistically larger value than that of group 1 (15.6°±6.8°) and group 2 (16.7°±8.8°) (p=0.017). In segment C, the segmental kyphosis of group 2 (12.9°±6.5°) and group 3 (12.2°±7.1°) showed statistically larger values than that of group 1 (9.5°±6.2°) (p=0.016). The A and D segments of the three groups were not significantly different.Conclusions: Increased TK was observed in the middle (segment B) and lower (segment C) thoracic segments in normal asymptomatic male subjects with age. The results from the natural progression of segmental kyphosis with age would provide baseline reference data to help surgeons choose the optimal point of the upper instrumented vertebra level for preventing proximal junctional kyphosis.