Proximal Junctional Kyphosis in Pediatric Deformity: Analysis of Management with a Surgical Technique Limiting Cervical Extension

Abstract

Introduction Proximal junctional kyphosis (PJK) is a relatively frequent complication of spinal deformity surgery which can result in significant symptoms and potential neurological compromise. Reconstruction of PJK in the cervico-thoracic junction usually entails proximal extension of fixation to the cervical spine, with a compromise of function in this young population. Material and Methods We designed a retrospective review of clinical and radiological features in a consecutive series of patients treated for PJK of the upper thoracic spine. Objective: discuss the use of an anterior plus posterior reconstructive technique which aims to avoid proximal extension into the cervical spine for the management of PJK in the pediatric deformity population. Patients: Three patients with spinal deformity (neuromuscular scoliosis 2, Scheuermanns kyphosis 1) developing progressive PJK were operated with an anterior and posterior reconstruction. Clinical and radiographic follow-up is analyses with a minimum of 9 months. Results All patients were successfully managed with adequate control of the progressive deformity and proximal extension into the cervical spine was significantly limited with this anterior and posterior approach. Conclusions For this selected group of patients with upper thoracic PJK, an interior and posterior surgical reconstruction was successful in managing the condition with limited extension into the cervical spine, thus avoiding greater future functional compromise.