Risk factors for proximal junctional kyphosis after pediatric spinal deformity surgery with halo gravity traction

Amanullah, Amir; Piazza, Martin; Qutteineh, Bilal; Samdani, Amer F.; Pahys, Joshua M.; Kim, Andrew Jeongyoon; Hwang, Steven W.

doi:10.1007/s00381-022-05596-3

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…Country Research type Follow-up month(m) Cases PJK Non-PJK Amanullah 2022 [13] USA Retrospective study Minimum 24 8…”

Section: Studymentioning

confidence: 99%

Incidence and risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis after correction surgery: a meta-analysis and systematic review

Wei

Xing

et al. 2023

Preprint

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Aim To analyze the risk factors of proximal junctional kyphosis (PJK) after correction surgery in patients with adolescent idiopathic scoliosis (AIS). Methods PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for retrospective studies utilizing all AIS patients with PJK after corrective surgery to collect preoperative, postoperative, and follow-up imaging parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), proximal junctional angle (PJA), the sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL), sacral slope (SS), rod contour angle (RCA) and upper instrumented vertebra (UIV). Results Nineteen retrospective studies were included in this meta-analysis, including 550 patients in the intervention group and 3456 patients in the control group. Overall, sex (OR 1.34, 95% CI (1.03,1.76), P = 0.03), larger preoperative TK(WMD 6.82, 95% CI (5.48,8.16), P＜0.00001), larger follow-up TK(WMD 8.96, 95% CI (5.62,12.30), P＜0.00001), larger postoperative LL(WMD 2.31, 95% CI (0.91,3.71), P = 0.001), larger follow-up LL(WMD 2.51, 95% CI (1.19,3.84), P = 0.0002), great change in LL(WMD − 2.72, 95% CI (-4.69,-0.76), P = 0.006), larger postoperative PJA(WMD 4.94, 95% CI (3.62,6.26), P＜0.00001), larger follow-up PJA(WMD 13.39, 95% CI (11.09,15.69), P＜0.00001), larger postoperative PI-LL (WMD − 9.57, 95% CI (-17.42,-1.71), P = 0.02), larger follow-up PI-LL(WMD − 12.62, 95% CI (-17.62,-7.62), P＜0.00001), larger preoperative SVA(WMD 0.73, 95% CI (0.26,1.19), P = 0.002), larger preoperative SS(WMD − 3.43, 95% CI (-4.71,-2.14), P＜0.00001), RCA(WMD 1.66, 95% CI (0.48,2.84), P = 0.006) were identified as risk factors for PJK in patients with AIS. Conclusion The incidence of PJK in patients with AIS was 19%. Sex, larger preoperative TK, larger follow-up TK, larger postoperative LL, larger follow-up LL, great LL change, larger postoperative PJA, larger follow-up PJA, larger postoperative PI-LL, larger follow-up PI-LL, larger preoperative SVA, larger preoperative SS and RCA were identified as risk factors for PJK in AIS post-correction surgery.

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“…Country Research type Follow-up month(m) Cases PJK Non-PJK Amanullah 2022 [13] USA Retrospective study Minimum 24 8…”

Section: Studymentioning

confidence: 99%

Incidence and risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis after correction surgery: a meta-analysis and systematic review

Wei

Xing

et al. 2023

Preprint

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Incidence and risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis after correction surgery: a meta-analysis and systematic review

Ji,

Wei,

Xing

et al. 2024

J Orthop Surg Res

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Aim To analyze the risk factors of proximal junctional kyphosis (PJK) after correction surgery in patients with adolescent idiopathic scoliosis (AIS). Methods PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for retrospective studies utilizing all AIS patients with PJK after corrective surgery to collect preoperative, postoperative, and follow-up imaging parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), proximal junctional angle (PJA), the sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence–lumbar lordosis (PI–LL), sacral slope (SS), rod contour angle (RCA) and upper instrumented vertebra (UIV). Results Nineteen retrospective studies were included in this meta-analysis, including 550 patients in the intervention group and 3456 patients in the control group. Overall, sex (OR 1.40, 95% CI (1.08, 1.83), P = 0.01), larger preoperative TK (WMD 6.82, 95% CI (5.48, 8.16), P < 0.00001), larger follow-up TK (WMD 8.96, 95% CI (5.62, 12.30), P < 0.00001), larger postoperative LL (WMD 2.31, 95% CI (0.91, 3.71), P = 0.001), larger follow-up LL (WMD 2.51, 95% CI (1.19, 3.84), P = 0.0002), great change in LL (WMD − 2.72, 95% CI (− 4.69, − 0.76), P = 0.006), larger postoperative PJA (WMD 4.94, 95% CI (3.62, 6.26), P < 0.00001), larger follow-up PJA (WMD 13.39, 95% CI (11.09, 15.69), P < 0.00001), larger postoperative PI–LL (WMD − 9.57, 95% CI (− 17.42, − 1.71), P = 0.02), larger follow-up PI–LL (WMD − 12.62, 95% CI (− 17.62, − 7.62), P < 0.00001), larger preoperative SVA (WMD 0.73, 95% CI (0.26, 1.19), P = 0.002), larger preoperative SS (WMD − 3.43, 95% CI (− 4.71, − 2.14), P < 0.00001), RCA (WMD 1.66, 95% CI (0.48, 2.84), P = 0.006) were identified as risk factors for PJK in patients with AIS. For patients with Lenke 5 AIS, larger preoperative TK (WMD 7.85, 95% CI (5.69, 10.00), P < 0.00001), larger postoperative TK (WMD 9.66, 95% CI (1.06, 18.26), P = 0.03, larger follow-up TK (WMD 11.92, 95% CI (6.99, 16.86), P < 0.00001, larger preoperative PJA (WMD 0.72, 95% CI (0.03, 1.41), P = 0.04, larger postoperative PJA (WMD 5.54, 95% CI (3.57, 7.52), P < 0.00001), larger follow-up PJA (WMD 12.42, 95% CI 9.24, 15.60), P < 0.00001, larger follow-up SVA (WMD 0.07, 95% CI (− 0.46, 0.60), P = 0.04), larger preoperative PT (WMD − 3.04, 95% CI (− 5.27, − 0.81), P = 0.008, larger follow-up PT (WMD − 3.69, 95% CI (− 6.66, − 0.72), P = 0.02) were identified as risk factors for PJK. Conclusion Following corrective surgery, 19% of AIS patients experienced PJK, with Lenke 5 contributing to 25%. Prior and post-op measurements play significant roles in predicting PJK occurrence; thus, meticulous, personalized preoperative planning is crucial. This includes considering individualized treatments based on the Lenke classification as our future evaluation standard.

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No Benefits in Using Magnetically Controlled Growing Rod as Temporary Internal Distraction Device in Staged Surgical Procedure for Management of Severe and Neglected Scoliosis in Adolescents

Grabala,

Chamberlin,

Grabala

et al. 2023

JCM

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Background: Severe spinal curvatures (SSCs) in children and adolescents have long been treated with preoperative Halo traction, in its various variations. There are also several radical techniques available for the management of neglected SSCs, such as osteotomies; however, these can be risky. Comparing the treatment outcomes when using preoperative Halo Gravity Traction (HGT) against the use of a Magnetically Controlled Growing Rod (MCGR) as a temporary internal distraction (TID) device, we evaluated the differences in surgical and radiological outcomes. Methods: We conducted a retrospective study of 30 patients with SSCs, treated with HGT followed by posterior spinal fusion (PSF; Group 1, n = 18) or treated using a temporary MCGR as a TID followed by PSF (Group 2, n = 12). All patients underwent surgical treatment between 2016 and 2022. The inclusion criteria were SSC > 90°, flexibility < 30%, and the use of preoperative HGT followed by PSF or the two-stage surgical procedure with initial TID rod placement (Stage 1) followed by PSF (Stage 2). The evaluated parameters were as follows: rib hump, trunk height, and radiographic outcomes. All parameters were collected preoperatively, after the initial surgery, after final correction and fusion, and during the final follow-up. Results: In Group 1, we evaluated 18 patients with a mean age of 15.5 years; in Group 2, we evaluated 12 patients with a mean age of 14.2 years. The interval between the staged procedures averaged 32.7 days. The mean preoperative main curves (MC) were 118° and 112° in Group 1 and Group 2, respectively. After definitive surgery, the MC was corrected to 42° and 44° in G1 and G2, respectively. The mean percentage correction of the MC was similar in both groups (65% vs. 61% in G1 and G2, respectively). The mean preoperative thoracic kyphosis was 92.5° in G1 and 98° in G2, corrected to 43.8° in G1 and 38.8° in G2. Trunk height increased by 9 cm on average. Conclusions: There are no benefits in using a MCGR as a temporary internal distraction device in the management of neglected scoliosis in adolescents. Surgical treatment of severe scoliosis may be safe, with a reduced risk of potential complications, when using preoperative HGT. A specific intraoperative complication when using a MCGR as a temporary internal distraction device was a 50% risk of transient neuromonitoring changes, due to significant force applied to the spine and radical distraction of the spine. We achieved similar clinical, radiographic, and pulmonary function outcomes for both techniques. The use of HGT causes less blood loss with a shorter overall time under anesthesia. Partial correction significantly aids the subsequent operation by facilitating a gradual reduction in the curvature, thereby reducing the difficulty of surgical treatment and the risk of neurological deficits.

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Risk factors for proximal junctional kyphosis after pediatric spinal deformity surgery with halo gravity traction

Cited by 3 publications

References 21 publications

Incidence and risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis after correction surgery: a meta-analysis and systematic review

Incidence and risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis after correction surgery: a meta-analysis and systematic review

Incidence and risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis after correction surgery: a meta-analysis and systematic review

No Benefits in Using Magnetically Controlled Growing Rod as Temporary Internal Distraction Device in Staged Surgical Procedure for Management of Severe and Neglected Scoliosis in Adolescents

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