What is the Risk of Developing Proximal Junctional Kyphosis During Growth Friendly Treatments for Early-onset Scoliosis?

El-Hawary, Ron; Sturm, Peter; Cahill, Patrick J.; Samdani, Amer F.; Vitale, Michael G.; Gabos, Peter G.; Bodin, Nathan D.; D'Amato, Charles R.; Harris, Colin; Khudairy, Ammar Al; Smith, John T.

doi:10.1097/bpo.0000000000000599

Cited by 45 publications

(17 citation statements)

References 41 publications

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“…This is concordant with previous reports, which have shown that a pre-operative TK > 60°increases the risk of PJK [15]. Other authors have also found that the effect of pre-operative kyphosis is more pronounced when the UIV is distal to T2 [13,24], which is why a UIV of T1 is desirable in hyperkyphotic patients, especially in neuromuscular curves.…”

Section: Discussionsupporting

confidence: 91%

“…Although most complications are minor, the high rates of unplanned return to the operating room are still a concern in growing rod constructs. Increased kyphosis of the vertebrae immediately cranial to the construct, or proximal junctional kyphosis (PJK), is a common complication with growing rod techniques, with an incidence of 20 to 45% depending on the definition and technique [8][9][10][11][12][13]. Several authors have attempted to compare the results and complications of different fixation strategies, including hooks, screws, wires, and hybrid constructs [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Complications of dual growing rod with all-pedicle screw instrumentation in the treatment of early-onset scoliosis

et al. 2021

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Background Treatment of early-onset scoliosis (EOS) is still a challenge to patients, families, and surgeons. Previous studies have indicated that EOS patients are at high risk for complications following growth-friendly surgery. This study was performed to evaluate the results and complications of all-pedicle screw dual growing rod instrumentation in the treatment of EOS. Methods In an IRB-approved retrospective study, we searched the electronic medical records of our institution for all patients who underwent posterior spinal instrumentation for scoliosis between March 2014 and March 2017. Patients under the age of 10 at the time of surgery who were treated with a growth-friendly technique were then selected. Patients with incomplete records and less than 2 years of follow-up were excluded. Charts, operative notes, clinic visits, and radiographs were extracted. Radiographs were reviewed, and the main curve Cobb angle, thoracic kyphosis, pelvic tilt, pelvic incidence, sacral slope, and proximal junctional angles were measured. We specifically looked for any intra-operative or post-operative complications. Statistical analysis was performed to determine the risk factors of complications. Results A total of 42 patients with a mean age of 4.8 ± 2.1 years (range, 1.5–8 years) were included in the final analysis. Patients were followed for a median of 34 months (range, 24–55). The major curve was corrected from a mean of 42.9° ± 10.7° to 28.8° ± 9.6° at the latest follow-up. Proximal junctional angles and thoracic kyphosis increased significantly during the follow-up period (both P values < 0.001). A total of 7 complications (17%) were observed. Four patients (10%) developed superficial surgical site infections, all of which resolved with antibiotics and one round of surgical debridement. Three cases (7%) of proximal junctional kyphosis (PJK) were encountered during the study period, none of which required revision surgery. Pre-operative thoracic kyphosis was the only significant risk factor for the development of PJK. Conclusions Our findings suggest that in settings without access to magnetically controlled growing rods, dual growing rods with all-pedicle screw instrumentation is still a viable treatment strategy with comparable results and complications. The most common complications are infection and PJK, with the latter being associated with a larger pre-operative thoracic kyphosis.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Complications of dual growing rod with all-pedicle screw instrumentation in the treatment of early-onset scoliosis

et al. 2021

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“…Among the included studies, many authors attempted to identify the risk factors associated with PJK development. Among these, El-Hawary et al 22 found that in comparison with subjects without PJK, subjects with PJK had significantly greater cervical lordosis and proximal junctional angle at final follow-up. Helgeson et al 24 noted a trend toward a decrease in PJK with placement of hooks at the upper instrumented vertebra than with screws.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Consequences of the Proximal Junctional Kyphosis After Spinal Deformity Surgery

Yan

2016

Medicine

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The aim of this study was to estimate the prevalence and patient outcomes of proximal junctional kyphosis (PJK) in pediatric patients and adolescents who received surgical interventions for the treatment of a spinal deformity.Literature was searched in electronic databases, and studies were selected by following précised eligibility criteria. Percent prevalence values of the PJK in individual studies were pooled to achieve a weighted effect size under the random effects model. Subgroup and meta-regression analyses were performed to appraise the factors affecting PJK prevalence.Twenty-six studies (2024 patients) were included in this meta-analysis. Average age of the patients was 13.8 ± 2.75 years of which 32 ± 20 % were males. Average follow-up was 51.6 ± 38.8 (range 17 ± 13 to 218 ± 60) months. Overall, the percent prevalence of PJK (95% confidence interval) was 11.02 (10.5, 11.5) %; P < 0.00001 which was inversely associated with age (meta-regression coefficient: –1.607 [–2.86, –0.36]; 0.014). Revision surgery rate in the patients with PJK was 10%. The prevalence of PJK was positively associated with the proximal junctional angle at last follow-up (coefficient: 2.248; P = 0.012) and the change in the proximal junctional angle from surgery to last follow-up (coefficient: 2.139; P = 0.014) but not with preoperative proximal junctional angle.The prevalence of PJK in the children and adolescent patients is 11%. About 10% of those affected require revision surgery.

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“…Although it was not statistically significant, the incidence of PJK was slightly lower in the VEPTR group than in the GRI group (18.2% vs 22.7%, respectively). In the study by El-Hawary et al, 8 the incidence of PJK in VEPTR patients was also relatively lower than that in GRI patients (17% vs 25% at immediate follow-up, and 25% vs 31% at final follow-up). The above results demonstrate a tendency to a higher incidence of PJK in the GRI group.…”

Section: Discussionmentioning

confidence: 79%

Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

Chen¹,

Song²,

Qiu³

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEAlthough the vertical expandable prosthetic titanium rib (VEPTR) and growing rod instrumentation (GRI) encourage spinal growth via regular lengthening, they can create different results because of their different fixation patterns and mechanisms in correcting scoliosis. Previous studies have focused comparisons on coronal plane deformity with minimal attention to the sagittal profile. In this retrospective study, the authors aimed to compare the evolution of the sagittal spinal profile in early-onset scoliosis (EOS) treated with VEPTR versus GRI.METHODSThe data for 11 patients with VEPTR and 22 with GRI were reviewed. All patients had more than 2 years’ follow-up with more than 2 lengthening procedures. Radiographic measurements were performed before and after the index surgery and at the latest follow-up. The complications in both groups were recorded.RESULTSPatients in both groups had similar diagnoses, age at the index surgery, and number of lengthening procedures. The changes in the major coronal Cobb angle and T1–S1 spinal height were not significantly different between the 2 groups. Compared with the GRI group, the VEPTR group had less correction in thoracic kyphosis (23% ± 12% vs 44% ± 16%, p < 0.001) after the index surgery and experienced a greater correction loss in thoracic kyphosis (46% ± 18% vs 11% ± 8%, p < 0.001) at the latest follow-up. Although the increase in the proximal junctional angle was not significantly different (VEPTR: 7° ± 4° vs GRI: 8° ± 5°, p = 0.569), the incidence of proximal junctional kyphosis was relatively lower in the VEPTR group (VEPTR: 18.2% vs GRI: 22.7%). No significant changes in the spinopelvic parameters were observed, while the sagittal vertical axis showed a tendency toward a neutral position in both groups. The overall complication rate was higher in the VEPTR group than in the GRI group (72.7% vs 54.5%).CONCLUSIONSThe VEPTR had coronal correction and spinal growth results similar to those with GRI. In the sagittal plane, however, the VEPTR was not comparable to the GRI in controlling thoracic kyphosis. Thus, for hyperkyphotic EOS patients, GRI is recommended over VEPTR.

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What is the Risk of Developing Proximal Junctional Kyphosis During Growth Friendly Treatments for Early-onset Scoliosis?

Abstract: Level III-therapeutic study (retrospective, comparative).

Cited by 45 publications

References 41 publications

Complications of dual growing rod with all-pedicle screw instrumentation in the treatment of early-onset scoliosis

Complications of dual growing rod with all-pedicle screw instrumentation in the treatment of early-onset scoliosis

Prevalence and Consequences of the Proximal Junctional Kyphosis After Spinal Deformity Surgery

Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

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