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Proximal Junctional Kyphosis After Posterior Spinal Instrumentation and Fusion in Young Children With Congenital Scoliosis: A Preliminary Report on its Incidence and Risk Factors.

Abstract：

STUDY DESIGN:A retrospective study. OBJECTIVE:To determine the incidence and risk factors of proximal junctional kyphosis (PJK) in young children who underwent posterior instrumented spinal fusion. SUMMARY OF BACKGROUND DATA:PJK is a well-recognized postoperative complication in adults and adolescents. However, there is a paucity of valid data with regard to PJK in young children with congenital scoliosis (CS) who were treated with posterior correction surgery. METHODS:This study reviewed the charts and radiographs of a consecutive series of young children with CS who underwent posterior instrumentation and fusion (≥4 levels) from January 2008 to May 2013. The patients were followed up for more than 24 months. Radiographic measurements were made preoperatively and throughout the follow-up period. From sagittal images, the following values were obtained: proximal junctional angle, sagittal vertical axis, pelvic incidence, thoracic kyphosis, lumbar lordosis, and segmental kyphosis. RESULTS:Totally 113 children were recruited in this study. The average age at surgery was 6.6 years, and the average follow-up period was 48.8 months. PJK occurred in 21 of the 113 patients and were mostly classified as ligamentous failure. In comparison with the non-PJK group, the PJK group showed greater preoperative Thoracic kyphosis (TK) (45.9° vs. 37.3°, P = 0.027), longer fusion levels (6.6 vs. 5.4, P < 0.01), and greater segmental kyphosis (SK) change (30.1° vs. 11.2°, P = 0.002). Both a change in SK greater than 30° and a preoperative TK greater than 40° were independent risk factors associated with PJK. In the PJK group, the average PJA increased by 12.4° at 3 months postoperatively and followed by slight improvement till the final follow-up. CONCLUSION:This study demonstrates a high rate of PJK in young children after correction surgery for CS. PJK mainly occurs within 3 months postoperatively and its risk factors include preoperative hyperkyphosis, over-correction of kyphosis, and ligamentous failure. LEVEL OF EVIDENCE:4.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Chen X,Chen ZH,Qiu Y,Zhu ZZ,Li S,Xu L,Sun X

doi

10.1097/BRS.0000000000002109

subject

Has Abstract

pub_date

2017-10-15 00:00:00

pages

E1197-E1203

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-201710150-00015

journal_volume

pub_type

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Proximal Junctional Kyphosis After Posterior Spinal Instrumentation and Fusion in Young Children With Congenital Scoliosis: A Preliminary Report on its Incidence and Risk Factors.