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Distal junctional kyphosis in adult cervical deformity patients: where does it occur?

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Abstract

Purpose

To evaluate the impact of the lowest instrumented vertebra (LIV) on Distal Junctional kyphosis (DJK) incidence in adult cervical deformity (ACD) surgery.

Methods

Prospectively collected data from ACD patients undergoing posterior or anterior–posterior reconstruction at 13 US sites was reviewed up to 2-years postoperatively (n = 140). Data was stratified into five groups by level of LIV: C6-C7, T1-T2, T3-Apex, Apex-T10, and T11-L2. DJK was defined as a kyphotic increase > 10° in Cobb angle from LIV to LIV-1. Analysis included DJK-free survival, covariate-controlled cox regression, and DJK incidence at 1-year follow-up.

Results

25/27 cases of DJK developed within 1-year post-op. In patients with a minimum follow-up of 1-year (n = 102), the incidence of DJK by level of LIV was: C6-7 (3/12, 25.00%), T1-T2 (3/29, 10.34%), T3-Apex (7/41, 17.07%), Apex-T10 (8/11, 72.73%), and T11-L2 (4/8, 50.00%) (p < 0.001). DJK incidence was significantly lower in the T1-T2 LIV group (adjusted residual = −2.13), and significantly higher in the Apex-T10 LIV group (adjusted residual = 3.91). In covariate-controlled regression using the T11-L2 LIV group as reference, LIV selected at the T1-T2 level (HR = 0.054, p = 0.008) or T3-Apex level (HR = 0.081, p = 0.010) was associated with significantly lower risk of DJK. However, there was no difference in DJK risk when LIV was selected at the C6-C7 level (HR = 0.239, p = 0.214).

Conclusion

DJK risk is lower when the LIV is at the upper thoracic segment than the lower cervical segment. DJK incidence is highest with LIV level in the lower thoracic or thoracolumbar junction.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China

    Jichao Ye

  2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Renaud Lafage, Virginie Lafage & Han-Jo Kim

  3. Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA

    Themistocles S. Protopsaltis & Peter G. Passias

  4. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA

    Justin S. Smith

  5. Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA

    Eric O. Klineberg

  6. Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA

    Khaled M. Kebaish

  7. Department of Neurological Surgery, University of California, San Francisco, CA, USA

    Justin K. Scheer & Christopher P. Ames

  8. Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA

    Gregory M. Mundis

  9. University of Calgary Spine Program, University of Calgary, Alberta, Canada

    Alex Soroceanu

  10. Rocky Mountain Hospital for Children, Presbyterian/St Luke’s Medical Center, Denver, CO, USA

    Shay Bess

  11. Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, NC, USA

    Christopher I. Shaffrey

  12. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid, Campus, Box 8233, St. Louis, MO, 63110, USA

    Sean M. Rider & Munish C. Gupta

  13. Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Sachin Gupta & Ali S. Farooqi

Authors
  1. Jichao Ye
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  2. Sean M. Rider
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  6. Themistocles S. Protopsaltis
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  19. Munish C. Gupta
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The International Spine Study Group (ISSG)

Corresponding author

Correspondence to Munish C. Gupta.

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Data was collected from a database of 13 spine centers in the United States, which was approved by the institutional review board (IRB) at each participating unit.

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Ye, J., Rider, S.M., Lafage, R. et al. Distal junctional kyphosis in adult cervical deformity patients: where does it occur?. Eur Spine J 32, 1598–1606 (2023). https://doi.org/10.1007/s00586-023-07631-6

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  • DOI: https://doi.org/10.1007/s00586-023-07631-6

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