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European Spine Journal

, Volume 25, Issue 8, pp 2376–2383 | Cite as

Incidence and risk factors for proximal junctional kyphosis: a meta-analysis

  • Feng-Yu Liu
  • Tao Wang
  • Si-Dong Yang
  • Hui Wang
  • Da-Long Yang
  • Wen-Yuan Ding
Original Article

Abstract

Purpose

To analyse the incidence and risk factors associated with proximal junctional kyphosis (PJK) following spinal fusion, we collect relative statistics from the articles on PJK and perform a meta-analysis.

Methods

An extensive search of literature was performed in PubMed, Embase, and The Cochrane Library (up to April 2015). The following risk factors were extracted: age at surgery, gender, combined anterior-posterior surgery, use of pedicle screw at top of construct, hybrid instrumentation, thoracoplasty, fusion to sacrum (S1), preoperative thoracic kyphosis angle (T5–T12) >40°, bone mineral density (BMD) and preoperative to postoperative sagittal vertical axis (SVA difference) >5 cm. Data analysis was conducted with RevMan 5.3 and STATA 12.0.

Results

A total of 14 unique studies including 2215 patients were included in the final analyses. The pooled analysis showed that there were significant difference in age at surgery >55 years old (OR 2.19, 95 % CI 1.36–3.53, p = 0.001), fusion to S1 (OR 2.12, 95 % CI 1.57–2.87, p < 0.001), T5–T12 >40° (OR 2.68, 95 % CI 1.73–4.13, p < 0.001), low BMD (OR 2.37, 95 % CI 1.45–3.87, p < 0.001) and SVA difference >5 cm (OR 2.53, 95 % CI 1.24–5.18, p = 0.01). However, there was no significant difference in gender (OR 0.98, 95 % CI 0.74–1.30, p = 0.87), combined anterior-posterior surgery (OR 1.55, 95 % CI 0.98–2.46, p = 0.06), use of pedicle screw at top of construct (OR 1.55, 95 % CI 0.67–3.59, p = 0.30), hybrid instrumentation (OR 1.31, 95 % CI 0.92–1.87, p = 0.13) and thoracoplasty (OR 1.55, 95 % CI 0.89–2.72, p = 0.13). The incidence of PJK following spinal fusion was 30 % (ranged from 17 to 62 %) based on the 14 studies.

Conclusions

The results of our meta-analysis suggest that age at surgery >55 years, fusion to S1, T5–T12 >40°, low BMD and SVA difference >5 cm are risk factors for PJK. However, gender, combined anterior–posterior surgery, use of pedicle screw at top of construct, hybrid instrumentation and thoracoplasty are not associated with PJK.

Keywords

Incidence Risk factors Proximal junctional kyphosis Meta-analysis 

Notes

Compliance with ethical standards

Conflict of interest

All authors have declared that we have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Feng-Yu Liu
    • 1
  • Tao Wang
    • 1
  • Si-Dong Yang
    • 1
  • Hui Wang
    • 1
  • Da-Long Yang
    • 1
  • Wen-Yuan Ding
    • 1
    • 2
  1. 1.Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
  2. 2.Hebei Provincial Key Laboratory of Orthopedic BiomechanicsShijiazhuangChina

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