Skip to main content

Risk factors for acute proximal junctional kyphosis after adult spinal deformity surgery in preoperative motion analysis

European Spine Journal volume 30, pages 1215–1225 (2021)Cite this article

Abstract

Objective

This study aimed to examine which motion analysis parameters regarding the dynamic aspects and/or balance affect the development acute proximal junctional kyphosis (PJK) following adult spinal deformity (ASD) surgery.

Methods

A total of 90 consecutive patients were recruited prospectively, who underwent a corrective surgery for ASD with sagittal imbalance. According to the development of acute PJK within 6 months after surgery, the patients were divided into the PJK+ and PJK− groups. Before surgery, three-dimensional gait analyses were performed using a motion analysis system. The preoperative continuous and categorical variables were compared between the PJK+ and PJK− groups using independent t tests and chi-square tests, respectively. Finally, a multivariate logistic regression model was used to identify the risk factors and calculate the odds ratio (OR) for acute PJK.

Results

A total of 20 and 70 patients were classified into the PJK+ and PJK− groups, respectively. There were no differences in the spinopelvic radiologic parameters pre- and postoperatively between the PJK+ and PJK− groups. The PJK+ group showed a significantly higher mean anterior pelvic tilt (Ant-PT) angle in preoperative motion analysis than the PJK− group (P = 0.001 for both sides). Multivariate analysis identified the mean Ant-PT angle (P = 0.047; OR 1.127; 95% CI 1.002–1.267) as a significant risk factor for acute PJK.

Conclusion

Preoperative Ant-PT angle during walking was associated with a higher OR in acute PJK after surgery.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Acaroglu E, European Spine Study G (2016) Decision-making in the treatment of adult spinal deformity. EFORT Open Rev 1:167–176. https://doi.org/10.1302/2058-5241.1.000013

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C, Wootten D (2009) Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976) 34:2171–2178. https://doi.org/10.1097/BRS.0b013e3181a8fdc8

    Article  Google Scholar 

  3. Yilgor C, Sogunmez N, Boissiere L, Yavuz Y, Obeid I, Kleinstuck F, Perez-Grueso FJS, Acaroglu E, Haddad S, Mannion AF, Pellise F, Alanay A, European Spine Study G (2017) Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Jt Surg Am 99:1661–1672. https://doi.org/10.2106/JBJS.16.01594

    Article  Google Scholar 

  4. Kim HJ, Boachie-Adjei O, Shaffrey CI, Schwab F, Lafage V, Bess S, Gupta MC, Smith JS, Deviren V, Akbarnia B, Mundis GM, O’Brien M, Hostin R, Ames C (2014) Upper thoracic versus lower thoracic upper instrumented vertebrae endpoints have similar outcomes and complications in adult scoliosis. Spine (Phila Pa 1976) 39:E795-799. https://doi.org/10.1097/brs.0000000000000339

    Article  Google Scholar 

  5. Cho SK, Bridwell KH, Lenke LG, Yi JS, Pahys JM, Zebala LP, Kang MM, Cho W, Baldus CR (2012) Major complications in revision adult deformity surgery: risk factors and clinical outcomes with 2- to 7-year follow-up. Spine (Phila Pa 1976) 37:489–500. https://doi.org/10.1097/BRS.0b013e3182217ab5

    Article  Google Scholar 

  6. Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D (2012) Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. Spine (Phila Pa 1976) 37:693–700. https://doi.org/10.1097/BRS.0b013e31822ff5c1

    Article  Google Scholar 

  7. Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G (2006) Sagittal thoracic decompensation following long adult lumbar spinal instrumentation and fusion to L5 or S1: causes, prevalence, and risk factor analysis. Spine (Phila Pa 1976) 31:2359–2366. https://doi.org/10.1097/01.brs.0000238969.59928.73

    Article  Google Scholar 

  8. Watanabe K, Lenke LG, Bridwell KH, Kim YJ, Koester L, Hensley M (2010) Proximal junctional vertebral fracture in adults after spinal deformity surgery using pedicle screw constructs: analysis of morphological features. Spine (Phila Pa 1976) 35:138–145. https://doi.org/10.1097/BRS.0b013e3181c8f35d

    Article  Google Scholar 

  9. Yagi M, Akilah KB, Boachie-Adjei O (2011) Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Spine (Phila Pa 1976) 36:E60-68. https://doi.org/10.1097/BRS.0b013e3181eeaee2

    Article  Google Scholar 

  10. Kim HJ, Iyer S (2016) Proximal Junctional Kyphosis. J Am Acad Orthop Surg 24:318–326. https://doi.org/10.5435/JAAOS-D-14-00393

    Article  PubMed  Google Scholar 

  11. Yagi M, Ohne H, Konomi T, Fujiyoshi K, Kaneko S, Komiyama T, Takemitsu M, Yato Y, Machida M, Asazuma T (2016) Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity. Osteoporos Int 27:3495–3502. https://doi.org/10.1007/s00198-016-3676-6

    CAS  Article  PubMed  Google Scholar 

  12. Cerpa M, Sardar Z, Lenke L (2020) Revision surgery in proximal junctional kyphosis. Eur Spine J. https://doi.org/10.1007/s00586-020-06320-y

    Article  PubMed  Google Scholar 

  13. Glassman SD, Coseo MP, Carreon LY (2016) Sagittal balance is more than just alignment: why PJK remains an unresolved problem. Scoliosis Spinal Disord 11:1. https://doi.org/10.1186/s13013-016-0064-0

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kim HJ, Shen F, Kang KT, Chun HJ, Kim ST, Chang BS, Lee CK, Yeom JS (2019) Failure of pelvic compensation in patients with severe positive sagittal imbalance: comparison between static radiographs and gait analysis of spinopelvic parameters in adult spinal deformity and lumbar stenosis. Spine (Phila Pa 1976). https://doi.org/10.1097/brs.0000000000002985

    Article  Google Scholar 

  15. Kim HJ, Chun HJ, Shen F, Kang KT, Chang BS, Lee CK, Yeom JS (2020) Analysis of pelvic compensation for dynamic sagittal imbalance using motion analysis. Eur Spine J. https://doi.org/10.1007/s00586-019-06267-9

    Article  PubMed  Google Scholar 

  16. Hostin R, McCarthy I, O’Brien M, Bess S, Line B, Boachie-Adjei O, Burton D, Gupta M, Ames C, Deviren V, Kebaish K, Shaffrey C, Wood K, Hart R (2013) Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976) 38:1008–1015. https://doi.org/10.1097/BRS.0b013e318271319c

    Article  Google Scholar 

  17. de Leva P (1996) Adjustments to Zatsiorsky-Seluyanov’s segment inertia parameters. J Biomech 29:1223–1230

    Article  Google Scholar 

  18. Fairbank JC, Pynsent PB (2000) The oswestry disability index. Spine (Philadelphia, Pa 1976) 25:2940–2952

    CAS  Article  Google Scholar 

  19. Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35:1095–1108

    CAS  Article  Google Scholar 

  20. Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol group. Ann Med 33:337–343. https://doi.org/10.3109/07853890109002087

    CAS  Article  PubMed  Google Scholar 

  21. Wade R, Yang H, McKenna C, Faria R, Gummerson N, Woolacott N (2013) A systematic review of the clinical effectiveness of EOS 2D/3D X-ray imaging system. Eur Spine J 22:296–304. https://doi.org/10.1007/s00586-012-2469-7

    Article  PubMed  Google Scholar 

  22. Lee CS, Lee CK, Kim YT, Hong YM, Yoo JH (2001) Dynamic sagittal imbalance of the spine in degenerative flat back: significance of pelvic tilt in surgical treatment. Spine (Phila Pa 1976) 26:2029–2035

    CAS  Article  Google Scholar 

  23. Legaye J (2014) Influence of age and sagittal balance of the spine on the value of the pelvic incidence. Eur Spine J 23:1394–1399. https://doi.org/10.1007/s00586-014-3207-0

    Article  Google Scholar 

  24. Bae J, Theologis AA, Jang JS, Lee SH, Deviren V (2017) Impact of fatigue on maintenance of upright posture: dynamic assessment of sagittal spinal deformity parameters after walking 10 minutes. Spine (Phila Pa 1976) 42:733–739. https://doi.org/10.1097/BRS.0000000000001898

    Article  Google Scholar 

  25. Mika AP, Mesfin A, Rubery PT, Molinari R, Kebaish KM, Menga EN (2019) Proximal junctional kyphosis: a pediatric and adult spinal deformity surgery dilemma. JBJS Rev 7:e4. https://doi.org/10.2106/JBJS.RVW.18.00059

    Article  PubMed  Google Scholar 

  26. Kim HJ, Bridwell KH, Lenke LG, Park MS, Song KS, Piyaskulkaew C, Chuntarapas T (2014) Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections. Spine (Phila Pa 1976) 39:E576–E580. https://doi.org/10.1097/BRS.0000000000000246

    Article  Google Scholar 

  27. Yagi M, King AB, Boachie-Adjei O (2012) Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis Minimum 5 years of follow-up. Spine (Phila Pa 1976) 37:1479–1489. https://doi.org/10.1097/BRS.0b013e31824e4888

    Article  Google Scholar 

  28. Keevil VL, Romero-Ortuno R (2015) Ageing well: a review of sarcopenia and frailty. Proc Nutr Soc 74:337–347. https://doi.org/10.1017/s0029665115002037

    Article  PubMed  Google Scholar 

  29. Kim HJ, Park S, Park SH, Heo YW, Chang BS, Lee CK, Yeom JS (2017) The significance of frailty in the relationship between socioeconomic status and health-related quality of life in the Korean community-dwelling elderly population: mediation analysis with bootstrapping. Qual Life Res. https://doi.org/10.1007/s11136-017-1672-8

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kim HJ, Park S, Park SH, Lee JH, Chang BS, Lee CK, Yeom JS (2019) The prevalence and impact of frailty in patients with symptomatic lumbar spinal stenosis. Eur Spine J 28:46–54. https://doi.org/10.1007/s00586-018-5710-1

    Article  PubMed  Google Scholar 

  31. Pennington Z, Cottrill E, Ahmed AK, Passias P, Protopsaltis T, Neuman B, Kebaish KM, Ehresman J, Westbroek EM, Goodwin ML, Sciubba DM (2019) Paraspinal muscle size as an independent risk factor for proximal junctional kyphosis in patients undergoing thoracolumbar fusion. J Neurosurg Spine 31:380–388. https://doi.org/10.3171/2019.3.SPINE19108

    Article  PubMed  Google Scholar 

  32. Gupta MC, Diebo BG, Protopsaltis TS, Hart RA, Smith JS, Ames CP, Lafage R, Scheer JK, Kim HJ, Bess S, Burton DC, Passias PG, Schwab FJ, Lafage V (2016) Bimodal incidence and causes of proximal junctional kyphosis (PJK) in adult spinal deformity (ASD). Spine J. https://doi.org/10.1016/j.spinee.2016.07.255

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Dae-Woong Ham and Heesoo Han have contributed equally to this work as a co-first author.

Authors and Affiliations

  1. Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea

    Dae-Woong Ham, Heesoo Han, Ho-Joong Kim, Sang-Min Park & Jin S. Yeom

  2. Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea

    Bong-Soon Chang

Authors
  1. Dae-Woong Ham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heesoo Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ho-Joong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sang-Min Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bong-Soon Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jin S. Yeom
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ho-Joong Kim.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ham, DW., Han, H., Kim, HJ. et al. Risk factors for acute proximal junctional kyphosis after adult spinal deformity surgery in preoperative motion analysis. Eur Spine J 30, 1215–1225 (2021). https://doi.org/10.1007/s00586-021-06830-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-021-06830-3

Keywords

  • Adult spinal deformity
  • Proximal junctional kyphosis
  • Motion analysis
  • Anterior pelvic tilt angle