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Can placement of hook at the upper instrumented level decrease the proximal junctional kyphosis risk in adolescent idiopathic scoliosis?

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Abstract

Objective

Proximal junctional kyphosis is a commonly encountered clinical and radiographic phenomenon after pediatric and adolescent spinal deformity surgery that may lead to postoperative deformity, pain, and dissatisfaction. The purpose of the study was to identify whether the placement of transverse process hooks is an effective way to prevent PJK.

Methods

Adolescent idiopathic scoliosis patients who underwent posterior spinal fusion between November 2015 and May 2019 were retrospectively analyzed. A minimum 2-year follow-up was required. Demographic and surgical data included UIV level type of instrumentation (hook vs screw) were reported. Radiologic parameters included main curve Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), and proximal junctional angle (PJA) were assessed. Patients were divided into two groups based on the type of instrumentation at the UIV level whether placement of hook versus pedicle screw.

Results

Three hundred and thirty-seven patients were included with the mean age 14.2 ± 1.9 years. Thirty patients (8.9%) were diagnosed with proximal junctional kyphosis radiographically. PJK incidence was found 3.2% (5/154) in the hook group and 13.3% (23/172) in the screw group and the difference found statistically significant. In the PJK group, preoperative thoracic kyphosis and the degree of kyphosis correction were also significantly higher than non-PJK patients.

Conclusion

Placement of transverse process hooks at the UIV level in posterior spinal fusion surgery for AIS patients was associated with decreased risk of PJK. A larger preoperative kyphosis and greater degree of kyphosis correction correlated with PJK.

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Funding

No funds, grants, or other support were received.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Johns Hopkins University, Baltimore, MD, USA

    Mehmet Erkilinc

  2. Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL, USA

    Melanie Coathup

  3. College of Medicine, University of Central Florida, Orlando, FL, USA

    Michael Grant Liska

  4. Department of Orthopedics, Nemours Children’s Hospital, 6535 Nemours Parkway, Orlando, FL, 32827, USA

    Mehmet Erkilinc & John Lovevoy

Authors
  1. Mehmet Erkilinc
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  2. Melanie Coathup
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  3. Michael Grant Liska
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  4. John Lovevoy
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Contributions

Mehmet Erkilinc contributed to study design, data collection, manuscript draft and statistical analysis; Melanie Coathup contributed to manuscript draft and statistical analysis; Michael Grant Liska contributed to data collection; John Lovejoy contributed to study design and manuscript review.

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Correspondence to Mehmet Erkilinc.

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IRB approval, Nemours Children’s Hospital Florida.

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Erkilinc, M., Coathup, M., Liska, M.G. et al. Can placement of hook at the upper instrumented level decrease the proximal junctional kyphosis risk in adolescent idiopathic scoliosis?. Eur Spine J 32, 3113–3117 (2023). https://doi.org/10.1007/s00586-023-07803-4

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  • DOI: https://doi.org/10.1007/s00586-023-07803-4

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