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Changes in health-related quality of life measures associated with degree of proximal junctional kyphosis

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Abstract

Purpose

To explore the changes in health-related quality of life parameters observed in patients experiencing varying degrees of proximal junctional kyphosis following corrective adult spinal deformity fusions.

Methods

Inclusion: adult spinal deformity patients > 18 y/o, undergoing spinal fusion. PJK: ≥ 10° measure of the sagittal Cobb angle between the inferior endplate of the UIV and the superior endplate of the UIV + 2. Severe PJK: > 28° PJK. Mild PJK: ≥ 10oand ≤ 28°. ANOVA, followed by ANCOVA, compared the change in HRQoLs between time points (BL, 1Y, 2Y) among PJK groups. Correlation-related change in PJK and change in HRQoL for mild and severe groups.

Results

969 patients (age: 64.5 y/o,75% F, posterior levels fused:12.3) were studied. 59% no PJK, 32% mild PJK, 9% severe PJK. No differences in HRQoLs were seen between no PJK and PJK groups at baseline, one year, and 2 years. Adjusted analysis revealed Severe PJK patients improved less in SRS-22 Satisfaction (NoPJK: 1.6, MildPJK: 1.6, SeverePJK: 1.0; p = 0.022) scores at 2 years. Linear regression analysis only found clinical improvement in SRS-22 Satisfaction to correlate with the change of the PJK angle by 2 years (R = 0.176, P = 0.008). No other HRQoL metric correlated with either the incidence of PJK or the change in the PJK angle by one or 2 years.

Conclusions

These results maintain that patients presenting with and without proximal junctional kyphosis report similar health-related qualities of life following corrective adult spinal deformity surgery, and SRS-22 Satisfaction may be a clinical correlate to the degree of PJK. Rather than proving proximal junctional kyphosis to have a minimal clinical impact overall on HRQoL metrics, these data suggest that future analysis of this phenomenon requires different assessments.

Level of evidence

Level of evidence: III.

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Data availability

Data are available from the corresponding author upon request.

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Funding

ISSG: The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes and individual donations, and supported the current work.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA

    Peter G. Passias, Nicholas J. Frangella, Tyler K. Williamson & Kevin A. Moattari

  2. Department of Orthopaedics, Lenox Hill Hospital | Northwell Health, New York, NY, USA

    Renaud Lafage, Virginie Lafage & Frank J. Schwab

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

    Justin S. Smith & Christopher I. Shaffrey

  4. Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Khaled M. Kebaish

  5. Department of Orthopaedic Surgery, Medical Center, University of Kansas, Kansas, KS, USA

    Douglas C. Burton

  6. Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA

    Robert A. Hart

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

    Christopher P. Ames

  8. Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA

    Shay Bess

  9. Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, New York Spine Institute, NYU Langone Medical Center, Orthopaedic Hospital—NYU School of Medicine, 301 East 17th St, New York, NY, 10003, USA

    Peter G. Passias

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  1. Peter G. Passias
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the International Spine Study Group

Contributions

PP, NJF, TKW, KAM, RL, VL, JSS, KMK, DCB, RAH, CPA, SB, CIS, FJS, International Spine Study Group (ISSG): Made Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work. PP, NJF, TKW, KAM, RL, VL, JSS, KMK, DCB, RAH, CPA, SB, CIS, FJS, International Spine Study Group (ISSG): Drafted the work or revised it critically for important intellectual content. PP, NJF, TKW, KAM, RL, VL, JSS, KMK, DCB, RAH, CPA, SB, CIS, FJS, International Spine Study Group (ISSG): Approved the version to be published. PP, NJF, TKW, KAM, RL, VL, JSS, KMK, DCB, RAH, CPA, SB, CIS, FJS, International Spine Study Group (ISSG): Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy of the integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Peter G. Passias.

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Each institution obtained approval from their local Institutional Review Board to enroll patients in the prospective database and informed consent was obtained from each patient.

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Passias, P.G., Frangella, N.J., Williamson, T.K. et al. Changes in health-related quality of life measures associated with degree of proximal junctional kyphosis. Spine Deform 11, 699–706 (2023). https://doi.org/10.1007/s43390-022-00607-4

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  • DOI: https://doi.org/10.1007/s43390-022-00607-4

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