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Changes in sagittal balance and pre-existing junctional angle influence development of proximal junctional kyphosis in growth guidance systems for early-onset scoliosis

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Abstract

Purpose

Proximal junctional kyphosis (PJK) has been reported to occur at a rate of about 30% in traditional growing rods (GR) and magnetically controlled growing rods (MCGR). Growth guidance systems (GGS) have non-rigid, gliding fixation along rods, which may mitigate PJK. There have been no studies done in shilla around PJK, hence this study aimed to assess the occurrence, risk factors, and timeline of PJK.

Methods

A prospective, multicenter database was queried for EOS patients who underwent surgery utilizing GGS. Inclusion criteria: < 10 years at index surgery and > 2 year follow-up.

Results

Sixty-five patients (thirty-six female) met inclusion criteria. Mean age at index surgery was 6.2 y/o (2–9); mean follow-up was 66 m. Most common etiologies were syndromic (n = 23). Mean thoracic kyphosis at pre-op was 41.8°, post-op was 35.5°, and final was 42.2°. Mean PJA at pre-op was 6.15°, post-op 1 was 4.2°, and final was 15.6°. Incidence of PJK at post-op was 35% and final was 43%. Pre-op sagittal balance and change in sagittal balance from pre-op to post-op were associated with post-op PJK (p = 0.05, 0.02). Change in spinal height from pre-op to post-op was associated with PJK at final (p = 0.04). Interestingly, increased PJA at pre-op was significantly associated with decreased PJK at post-op and final (p = 0.01, 0.03).

Conclusion

PJK was identified in 43% of patients post-operatively after GGS for EOS. Pre-op PJA was negatively correlated with an increased incidence of PJK. Changes in sagittal balance, in either direction, was the strongest predictor for development of PJK post-operatively.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, St Louis Children’s Hospital, Washington University School of Medicine, Saint Louis, MO, 63110, USA

    Reme Emmanuel Arhewoh, Ian Marigi & Scott Luhmann

  2. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, 48109, USA

    Reme Emmanuel Arhewoh

  3. Department of Orthopaedics, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR, 72205, USA

    Richard McCarthy

  4. Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA

    David Skaggs

  5. Division of Pediatric Orthopaedics, Johns Hopkins University, Baltimore, MD, 21287, USA

    Paul Sponseller

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  1. Reme Emmanuel Arhewoh
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  2. Ian Marigi
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Pediatric Spine Study Group

Contributions

RMA, IM, RM, DS, PS, SL, Pediatric Spine Study Group: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. RMA, IM, RM, DS, PS, SL, Pediatric Spine Study Group: drafting the work or revising it critically for important intellectual content. RMA, IM, RM, DS, PS, SL, Pediatric Spine Study Group: final approval of the version to be published. RMA, IM, RM, DS, PS, SL, Pediatric Spine Study Group: agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Scott Luhmann.

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No human subjects or animals participated; therefore, no informed consent was obtained. IRB approval was obtained from Washington University Institutional Review Board, IRB 201102008.

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Arhewoh, R.E., Marigi, I., McCarthy, R. et al. Changes in sagittal balance and pre-existing junctional angle influence development of proximal junctional kyphosis in growth guidance systems for early-onset scoliosis. Spine Deform 12, 239–246 (2024). https://doi.org/10.1007/s43390-023-00754-2

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