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Risk factors for proximal junctional kyphosis in a multicenter study of Lenke type 5 and 6 adolescent idiopathic scoliosis patients

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Abstract

Purpose

In Lenke type 5 and 6 curves, a major thoracolumbar or lumbar curve, the rates of PJK are reported as high as 50%. The purpose of this study was to confirm the rate of PJK, investigate possible risk factors, and evaluate surgical complications and the long-term effects of PJK on patient outcomes.

Methods

A retrospective review of multicenter data identified 192 with patients with 2 year and 94 with 5-year follow-up. Included patients had a Lenke type 5 or 6 curve and underwent a selective thoracolumbar or lumbar curve fusion. All radiographs preoperatively and postoperatively (1 year, 2 years, and 5 years) were evaluated. Demographic and radiographic data was analyzed as risk factors for PJK using a multi-variate regression. Outcomes scores and complications were compared between groups.

Results

17 patients (8.9%) developed radiographic PJK; 1 at 1 year, 7 at 2 years, and another 9 at 5 years. All 17 patients had an upper instrumented vertebra (UIV) within 3 levels or less caudal of the thoracic kyphosis apex (the most horizontal vertebra on the sagittal); no patient with a UIV 4 or more levels from the thoracic apex (n = 96) developed PJK (X2 = 13.03, p < 0.001). In addition, PJA > 8° was found to significantly increase the risk of PJK (p = 0.039). SRS scores were significantly worse for PJK patients at 5 years in the self-image and function (p < 0.01).

Conclusion

In Lenke 5/6 curves, no patient with a UIV 4 or more levels caudal to the thoracic kyphosis apex had PJK up to 5 years postoperatively. PJA greater than 8° was identified as a risk factor for PJK. Patients with radiographic PJK had worse SRS scores 5 years postoperatively.

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Data availability

The data used to support the findings of this study are available from the Harms Study Group and corresponding author upon request.

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Disclosures

One author Dr. Lawrence Lenke is a member of the Harm’s Study Group and contributes patients to the database used for this study. There is no financial aspect or payment related to this. The other authors have no relevant disclosures.

Funding

No funding sources were utiilzed to complete this study.

Author information

Authors and Affiliations

  1. The Och Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, NY, 10032, USA

    Josephine R. Coury, Zeeshan M. Sardar, Yong Shen, Mark Ren, Rasheed Hosein-Woodley & Lawrence G. Lenke

Authors
  1. Josephine R. Coury
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  2. Zeeshan M. Sardar
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  3. Yong Shen
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  4. Mark Ren
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  5. Rasheed Hosein-Woodley
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  6. Lawrence G. Lenke
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Consortia

Harms Study Group

Contributions

JRC: conception, analysis, interpretation of data, data collection, statistics, draft manuscript/final manuscript, approved to be published, accountable for work. ZMS: conception, interpretation of data, final manuscript, approved to be published, accountable for work. YS: analysis, data collection, interpretation of data, draft manuscript, approved to be published, accountable for work. MR: analysis, data collection, interpretation of data, draft manuscript, approved to be published, accountable for work. RH-W: analysis, interpretation of data, statistics, draft manuscript, approved to be published, accountable for work. Harms Study Group: provided data points for study, not involved in manuscript, requested name on publication as provider of data, accountable for data. If this is more appropriate for an acknowledgement, we can certainly do that, but usually the group receives an authorship credit for the patients they provide. LGL: conception, interpretation of data, final manuscript, approved to be published, accountable for work.

Corresponding author

Correspondence to Josephine R. Coury.

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Conflict of interest

None of the authors have a financial or non-financial interest directly or indirectly related to the work submitted for publication.

Ethical approval

This work was approved by Columbia’s IRB. Patient information was protected by the Harms Database.

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Coury, J.R., Sardar, Z.M., Shen, Y. et al. Risk factors for proximal junctional kyphosis in a multicenter study of Lenke type 5 and 6 adolescent idiopathic scoliosis patients. Spine Deform 12, 173–180 (2024). https://doi.org/10.1007/s43390-023-00762-2

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