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Compensation from mild and severe cases of early proximal junctional kyphosis may manifest as progressive cervical deformity at two year follow-up

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Abstract

Background

Postoperative reciprocal changes (RC) in the cervical spine associated with varying factors of proximal junctional kyphosis (PJK) following fusions of the thoracopelvic spine are poorly understood.

Purpose

Explore reciprocal changes in the cervical spine associated with varying factors (severity, progression, patient age) of PJK in patients undergoing adult spinal deformity (ASD) correction.

Patients and methods

Retrospective review of a multicenter ASD database. Inclusion: ASD patients > 18 y/o, undergoing fusions from the thoracic spine (UIV: T6-T12) to the pelvis with two-year radiographic data. ASD was defined as: Coronal Cobb angle ≥ 20°, Sagittal Vertical Axis ≥ 5 cm, Pelvic Tilt ≥ 25°, and/or Thoracic Kyphosis ≥ 60°. PJK was defined as a ≥ 10° measure of the sagittal Cobb angle between the inferior endplate of the UIV and the superior endplate of the UIV + 2. Patients were grouped by mild (M; 10°–20°) and severe (S; > 20°) PJK at one year. Propensity Score Matching (PSM) controlled for CCI, age, PI and UIV. Unpaired and paired t test analyses determined difference between RC parameters and change between time points. Pearson bi-variate correlations analyzed associations between RC parameters (T4-T12, TS-CL, cSVA, C2-Slope, and T1-Slope) and PJK descriptors.

Results

284 ASD patients (UIV: T6: 1.1%; T7: 0.7%; T8: 4.6%; T9: 9.9%; T10: 58.8%; T11: 19.4%; T12: 5.6%) were studied. PJK analysis consisted of 182 patients (Mild = 91 and Severe = 91). Significant difference between M and S groups were observed in T4-T12 Δ1Y(− 16.8 v − 22.8, P = 0.001), TS-CLΔ1Y(− 0.6 v 2.8, P = 0.037), cSVAΔ1Y(− 1.8 v 1.9, P = 0.032), and C2 slopeΔ1Y(− 1.6 v 2.3, P = 0.022). By two years post-op, all changes in cervical alignment parameters were similar between mild and severe groups. Correlation between age and cSVAΔ1Y(R = 0.153, P = 0.034) was found. Incidence of severe PJK was found to correlate with TS-CLΔ1Y(R = 0.142, P = 0.049), cSVAΔ1Y(R = 0.171, P = 0.018), C2SΔ1Y(R = 0.148, P = 0.040), and T1SΔ2Y(R = 0.256, P = 0.003).

Conclusions

Compensation within the cervical spine differed between individuals with mild and severe PJK at one year postoperatively. However, similar levels of pathologic change in cervical alignment parameters were seen by two years, highlighting the progression of cervical compensation due to mild PJK over time. These findings provide greater evidence for the development of cervical deformity in individuals presenting with proximal junctional kyphosis.

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Funding

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

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Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA

    Peter G. Passias, Sara Naessig & Tyler K. Williamson

  2. Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA

    Renaud Lafage & Frank J. Schwab

  3. Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA

    Renaud Lafage, Virginie Lafage & Frank J. Schwab

  4. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    Justin S. Smith

  5. Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA

    Munish C. Gupta

  6. UTHealth Houston, McGovern Medical School, CA, USA

    Eric Klineberg

  7. Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA

    Douglas C. Burton

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

    Christopher Ames

  9. Rocky Mountain Scoliosis and Spine, Denver, CO, USA

    Shay Bess

  10. Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Christopher Shaffrey

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  1. Peter G. Passias
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on behalf of the International Spine Study Group (ISSG)

Contributions

Conception and design: PP, SN, TKW, RL, VL, FS, CS, JSS, MCG, EK,DCB, CA, SB; acquisition and data: SN, TKW, RL, FS, CS, JSS, MCG, EK,DCB, CA, SB; analysis and interpretation of data: PP, SN, TKW, RL, VL, JSS; approved the version to be published: PP, SN, TKW, RL, VL, FS, CS, JSS, MCG, EK,DCB, CA, SB; drafting of the manuscript: PP, SN, TKW; Critical revision of the manuscript for important intellectual content: PP, SN, TKW, RL, VL, FS, CS, JSS, MCG, EK,DCB, CA, SB; statistical analysis: PP, SN, TKW; obtaining funding: PP; administrative, technical or material support: none; agree to be accountable for all aspects of the work: PP, SN, TKW, RL, VL, FS, CS, JSS, MCG, EK,DCB, CA, SB; supervision: RL, VL, FS, CS, JSS, MCG, EK,DCB, CA, SB.

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Correspondence to Peter G. Passias.

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Conflict of interest

Peter G Passias MD–Reports personal consulting fees for Spinewave, Zimmer Biomet, DePuy Synthes, and Medicrea outside the submitted work.

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Passias, P.G., Naessig, S., Williamson, T.K. et al. Compensation from mild and severe cases of early proximal junctional kyphosis may manifest as progressive cervical deformity at two year follow-up. Spine Deform 12, 221–229 (2024). https://doi.org/10.1007/s43390-023-00763-1

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