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The Risk of Proximal Junctional Kyphosis Decreases in Patients With Optimal Thoracic Kyphosis

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Abstract

Study Design

A retrospective study of surgical outcomes.

Objective

This study aimed to investigate the preoperative risk factors for proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery.

Summary of Background Data

The cause of PJK is still unclear, although some risk factors have been reported in ASD surgery.

Methods

A total of 185 patients who were followed up for more than two years and underwent ASD surgery were recruited. PJK was defined as a proximal junctional angle ≥20° or reoperation due to PJK within two years after surgery. These patients were divided into PJK and non-PJK groups. Whole-spine standing radiography was performed before and immediately, one year, and two years after the surgery.

Results

The PJK and non-PJK groups comprised 58 and 127 cases, respectively. The incidence of PJK demonstrated significant differences according to preoperative thoracic kyphosis (TK): 37% (TK ≤19°), 33% (TK 20°–29°), 9% (TK 30°–39°), 32% (TK 40°–49°), and 41% (TK ≥50°) (p < .05). Logistic regression analysis suggested that the amount of change in TK before and just after the surgery (ΔTK) was a significant risk factor for PJK (p < .001; odds ratio 1.062, 95% confidence interval 1.029–1.097).

Conclusion

ΔTK was less in the TK group of 30°–39° because the TK of patients who underwent ASD surgery converged to 34.5° just after surgery. Consequently, a lower or higher TK was likely to result in a large ΔTK just after surgery. Therefore, patients who had an optimal TK (30°–39°) had a lower risk of PJK.

Level of Evidence

Level IV.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1-20-1 Handayama, 431-3192, Higashi-ku, Hamamatsu City, Shizuoka, Japan

    Shin Oe MD & Daisuke Togawa MD, PhD

  2. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, 431-3192, Higashi-ku, Hamamatsu City, Shizuoka, Japan

    Tomohiko Hasegawa MD, PhD, Yu Yamato MD, PhD, Go Yoshida MD, PhD, Tatsuya Yasuda MD, Tomohiro Banno MD, PhD, Hideyuki Arima MD, PhD, Yuki Mihara MD, Hiroki Ushirozako MD & Yukihiro Matsuyama MD, PhD

  3. Department of Orthopedic Surgery, Hamamatsu Medical Center, 3-2-8, Tomitsukacho, Shizuoka Prefecture, 432-8580, Naka Ward, Hamamatsu, Japan

    Sho Kobayashi MD, PhD

Authors
  1. Shin Oe MD
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  2. Daisuke Togawa MD, PhD
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  3. Tomohiko Hasegawa MD, PhD
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  4. Yu Yamato MD, PhD
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  5. Go Yoshida MD, PhD
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  6. Sho Kobayashi MD, PhD
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  7. Tatsuya Yasuda MD
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  8. Tomohiro Banno MD, PhD
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  9. Hideyuki Arima MD, PhD
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  10. Yuki Mihara MD
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  11. Hiroki Ushirozako MD
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  12. Yukihiro Matsuyama MD, PhD
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Corresponding author

Correspondence to Shin Oe MD.

Additional information

Author disclosures: SO (other from Medtronic Sofamor Danec Inc., Japan Medical Dynamic Marketing, and Meitoku Medical Institution Jyuzen Memorial Hospital, outside the submitted work), DT (other from Medtronic Sofamor Danec Inc., Japan Medical Dynamic Marketing, and Meitoku Medical Institution Jyuzen Memorial Hospital, outside the submitted work), TH (none), YY (none), GY (none), SK (none), TY (none), TB (none), HA (none), YM (none), HU (none), YM (none).

IRB approval: The study protocol was approved by the institutional review board of Hamamatsu University School of Medicine, Shizuoka, Japan.

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Oe, S., Togawa, D., Hasegawa, T. et al. The Risk of Proximal Junctional Kyphosis Decreases in Patients With Optimal Thoracic Kyphosis. Spine Deform 7, 759–770 (2019). https://doi.org/10.1016/j.jspd.2018.12.007

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  • DOI: https://doi.org/10.1016/j.jspd.2018.12.007

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