Operative choices matter: the role of UIV and sagittal balance in the development of proximal junctional kyphosis following posterior instrumentation for Scheuermann’s kyphosis

Adam N. Fano, Hiroko Matsumoto, Rishi Sinha, Lisa Bonsignore-Opp, Afrain Z. Boby, Benjamin D. Roye, Rajiv Iyer, Lawrence G. Lenke, Andrew Luzzi, Amber Sentell Mizerik, Peter O. Newton, Baron Lonner, Michael G. Vitale

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose: This study sought to investigate associations between upper instrumented vertebra (UIV) location and the risk of proximal junctional kyphosis (PJK) at 2 years following posterior spinal fusion (PSF) for Scheuermann’s kyphosis (SK). Methods: In this retrospective cohort study, SK patients who underwent PSF and reached 2 years postop were identified in a multicenter international registry, excluding those with anterior release, prior spine surgery, neuromuscular comorbidity, post-traumatic kyphosis, or kyphosis apex below T11–T12. Location of UIV as well as the number of levels between UIV and preoperative kyphosis apex was determined. Additionally, the degree of kyphosis correction was evaluated. PJK was defined as a proximal junctional angle ≥ 10° that is ≥ 10° greater than the preoperative measurement. Results: 90 patients (16.5 ± 1.9 yo, 65.6% male) were included. Preoperative and 2-year postoperative major kyphosis was 74.6 ± 11.6° and 45.9 ± 10.5°, respectively. Twenty-two (24.4%) patients developed PJK at 2 years. Patients with UIV below T2 had a 2.09 times increased risk of PJK when compared to those with UIV at or above T2, adjusting for distance between UIV and preoperative kyphosis apex [95% Confidence Interval (CI) 0.94; 4.63, p = 0.070]. Patients with UIV ≤ 4.5 vertebrae from the apex had a 1.57 times increased risk of PJK, adjusting for UIV relative to T2 [95% CI 0.64; 3.87, p = 0.326]. Conclusion: SK patients with UIV below T2 had an increased risk of developing PJK at 2 years following PSF. This association supports consideration of UIV location during preoperative planning. Level of Evidence: Prognostic Level II.

Original languageEnglish
Pages (from-to)993-1000
Number of pages8
JournalSpine Deformity
Volume11
Issue number4
DOIs
StatePublished - Jul 2023

Keywords

  • Kyphosis apex
  • Pelvic incidence (PI)
  • Posterior spinal fusion (PSF)
  • Proximal junctional kyphosis (PJK)
  • Scheuermann’s kyphosis (SK)
  • Upper instrumented vertebra (UIV)

Fingerprint

Dive into the research topics of 'Operative choices matter: the role of UIV and sagittal balance in the development of proximal junctional kyphosis following posterior instrumentation for Scheuermann’s kyphosis'. Together they form a unique fingerprint.

Cite this