Surgical, Radiographic, and Patient-Related Risk Factors for Proximal Junctional Kyphosis: A Meta-Analysis

Jun S. Kim, Kevin Phan, Zoe B. Cheung, Nam Lee, Luilly Vargas, Varun Arvind, Robert K. Merrill, Sunder Gidumal, John Di Capua, Samuel Overley, James Dowdell, Samuel K. Cho

Research output: Contribution to journalArticlepeer-review

74 Scopus citations

Abstract

Study Design: Meta-analysis. Objective: Proximal junctional kyphosis (PJK) is a complication of surgical management for adult spinal deformity with a multifactorial etiology. Many risk factors are controversial and their relative importance are not fully understood. We aimed to identify the surgical, radiographic, and patient-related risk factors associated with PJK and proximal junctional failure (PJF). Methods: A systematic literature search was performed using PubMed, Cochrane Database of Systematic Reviews, and EMBASE. The inclusion criteria included prospective randomized control trials and prospective/retrospective cohort studies of adult patients with radiographic evidence of PJK, which was defined as a proximal junctional sagittal Cobb angle ≥10° and at least 10° greater than the preoperative measurement. Studies required a minimum of 10 patients and 12 months of follow-up. Results: A total of 14 unique studies, including 1908 patients were included. The pooled analysis showed significant differences between the PJK and non-PJK groups in age (weighted mean difference [WMD] −3.80; P =.03), prevalence of osteopenia/osteoporosis (odds ratio [OR] 1.99; P =.0004), preoperative sagittal vertical axis (SVA) (WMD −17.52; P =.02), preoperative lumbar lordosis (LL) (WMD −1.22; P =.002), pedicle screw instrumentation at the upper instrumented vertebra (UIV) (OR 1.67; P =.02), change in SVA (WMD −11.87; P =.01), fusion to sacrum/pelvis/ilium (OR 2.14; P <.00 001), change in LL (WMD −5.61; P =.01), and postoperative SVA (WMD −7.79; P =.008). Conclusions: Our meta-analysis suggests that age, osteopenia/osteoporosis, high preoperative SVA, high postoperative SVA, low preoperative LL, use of pedicle screws at the UIV, SVA change/correction, LL change/correction, and fusion to sacrum/pelvis/iliac region are risk factors for PJK.

Original languageEnglish
Pages (from-to)32-40
Number of pages9
JournalGlobal Spine Journal
Volume9
Issue number1
DOIs
StatePublished - 1 Feb 2019

Keywords

  • adult spinal deformity
  • lumbar lordosis
  • meta-analysis
  • proximal junctional failure (PJF)
  • proximal junctional kyphosis (PJK)
  • risk factors
  • sagittal imbalance
  • sagittal vertical axis (SVA)

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