TY - JOUR
T1 - Surgical, Radiographic, and Patient-Related Risk Factors for Proximal Junctional Kyphosis
T2 - A Meta-Analysis
AU - Kim, Jun S.
AU - Phan, Kevin
AU - Cheung, Zoe B.
AU - Lee, Nam
AU - Vargas, Luilly
AU - Arvind, Varun
AU - Merrill, Robert K.
AU - Gidumal, Sunder
AU - Di Capua, John
AU - Overley, Samuel
AU - Dowdell, James
AU - Cho, Samuel K.
N1 - Publisher Copyright:
© The Author(s) 2018.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - 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.
AB - 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.
KW - adult spinal deformity
KW - lumbar lordosis
KW - meta-analysis
KW - proximal junctional failure (PJF)
KW - proximal junctional kyphosis (PJK)
KW - risk factors
KW - sagittal imbalance
KW - sagittal vertical axis (SVA)
UR - http://www.scopus.com/inward/record.url?scp=85060974273&partnerID=8YFLogxK
U2 - 10.1177/2192568218761362
DO - 10.1177/2192568218761362
M3 - Article
AN - SCOPUS:85060974273
SN - 2192-5682
VL - 9
SP - 32
EP - 40
JO - Global Spine Journal
JF - Global Spine Journal
IS - 1
ER -