Risk Factor Analysis for Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery: A New Simple Scoring System to Identify High-Risk Patients.
| dc.contributor.author | Lafage, Renaud | |
| dc.contributor.author | Beyer, George | |
| dc.contributor.author | Schwab, Frank | |
| dc.contributor.author | Klineberg, Eric | |
| dc.contributor.author | Burton, Douglas | |
| dc.contributor.author | Bess, Shay | |
| dc.contributor.author | Kim, Han Jo | |
| dc.contributor.author | Smith, Justin | |
| dc.contributor.author | Ames, Christopher | |
| dc.contributor.author | Hostin, Richard | |
| dc.contributor.author | Khalife, Marc | |
| dc.contributor.author | Shaffrey, Christopher | |
| dc.contributor.author | Mundis, Gregory | |
| dc.contributor.author | Lafage, Virginie | |
| dc.date.accessioned | 2023-06-19T19:46:59Z | |
| dc.date.available | 2023-06-19T19:46:59Z | |
| dc.date.issued | 2020-10 | |
| dc.date.updated | 2023-06-19T19:46:58Z | |
| dc.description.abstract | Study designRetrospective cohort study.ObjectiveDevelop a simple scoring system to estimate proximal junctional kyphosis (PJK) risk.MethodsA total of 417 adult spinal deformity (ASD) patients (80% females, 57.8 years) with 2-year follow-up were included. PJK was defined as a >10° kyphotic angle between the upper-most instrumented vertebra (UIV) and the vertebrae 2 levels above the UIV (UIV+2). Based on a previous literature review, the following point score was attributed to parameters likely to impact PJK development: age >55 years (1 point), fusion to S1/ilium (1 point), UIV in the upper thoracic spine (UIV-UT: 1 point), UIV in the lower thoracic region (UIV-LT: 2 points), flattening of the thoracic kyphosis (TK) relative to the lumbar lordosis (LL; ie, ▵LL - ▵TK) greater than 10° (1 point).ResultsAt 2 years, the overall PJK rate was 43%. The odds ratios for each risk factor were the following: age >55 years (2.52), fusion to S1/ilium (5.17), UIV-UT (6.63), UIV-LT (8.24), and ▵LL - ▵TK >10° (1.59). Analysis by risk factor revealed a significant impact on PJK (no PJK vs PJK): age >55 years (28% vs 51%, P < .001), LIV S1/ilium (16.3% vs 51.4%, P < .001), UIV in lower thoracic spine (12.0% vs 38.7% vs 52.9%, P < .001), and a >10° surgical reduction in TK relative to LL increase (40.0% vs 51.5%, P < .001). The PJK rate by point score was as follows: 1 = 17%, 2 = 29%, 3 = 40%, 4 = 53%, and 5 = 69%.ConclusionA pragmatic scoring system was developed that is tied to the increasing risk of PJK. These findings are helpful for surgical planning and preoperative counseling. | |
| dc.identifier.issn | 2192-5682 | |
| dc.identifier.issn | 2192-5690 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | SAGE Publications | |
| dc.relation.ispartof | Global spine journal | |
| dc.relation.isversionof | 10.1177/2192568219882350 | |
| dc.subject | adult spinal deformity | |
| dc.subject | proximal junctional kyphosis | |
| dc.subject | risk factors | |
| dc.subject | sagittal alignment | |
| dc.subject | scoring system | |
| dc.title | Risk Factor Analysis for Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery: A New Simple Scoring System to Identify High-Risk Patients. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Shaffrey, Christopher|0000-0001-9760-8386 | |
| pubs.begin-page | 863 | |
| pubs.end-page | 870 | |
| pubs.issue | 7 | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Orthopaedic Surgery | |
| pubs.organisational-group | Neurosurgery | |
| pubs.publication-status | Published | |
| pubs.volume | 10 |
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