Distal junctional kyphosis in adult cervical deformity patients: where does it occur?

dc.contributor.author

Ye, Jichao

dc.contributor.author

Rider, Sean M

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Lafage, Renaud

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Gupta, Sachin

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Farooqi, Ali S

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Protopsaltis, Themistocles S

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Passias, Peter G

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Smith, Justin S

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Lafage, Virginie

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Kim, Han-Jo

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Klineberg, Eric O

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Kebaish, Khaled M

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Scheer, Justin K

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Mundis, Gregory M

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Soroceanu, Alex

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Bess, Shay

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Ames, Christopher P

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Shaffrey, Christopher I

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Gupta, Munish C

dc.contributor.author

International Spine Study Group (ISSG)

dc.date.accessioned

2023-06-15T16:45:01Z

dc.date.available

2023-06-15T16:45:01Z

dc.date.issued

2023-05

dc.date.updated

2023-06-15T16:45:00Z

dc.description.abstract

Purpose

To evaluate the impact of the lowest instrumented vertebra (LIV) on Distal Junctional kyphosis (DJK) incidence in adult cervical deformity (ACD) surgery.

Methods

Prospectively collected data from ACD patients undergoing posterior or anterior-posterior reconstruction at 13 US sites was reviewed up to 2-years postoperatively (n = 140). Data was stratified into five groups by level of LIV: C6-C7, T1-T2, T3-Apex, Apex-T10, and T11-L2. DJK was defined as a kyphotic increase > 10° in Cobb angle from LIV to LIV-1. Analysis included DJK-free survival, covariate-controlled cox regression, and DJK incidence at 1-year follow-up.

Results

25/27 cases of DJK developed within 1-year post-op. In patients with a minimum follow-up of 1-year (n = 102), the incidence of DJK by level of LIV was: C6-7 (3/12, 25.00%), T1-T2 (3/29, 10.34%), T3-Apex (7/41, 17.07%), Apex-T10 (8/11, 72.73%), and T11-L2 (4/8, 50.00%) (p < 0.001). DJK incidence was significantly lower in the T1-T2 LIV group (adjusted residual = -2.13), and significantly higher in the Apex-T10 LIV group (adjusted residual = 3.91). In covariate-controlled regression using the T11-L2 LIV group as reference, LIV selected at the T1-T2 level (HR = 0.054, p = 0.008) or T3-Apex level (HR = 0.081, p = 0.010) was associated with significantly lower risk of DJK. However, there was no difference in DJK risk when LIV was selected at the C6-C7 level (HR = 0.239, p = 0.214).

Conclusion

DJK risk is lower when the LIV is at the upper thoracic segment than the lower cervical segment. DJK incidence is highest with LIV level in the lower thoracic or thoracolumbar junction.
dc.identifier

10.1007/s00586-023-07631-6

dc.identifier.issn

0940-6719

dc.identifier.issn

1432-0932

dc.identifier.uri

https://hdl.handle.net/10161/27985

dc.language

eng

dc.publisher

Springer Science and Business Media LLC

dc.relation.ispartof

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

dc.relation.isversionof

10.1007/s00586-023-07631-6

dc.subject

International Spine Study Group (ISSG)

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Thoracic Vertebrae

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Humans

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Kyphosis

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Musculoskeletal Abnormalities

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Postoperative Complications

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Spinal Fusion

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Retrospective Studies

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Adult

dc.title

Distal junctional kyphosis in adult cervical deformity patients: where does it occur?

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

1598

pubs.end-page

1606

pubs.issue

5

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

Published

pubs.volume

32

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