Extension of Fusion to the Cervical Spine Versus Upper Thoracic Spine for the Management of Proximal Junctional Kyphosis of Thoracolumbar Fusion
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2026-05
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<jats:sec> <jats:title>Study Design:</jats:title> <jats:p>Retrospective review of multicenter, prospective cervical deformity database.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective:</jats:title> <jats:p>To compare outcomes of extension of fusion to the cervical spine versus the upper thoracic (UT) spine.</jats:p> </jats:sec> <jats:sec> <jats:title>Summary of Background Data:</jats:title> <jats:p>Proximal junctional kyphosis (PJK) management after thoracolumbar fusion requires extension of fusion to the proximal spinal segments. Unlike extensions to the less mobile thoracic segments, crossing the cervicothoracic junction (CTJ) involves more mobile cervical segments and creates different biomechanical influences and clinical outcomes. No study has compared the outcomes of extending fusion to the cervical versus the UT spine.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Patients with thoracic PJK who underwent revision with extension of fusion to either the cervical or UT (T1 or T2) spine were identified in a multicenter, prospective cervical deformity database. Patients with cervical upper instrumented vertebra (UIV) were subdivided into lower cervical (LC; C4–7) and upper cervical (UC; and occiput–C3) groups. Baseline demographics, surgical variables, radiographic outcomes, 2-year health-related quality-of-life scores, complications, and revision rates were analyzed.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p> Fifty-one patients (mean age: 60.4±12.9 y; 91% female) with at least 2 years of follow-up were included. Twelve had extension to the UT, 20 to the LC, and 19 to the UC spine. Demographic data, Charlson Comorbidity Index, follow-up duration, surgical parameters, radiographic measurements, recurrent PJK and reoperation rates, and 2-year patient-reported outcome scores were similar across groups. The instrumentation failure rate was higher in the LC (25%) than in the UT (0%) and UC (8%) groups ( <jats:italic toggle="yes">P</jats:italic> =0.03). </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>Stopping fusion at T1 or T2 did not result in greater complication or reoperation rates than extending to the cervical spine. The instrumentation-related complication rate was higher for extension to the LC than to the UC or UT spine. Crossing the CTJ should be individualized, but may not prevent additional proximal junctional-level problems in the management of thoracolumbar fusion PJK.</jats:p> </jats:sec> <jats:sec> <jats:title>Level of Evidence:</jats:title> <jats:p>Level IV.</jats:p> </jats:sec>
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Sulieman, Ahmed, Maxwell Sahhar, Yesha H Parekh, Virginie Lafage, Renaud Lafage, Breton G Line, Christopher P Ames, Shay Bess, et al. (2026). Extension of Fusion to the Cervical Spine Versus Upper Thoracic Spine for the Management of Proximal Junctional Kyphosis of Thoracolumbar Fusion. Clinical Spine Surgery, 39(4). pp. 160–167. 10.1097/bsd.0000000000002060 Retrieved from https://hdl.handle.net/10161/34671.
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Peter Passias
Throughout my medical career, I have remained dedicated to improving my patients' quality of life. As a specialist in adult cervical and spinal deformity surgery, I understand the significant impact our interventions have on individuals suffering from debilitating pain and physical and mental health challenges. Spinal deformity surgery merges the complexities of spinal biomechanics with the needs of an aging population. My research focuses on spinal alignment, biomechanics, innovative surgical techniques, and health economics to ensure value-based care that enhances patient outcomes.
Christopher Ignatius Shaffrey
I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.
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