Correlation Between Postoperative Distribution of Lordosis and Reciprocal Progression of Thoracic Kyphosis and Occurrence of Proximal Junctional Kyphosis Following Surgery for Adult Spinal Deformity

Study Design: This was a retrospective cohort study using consecutive patients. Objectives: The objectives of this study were to evaluate the effect of lumbar lordosis (LL) construction on postoperative reciprocal progression of thoracic kyphosis (TK) and occurrence of proximal junctional kyphosis (PJK) following surgery for adult spinal deformity (ASD). Summary of Background Data: A large postoperative TK has been reported as an iatrogenic risk factor for PJK following surgery for ASD. Therefore, knowing how to anticipate and regulate postoperative reciprocal progression in TK with LL restorative surgery is important to prevent PJK. The LL proportion including distribution of the lordosis (lordosis distribution index: LDI) in the lower (L4–S1) and upper (L1–L3) arcs has been known as important because it alters the distribution of load. However, the influence of postoperative LL construction on postoperative reciprocal change in TK resulting in PJK is largely unknown. Methods: Sixty-six consecutive patients with ASD treated with LL restorative surgery with a fusion level consistently selected from T8–T10 to the pelvis and followed-up for a minimum of 1 year. Abnormal PJK was evaluated according to the Boachie-Adjei classification. Roland-Morris Disability Questionnaire and Oswestry Disability Index were measured at 1 year after surgery. Results: The prevalence of PJK in the present study was 33.3%. Outcomes of patients with PJK were significantly worse than in patients without PJK, regardless of PJK grade. Postoperative reciprocal progression in TK with LL restorative surgery was found. Preoperative risk factors of PJK were older age and smaller sacral slope angle. Postoperative risk factors for PJK included increased TK and decreased LDI. We found a strong correlation between postoperative LDI and reciprocal progression of TK resulting in PJK. Conclusions: Postoperative LDI is crucial to prevent excess reciprocal progression of TK resulting in PJK.

[1]  K. Ha,et al.  Minimally Invasive Lateral Lumbar Interbody Fusion for Adult Spinal Deformity: Clinical and Radiological Efficacy With Minimum Two Years Follow-up , 2018, Spine.

[2]  S. Burch,et al.  Factors Associated With the Development of and Revision for Proximal Junctional Kyphosis in 440 Consecutive Adult Spinal Deformity Patients , 2017, Spine.

[3]  C. Ames,et al.  Orientation of the Upper-most Instrumented Segment Influences Proximal Junctional Disease Following Adult Spinal Deformity Surgery , 2017, Spine.

[4]  Justin K Scheer,et al.  Virtual Modeling of Postoperative Alignment After Adult Spinal Deformity Surgery Helps Predict Associations Between Compensatory Spinopelvic Alignment Changes, Overcorrection, and Proximal Junctional Kyphosis , 2017, Spine.

[5]  H. Wong,et al.  T9 versus T10 as the upper instrumented vertebra for correction of adult deformity-rationale and recommendations. , 2017, The spine journal : official journal of the North American Spine Society.

[6]  T. Jahng,et al.  Rod stiffness as a risk factor of proximal junctional kyphosis after adult spinal deformity surgery: comparative study between cobalt chrome multiple-rod constructs and titanium alloy two-rod constructs. , 2017, The spine journal : official journal of the North American Spine Society.

[7]  Timothy R. Smith,et al.  Spinal Implant Density and Postoperative Lumbar Lordosis as Predictors for the Development of Proximal Junctional Kyphosis in Adult Spinal Deformity. , 2016, World neurosurgery.

[8]  Yongjung Kim,et al.  Patients with proximal junctional kyphosis after stopping at thoracolumbar junction have lower muscularity, fatty degeneration at the thoracolumbar area. , 2016, The spine journal : official journal of the North American Spine Society.

[9]  Kei Watanabe,et al.  Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects , 2016, European Spine Journal.

[10]  F. Pellisé,et al.  Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning , 2016, European Spine Journal.

[11]  S. Inami,et al.  Optimum pelvic incidence minus lumbar lordosis value can be determined by individual pelvic incidence , 2016, European Spine Journal.

[12]  D. Togawa,et al.  Calculation of the Target Lumbar Lordosis Angle for Restoring an Optimal Pelvic Tilt in Elderly Patients With Adult Spinal Deformity , 2016, Spine.

[13]  D. K. Hamilton,et al.  Time to Development, Clinical and Radiographic Characteristics, and Management of Proximal Junctional Kyphosis Following Adult Thoracolumbar Instrumented Fusion for Spinal Deformity , 2015, Journal of spinal disorders & techniques.

[14]  Justin K Scheer,et al.  Proximal Junctional Kyphosis and Failure After Spinal Deformity Surgery: A Systematic Review of the Literature as a Background to Classification Development , 2014, Spine.

[15]  Munish C. Gupta,et al.  T1 Pelvic Angle (TPA) Effectively Evaluates Sagittal Deformity and Assesses Radiographical Surgical Outcomes Longitudinally , 2014, Spine.

[16]  O. Boachie-Adjei,et al.  Characterization and Surgical Outcomes of Proximal Junctional Failure in Surgically Treated Patients With Adult Spinal Deformity , 2014, Spine.

[17]  L. Lenke,et al.  Patients With Proximal Junctional Kyphosis Requiring Revision Surgery Have Higher Postoperative Lumbar Lordosis and Larger Sagittal Balance Corrections , 2014, Spine.

[18]  M. Matsumoto,et al.  Factors Affecting the Postoperative Progression of Thoracic Kyphosis in Surgically Treated Adult Patients With Lumbar Degenerative Scoliosis , 2014, Spine.

[19]  S. Burch,et al.  Predictive Factors for Proximal Junctional Kyphosis in Long Fusions to the Sacrum in Adult Spinal Deformity , 2013, Spine.

[20]  Samuel K. Cho,et al.  Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle. , 2013, Neurosurgery.

[21]  L. Lenke,et al.  Proximal Junctional Kyphosis Results in Inferior SRS Pain Subscores in Adult Deformity Patients , 2013, Spine.

[22]  O. Boachie-Adjei,et al.  Incidence, Risk Factors, and Natural Course of Proximal Junctional Kyphosis: Surgical Outcomes Review of Adult Idiopathic Scoliosis. Minimum 5 Years of Follow-up , 2012, Spine.

[23]  P. Roussouly,et al.  Sagittal parameters of the spine: biomechanical approach , 2011, European Spine Journal.

[24]  O. Boachie-Adjei,et al.  Incidence, Risk Factors and Classification of Proximal Junctional Kyphosis: Surgical Outcomes Review of Adult Idiopathic Scoliosis , 2011, Spine.

[25]  Pierre Roussouly,et al.  Sagittal plane deformity: an overview of interpretation and management , 2010, European Spine Journal.

[26]  J. Buchowski,et al.  Role of Pelvic Incidence, Thoracic Kyphosis, and Patient Factors on Sagittal Plane Correction Following Pedicle Subtraction Osteotomy , 2009, Spine.

[27]  J. Jang,et al.  Influence of Lumbar Lordosis Restoration on Thoracic Curve and Sagittal Position in Lumbar Degenerative Kyphosis Patients , 2009, Spine.