@article{d2a328fab4d3425496d2f30030821b9b,
title = "Incidence of acute, progressive, and delayed proximal junctional kyphosis over an 8-year period in adult spinal deformity patients",
abstract = "BACKGROUND: Proximal junctional kyphosis (PJK) is a common radiographic complication of adult spinal deformity (ASD) corrective surgery. Although previous literature has reported a 5 to 61% incidence of PJK, these studies are limited by small sample sizes and short-term follow-up. OBJECTIVE: To assess the incidence of PJK utilizing a high-powered ASD database. METHODS: Retrospective review of a prospective multicenter ASD database. Operative ASD patients > 18 yr old from 2009 to 2017 were included. PJK was defined as ≥ 10° for the sagittal Cobb angle between the inferior upper instrumented vertebra (UIV) endplate and the superior endplate of the UIV + 2. Chi-square analysis and post hoc testing assessed annual and overall incidence of acute (6-wk follow-up [f/u]), progressive (increase in degree of PJK from 6 wk to 1 yr), and delayed (1-yr, 2-yr, and 3-yr f/u) PJK development. RESULTS: A total of 1005 patients were included (age: 59.3; 73.5% F; body mass index: 27.99). Overall PJK incidence was 69.4%. Overall incidence of acute PJK was 48.0%. Annual incidence of acute PJK has decreased from 53.7% in 2012 to 31.6% in 2017 (P = .038). Overall incidence of progressive PJK was 35.0%, with stable rates observed from 2009 to 2016 (P = .297). Overall incidence of 1-yr-delayed PJK was 9.3%. Annual incidence of 1-yr-delayed PJK has decreased from 9.2% in 2009 to 3.2% in 2016 (P < .001). Overall incidence of 2-yr-delayed PJK development was 4.3%. Annual incidence of 2-yr-delayed PJK has decreased from 7.3% in 2009 to 0.9% in 2015 (P < .05). Overall incidence of 3-yr-delayed PJK was 1.8%, with stable rates observed from 2009 to 2014 (P = .594). CONCLUSION: Although progressive PJK has remained a challenge for physicians over time, significantly lower incidences of acute and delayed PJK in recent years may indicate improving operative decision-making and management strategies.",
keywords = "Adult spinal deformity, Incidence, Proximal junctional kyphosis",
author = "{International Spine Study Group} and Segreto, {Frank A.} and Passias, {Peter G.} and Renaud Lafage and Virginie Lafage and Smith, {Justin S.} and Line, {Breton G.} and Mundis, {Gregory M.} and Bortz, {Cole A.} and Stekas, {Nicholas D.} and Horn, {Samantha R.} and Diebo, {Bassel G.} and Brown, {Avery E.} and Yael Ihejirika and Nunley, {Pierce D.} and Daniels, {Alan H.} and Gupta, {Munish C.} and Gum, {Jeffrey L.} and {Kojo Hamilton}, D. and Klineberg, {Eric O.} and Burton, {Douglas C.} and Hart, {Robert A.} and Schwab, {Frank J.} and Shay Bess and Shaffrey, {Christopher I.} and Ames, {Christopher P.}",
note = "Funding Information: The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes and individual donations, which supported the current work. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Dr Passias receives consulting fees from Medicrea and SpineWave; serves on the Scientific Advisory Board for Allosource; receives teaching/speaking fees for Zimmer Biomet and Globus; has a grant from CSRS; and works on a research study for Aesculap. Dr Lafage owns stock in Nemaris; receives teaching/speaking fees from DePuy Synthes, NuVasive, K2M, and Medtronic; and is on the board of directors for Nemaris. Dr Smith receives royalties and fees for consulting and speaking/teaching from Zimmer Biomet; fees for consulting and speaking/teaching from NuVasive; fees for consulting from Carapedics; fees for speaking/teaching from K2M; and fellowship support from AOSpine and NREF. Dr Mundis receives royalties and fees for consulting from NuVasive and K2M; and grants from DePuy Synthes and NuVasive. Dr Nunley is an owner at and receives investment interest from Safwire Funding Information: LLC; receives royalties from K2M; and receives royalties and fees for consulting from Zimmer Biomet. Dr Daniels receives royalties and fees for consulting from Stryker and Spineart. Dr Gupta receives royalties and fees for consulting from DePuy Synthes; owns stock in Johnson & Johnson and Procter & Gamble; receives fees for consulting from Orthofix; receives fellowship support and fees for speaking/teaching and honoraria from AOSpine North America; is on the board of directors for the Scoliosis Research Society; is treasurer for FOSA; and receives fellowship support from OMeGA. Dr Gum receives fees for consulting from Medtronic, NuVasive, Alphatec, Stryker, Acuity, K2M, and Mazor; fees for advising from NuVasive and K2M; royalties from Acuity; honorarium from Pacira Pharmaceuticals and Baxter; funds directly to the database company from NuVasive; research support from Norton Healthcare, Integra, Intellrod Spine Inc, International Spine Study Group Foundation, and Pfizer; and he is an employee of Norton Healthcare and owns stock in Cingulate Therapeutics. Dr Klineberg receives fees for consulting from DePuy Synthes, Stryker, Springer, and Trevana; honoraria from AOSpine and K2M; and fellowship support from AOSpine. Dr Burton receives fees for consulting from DePuy Synthes and Allosource; and is a patent holder for DePuy Synthes. Dr Hart receives royalties and fees for consulting from Seaspoine Othopedics Corp, DePuy Synthes, Medtronic, Synthes GMBH, Innovasis, Titan Spine, K2M, and Globus Medical. Dr Schwab receives royalties and fees for speaking/teaching from and is a patent holder for Zimmer Biomet, NuVasive, K2M, and MSD; receives fees for speaking/teaching and consulting from Medicrea; and is on the board of directors and a shareholder for Nemaris. Dr Bess receives royalties and research support from K2M, Innovasis, and NuVasive; fees for consulting from K2M and Pioneer; royalties from Pioneer; and research support from DePuy Synthes Spine and Stryker. Dr Shaffrey is a patent holder for and receives royalties and fees for consulting from Medtronic, NuVasive, and Zimmer Biomet; owns stock in NuVasive; receives fees for consulting from K2M, Stryker, and In Vivo; and receives grants from the National Institutes of Health, Department of Defense, ISSG, DePuy Synthes, and AOSpine. Dr Ames receives fees for consulting from DePuy Synthes, Medtronic, and Stryker; receives royalties from Stryker and Zimmer Biomet; and is a patent holder for Fish & Richardson PC. Publisher Copyright: Copyright {\textcopyright} 2019 by the Congress of Neurological Surgeons.",
year = "2020",
month = jan,
day = "1",
doi = "10.1093/ons/opz128",
language = "English (US)",
volume = "18",
pages = "75--82",
journal = "Operative Neurosurgery",
issn = "2332-4252",
publisher = "Lippincott Williams and Wilkins",
number = "1",
}