Incidence of acute, progressive, and delayed proximal junctional kyphosis over an 8-year period in adult spinal deformity patients

International Spine Study Group

doi:10.1093/ons/opz128

Incidence of acute, progressive, and delayed proximal junctional kyphosis over an 8-year period in adult spinal deformity patients

International Spine Study Group

Orthopedics

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

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.

Original language	English (US)
Pages (from-to)	75-82
Number of pages	8
Journal	Operative Neurosurgery
Volume	18
Issue number	1
DOIs	https://doi.org/10.1093/ons/opz128
State	Published - Jan 1 2020

Keywords

Adult spinal deformity
Incidence
Proximal junctional kyphosis

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1093/ons/opz128

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@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 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",

}

TY - JOUR

T1 - Incidence of acute, progressive, and delayed proximal junctional kyphosis over an 8-year period in adult spinal deformity patients

AU - International Spine Study Group

AU - Segreto, Frank A.

AU - Passias, Peter G.

AU - Lafage, Renaud

AU - Lafage, Virginie

AU - Smith, Justin S.

AU - Line, Breton G.

AU - Mundis, Gregory M.

AU - Bortz, Cole A.

AU - Stekas, Nicholas D.

AU - Horn, Samantha R.

AU - Diebo, Bassel G.

AU - Brown, Avery E.

AU - Ihejirika, Yael

AU - Nunley, Pierce D.

AU - Daniels, Alan H.

AU - Gupta, Munish C.

AU - Gum, Jeffrey L.

AU - Kojo Hamilton, D.

AU - Klineberg, Eric O.

AU - Burton, Douglas C.

AU - Hart, Robert A.

AU - Schwab, Frank J.

AU - Bess, Shay

AU - Shaffrey, Christopher I.

AU - Ames, Christopher P.

N1 - 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 Publisher Copyright: Copyright © 2019 by the Congress of Neurological Surgeons.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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.

AB - 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.

KW - Adult spinal deformity

KW - Incidence

KW - Proximal junctional kyphosis

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U2 - 10.1093/ons/opz128

DO - 10.1093/ons/opz128

M3 - Article

C2 - 31172190

AN - SCOPUS:85076586131

VL - 18

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EP - 82

JO - Operative Neurosurgery

JF - Operative Neurosurgery

SN - 2332-4252

IS - 1

ER -

Incidence of acute, progressive, and delayed proximal junctional kyphosis over an 8-year period in adult spinal deformity patients

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