Results of the 2014 SRS survey on PJK/PJF: A report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development

SRS Adult Spinal Deformity Committee

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Study Design. An electronic survey administered to Scoliosis Research Society membership. Objective. To characterize surgeon views regarding proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) management providing the framework in which a PJK/PJF classification system and treatment guidelines could be established. Summary of Background Data. PJK/PJF are common complications of adult spinal deformity surgery. To date, there is no consensus on PJK/PJF definitions, classification, and indications for revision surgery. There is a paucity of data on deformity surgeon practice pattern variations and consensus opinion on treatment and prevention. Methods. An electronic 19-question survey regarding PJK/PJF was administered to members of the Scoliosis Research Society who treat adult spinal deformity. Determinants included the surgeons' type of practice, number of years in practice, agreement with given PJK/PJF definitions, importance of key factors influencing prevention and revision, prevention methods currently used, and the importance of developing a classification system. Results. A total of 226 surgeons responded (38.8% response rate). Both 44.4% of surgeons selected "extremely important" and 40.8% selected "very important" that PJK in adult spinal deformity surgery is a very important issue and that a Scoliosis Research Society PJK/PJF classification system and guidelines for detection and prevention of PJK/PJF is a "must have" (18.1%) and "very likely helpful" (31.9%). Both 86.2% and 90.7% of surgeons agreed with the provided definitions of PJK and PJF, respectively. Top 5 revision indications included neurological deficit, severe focal pain, translation or subluxation fracture, a change in kyphosis angle of greater than 30°, chance fracture, spondylolisthesis greater than 6 mm, and instrumentation prominence. The majority of respondents use a PJK/PJF prevention strategy 60% of the time or more, the most common were terminal rod contour, preoperative bone mineral density testing, and frequent radiographical studies during first 3 months postoperative, preoperative bone mineral density medication for low bone mineral density. Conclusion. The results of this study provide insight from the practicing surgeons' perspective of the management of PJK and PJF that may aid in the validation of current definitions and consensusbased treatment decisions and prevention guidelines.

Original languageEnglish (US)
Pages (from-to)829-840
Number of pages12
JournalSpine
Volume40
Issue number11
DOIs
StatePublished - 2015

Fingerprint

Kyphosis
Therapeutics
Scoliosis
Bone Density
Guidelines
Surveys and Questionnaires
Consensus
Research
Spondylolisthesis
Surgeons
Reoperation

Keywords

  • Adult spinal deformity
  • Classification system
  • PJF
  • PJK
  • PJK prevention strategies
  • Proximal junctional failure
  • Proximal junctional kyphosis
  • Scoliosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Results of the 2014 SRS survey on PJK/PJF : A report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development. / SRS Adult Spinal Deformity Committee.

In: Spine, Vol. 40, No. 11, 2015, p. 829-840.

Research output: Contribution to journalArticle

@article{9b64e9c4fc02441a9b1ed58f76f3e576,
title = "Results of the 2014 SRS survey on PJK/PJF: A report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development",
abstract = "Study Design. An electronic survey administered to Scoliosis Research Society membership. Objective. To characterize surgeon views regarding proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) management providing the framework in which a PJK/PJF classification system and treatment guidelines could be established. Summary of Background Data. PJK/PJF are common complications of adult spinal deformity surgery. To date, there is no consensus on PJK/PJF definitions, classification, and indications for revision surgery. There is a paucity of data on deformity surgeon practice pattern variations and consensus opinion on treatment and prevention. Methods. An electronic 19-question survey regarding PJK/PJF was administered to members of the Scoliosis Research Society who treat adult spinal deformity. Determinants included the surgeons' type of practice, number of years in practice, agreement with given PJK/PJF definitions, importance of key factors influencing prevention and revision, prevention methods currently used, and the importance of developing a classification system. Results. A total of 226 surgeons responded (38.8{\%} response rate). Both 44.4{\%} of surgeons selected {"}extremely important{"} and 40.8{\%} selected {"}very important{"} that PJK in adult spinal deformity surgery is a very important issue and that a Scoliosis Research Society PJK/PJF classification system and guidelines for detection and prevention of PJK/PJF is a {"}must have{"} (18.1{\%}) and {"}very likely helpful{"} (31.9{\%}). Both 86.2{\%} and 90.7{\%} of surgeons agreed with the provided definitions of PJK and PJF, respectively. Top 5 revision indications included neurological deficit, severe focal pain, translation or subluxation fracture, a change in kyphosis angle of greater than 30°, chance fracture, spondylolisthesis greater than 6 mm, and instrumentation prominence. The majority of respondents use a PJK/PJF prevention strategy 60{\%} of the time or more, the most common were terminal rod contour, preoperative bone mineral density testing, and frequent radiographical studies during first 3 months postoperative, preoperative bone mineral density medication for low bone mineral density. Conclusion. The results of this study provide insight from the practicing surgeons' perspective of the management of PJK and PJF that may aid in the validation of current definitions and consensusbased treatment decisions and prevention guidelines.",
keywords = "Adult spinal deformity, Classification system, PJF, PJK, PJK prevention strategies, Proximal junctional failure, Proximal junctional kyphosis, Scoliosis",
author = "{SRS Adult Spinal Deformity Committee} and Scheer, {Justin K.} and Shayan Fakurnejad and Darryl Lau and Daubs, {Michael D.} and Coe, {Jeffrey D.} and Paonessa, {Kenneth J.} and LaGrone, {Michael O.} and Amaral, {Rodrigo A.} and Trobisch, {Per D.} and Lee, {Jung Hee} and Daniel Fabris-Monterumici and Neel Anand and Cree, {Andrew K.} and Robert Hart and Hey, {Lloyd A.} and Ames, {Christopher P.}",
year = "2015",
doi = "10.1097/BRS.0000000000000897",
language = "English (US)",
volume = "40",
pages = "829--840",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "11",

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T1 - Results of the 2014 SRS survey on PJK/PJF

T2 - A report on variation of select SRS member practice patterns, treatment indications, and opinions on classification development

AU - SRS Adult Spinal Deformity Committee

AU - Scheer, Justin K.

AU - Fakurnejad, Shayan

AU - Lau, Darryl

AU - Daubs, Michael D.

AU - Coe, Jeffrey D.

AU - Paonessa, Kenneth J.

AU - LaGrone, Michael O.

AU - Amaral, Rodrigo A.

AU - Trobisch, Per D.

AU - Lee, Jung Hee

AU - Fabris-Monterumici, Daniel

AU - Anand, Neel

AU - Cree, Andrew K.

AU - Hart, Robert

AU - Hey, Lloyd A.

AU - Ames, Christopher P.

PY - 2015

Y1 - 2015

N2 - Study Design. An electronic survey administered to Scoliosis Research Society membership. Objective. To characterize surgeon views regarding proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) management providing the framework in which a PJK/PJF classification system and treatment guidelines could be established. Summary of Background Data. PJK/PJF are common complications of adult spinal deformity surgery. To date, there is no consensus on PJK/PJF definitions, classification, and indications for revision surgery. There is a paucity of data on deformity surgeon practice pattern variations and consensus opinion on treatment and prevention. Methods. An electronic 19-question survey regarding PJK/PJF was administered to members of the Scoliosis Research Society who treat adult spinal deformity. Determinants included the surgeons' type of practice, number of years in practice, agreement with given PJK/PJF definitions, importance of key factors influencing prevention and revision, prevention methods currently used, and the importance of developing a classification system. Results. A total of 226 surgeons responded (38.8% response rate). Both 44.4% of surgeons selected "extremely important" and 40.8% selected "very important" that PJK in adult spinal deformity surgery is a very important issue and that a Scoliosis Research Society PJK/PJF classification system and guidelines for detection and prevention of PJK/PJF is a "must have" (18.1%) and "very likely helpful" (31.9%). Both 86.2% and 90.7% of surgeons agreed with the provided definitions of PJK and PJF, respectively. Top 5 revision indications included neurological deficit, severe focal pain, translation or subluxation fracture, a change in kyphosis angle of greater than 30°, chance fracture, spondylolisthesis greater than 6 mm, and instrumentation prominence. The majority of respondents use a PJK/PJF prevention strategy 60% of the time or more, the most common were terminal rod contour, preoperative bone mineral density testing, and frequent radiographical studies during first 3 months postoperative, preoperative bone mineral density medication for low bone mineral density. Conclusion. The results of this study provide insight from the practicing surgeons' perspective of the management of PJK and PJF that may aid in the validation of current definitions and consensusbased treatment decisions and prevention guidelines.

AB - Study Design. An electronic survey administered to Scoliosis Research Society membership. Objective. To characterize surgeon views regarding proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) management providing the framework in which a PJK/PJF classification system and treatment guidelines could be established. Summary of Background Data. PJK/PJF are common complications of adult spinal deformity surgery. To date, there is no consensus on PJK/PJF definitions, classification, and indications for revision surgery. There is a paucity of data on deformity surgeon practice pattern variations and consensus opinion on treatment and prevention. Methods. An electronic 19-question survey regarding PJK/PJF was administered to members of the Scoliosis Research Society who treat adult spinal deformity. Determinants included the surgeons' type of practice, number of years in practice, agreement with given PJK/PJF definitions, importance of key factors influencing prevention and revision, prevention methods currently used, and the importance of developing a classification system. Results. A total of 226 surgeons responded (38.8% response rate). Both 44.4% of surgeons selected "extremely important" and 40.8% selected "very important" that PJK in adult spinal deformity surgery is a very important issue and that a Scoliosis Research Society PJK/PJF classification system and guidelines for detection and prevention of PJK/PJF is a "must have" (18.1%) and "very likely helpful" (31.9%). Both 86.2% and 90.7% of surgeons agreed with the provided definitions of PJK and PJF, respectively. Top 5 revision indications included neurological deficit, severe focal pain, translation or subluxation fracture, a change in kyphosis angle of greater than 30°, chance fracture, spondylolisthesis greater than 6 mm, and instrumentation prominence. The majority of respondents use a PJK/PJF prevention strategy 60% of the time or more, the most common were terminal rod contour, preoperative bone mineral density testing, and frequent radiographical studies during first 3 months postoperative, preoperative bone mineral density medication for low bone mineral density. Conclusion. The results of this study provide insight from the practicing surgeons' perspective of the management of PJK and PJF that may aid in the validation of current definitions and consensusbased treatment decisions and prevention guidelines.

KW - Adult spinal deformity

KW - Classification system

KW - PJF

KW - PJK

KW - PJK prevention strategies

KW - Proximal junctional failure

KW - Proximal junctional kyphosis

KW - Scoliosis

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DO - 10.1097/BRS.0000000000000897

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