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Proximal junctional kyphosis in thoracic adolescent idiopathic scoliosis: risk factors and compensatory mechanisms in a multicenter national cohort

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Abstract

Introduction

Proximal junctional kyphosis (PJK) is a frequent complication, up to 46%, in adolescent idiopathic scoliosis surgical treatment (AIS). Several risk factors have been evoked but remain controversial. The purpose of this study was to analyze the incidence of PJK in a multicenter cohort of AIS patient and to determine risk factor for PJK.

Materials and methods

Lenke I and II AIS patients operated between 2011 and 2015 (minimum of 2-years follow-up) were included. On fullspine X-rays, coronal and sagittal radiographic parameters were measured preoperatively, postoperatively and at final follow-up. Occurrence of radiological PJK corresponding to a 10° increase in the sagittal Cobb angle, measured between the upper instrumented vertebra (UIV) and UIV + 2, between postoperative and 2-years follow-up X-rays, was reported.

Results

Among the 365 patients included, 15.6% (n = 57) developed a PJK and only 10 patients required a revision surgery. Preoperatively, PJK patients had significantly larger pelvic incidence (57° ± 13° vs. 51° ± 12°), larger lumbar lordosis (LL) (63° ± 12° vs. 57° ± 11°) and bigger C7 slope. Postoperatively (3 months), in the non-PJK group, thoracic kyphosis (TK) was increased and LL was not significantly different. However, postoperatively, in the PJK group, no significant change was observed in TK, whereas C7 slope decreased and LL significantly increased. There was also a postoperative change in inflection point which was located at a more proximal level in the PJK group. Between postoperative time and final follow-up, TK and LL significantly increased in the PJK group.

Conclusion

PJK is a frequent complication in thoracic AIS, occurring 16%, but remains often asymptomatic (less than 3% of revisions in the entire cohort). An interesting finding is that patients with high pelvic incidence and consequently large LL and TK were more at risk of PJK. As demonstrated in ASD, one of the causes of PJK might be postoperative posterior imbalance that can be due to increased LL, insufficient TK or inflection point shift during surgery.

Graphical abstract

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Authors and Affiliations

  1. Pediatric Orthoapedic Department, Robert Debre University Hospital, Paris VII University, Paris, France

    Emmanuelle Ferrero, Nicolas Bocahut, Keyvan Mazda & Brice Ilharreborde

  2. Pediatric Orthoapedic Department, Pellegrin University Hospital, Bordeaux, France

    Yan Lefevre

  3. Orthoapedic Department, Centre medico chirurgical Les Massues, Lyon, France

    Pierre Roussouly & Kariman Abelin-Genevois

  4. Pediatric Orthoapedic Department, La Timone University Hospital, Marseille, France

    Sebastien Pesenti & Jean-Luc Jouve

  5. Pediatric Orthoapedic Department, Clocheville University Hospital, Tours, France

    Walid Lakhal & Thierry Odent

  6. Pediatric Orthoapedic Department, Centre Hopale institut Calot, Berck, France

    Christian Morin

  7. Pediatric Orthoapedic Department, Lenval Hospital, Nice, France

    Jean-Luc Clement

  8. Pediatric Orthoapedic Department, Purpan University Hospital, Toulouse, France

    Roxane Compagnon & Jérôme Sales de Gauzy

Authors
  1. Emmanuelle Ferrero
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  2. Nicolas Bocahut
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  3. Yan Lefevre
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  9. Jean-Luc Clement
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  12. Jean-Luc Jouve
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  13. Keyvan Mazda
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  15. Brice Ilharreborde
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Consortia

Groupe d’Etude sur la Scoliose (GES)

Corresponding author

Correspondence to Emmanuelle Ferrero.

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Conflict of interest

The authors declare that they have no conflict of interest except for the authors B. Ilharreborde: consulting for EOS imaging, Medtronic, Implanet, Zimmer Biomet. K. Mazda: consulting for Implanet, royalties from Zimmer.

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Ferrero, E., Bocahut, N., Lefevre, Y. et al. Proximal junctional kyphosis in thoracic adolescent idiopathic scoliosis: risk factors and compensatory mechanisms in a multicenter national cohort. Eur Spine J 27, 2241–2250 (2018). https://doi.org/10.1007/s00586-018-5640-y

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  • DOI: https://doi.org/10.1007/s00586-018-5640-y

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