Abstract
While sagittal balance of the spine is examined regularly before and after surgery for kyphotic spinal deformity, current radiographic measurement techniques limit assessment of sagittal balance to the spine and pelvis (or femoral heads) only and ignore the head and shoulder position. Patients with kyphotic deformity often have anterior positioning of the head, along with protracted shoulders with limited shoulder motion and weak back muscles.
Highlights
Posterior spinal instrumentation and fusion is a common procedure for correction of severe spinal deformities
Unlike the other two cases, this patient had a persistently high kyphotic bending moment (Mtotal) and anterior positioning of his head and shoulders that did not improve with surgery
Quantifying the kyphotic deforming forces produced by the head and shoulder position is simple and informative
Summary
Posterior spinal instrumentation and fusion is a common procedure for correction of severe spinal deformities This procedure involves the placement of metal rods anchored to the spine proximally and distally with pedicle screws or hooks, to align the spine and correct the deformity. Proximal junctional failure is a progressive localized kyphosis that develops just superior to the proximal fixation site. It has a reported incidence ranging from 5.8% to 59%, depending on the patient population, with higher rates observed in elderly patients [7]. Loss of proximal fixation includes loosening or pullout of pedicle screws or hooks at the proximal fixation site and is especially common in patients with kyphosis and osteoporosis [8]
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