Abstract
ABSTRACT Objective The primary objective of this study was to analyze the prevalence of PJK in patients with neuromuscular scoliosis submitted to posterior spinal arthrodesis with instrumentation. Proximal junctional kyphosis (PJK) is a frequent phenomenon that, due to its importance, began to be studied by several authors, who laid the foundations for the radiographic definition and possible risk factors for its occurrence after long spinal arthrodesis with instrumentation. Despite the large number of PJK studies, most were related to the occurrence of adolescent idiopathic scoliosis, adult deformity and early-onset scoliosis, with few being targeted to patients with congenital and neuromuscular scoliosis. Methods In this study, data from electronic medical records of patients with neuromuscular scoliosis who underwent posterior arthrodesis with instrumentation between the years 2014 and 2016 were analyzed. Information on age, gender, pathology and radiographic measurements were extracted from this sample at the 2nd and 24th postoperative months. Results A total of 39 patients with neuromuscular scoliosis were analyzed. The sample was predominantly male (58.87%) and the mean age was 14.05 years. PJK occurred in 18 patients during the two years following surgery, with a prevalence of 46.15%. The incidence of PJK in the 2nd and 24th postoperative months was 23.1% and 30%, respectively. Conclusions A prevalence of PJK of 46.15% was found in patients with neuromuscular scoliosis treated surgically with posterior instrumentation after two years of follow-up, as compared to previous results . Level of Evidence III; Cross-sectional observational study.
Highlights
Proximal junctional kyphosis (PJK), which consists of a non-physiological abnormality in the sagittal plane that occurs following surgery in the segment proximal to the arthrodesis, is one of the postoperative complications that confronts the spine surgeon
The primary objective of this study was to analyze the prevalence of PJK in patients with neuromuscular scoliosis submitted to posterior spinal arthrodesis with instrumentation
For the radiographic evaluation and PJK diagnosis we used the method proposed by Glattes et al.,[3] in which the sagittal proximal junctional Cobb angle (PJA), measured between the lower vertebral endplate of the uppermost instrumented vertebra (UIV) and the upper endplate of the two suprajacent vertebrae, measures >10o and at least 10o greater than the preoperative measurement of the segment. (Figure 1) The data were obtained from the electronic medical records archive
Summary
Proximal junctional kyphosis (PJK), which consists of a non-physiological abnormality in the sagittal plane that occurs following surgery in the segment proximal to the arthrodesis, is one of the postoperative complications that confronts the spine surgeon. In 1999, Lee et al.[2] defined abnormal PJK as kyphosis, measured from T2 to the proximal instrumented level, >5o above the sum of the normal values of each segment as previously described by Bernhardt and Bridwell.[1] In 2005 Glattes et al.[3] modified the definition of PJK to a sagittal proximal junctional Cobb angle measured between the lower vertebral endplate of the uppermost instrumented vertebra (UIV) and the upper vertebral endplate of the 2 suprajacent vertebrae that is >10o and at least 10o greater than the preoperative measurement of the segment. In 2010 Helgeson et al.[4] proposed another method to define PJK using the upper vertebral endplate of the adjacent vertebra and the lower vertebral endplate of the UIV as a basis They suggested abnormality to be an angle more than two standard deviations greater than the normal segment, which in that case was 15o, and they redefined PJK as any increase in postoperative kyphosis >15o
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