Results of Revision Surgery for Proximal Junctional Kyphosis Following Posterior Segmental Instrumentation: Minimum 2-Year Postrevision Follow-Up. Issue 24 (15th December 2016)

• Record Type: Journal Article
• Authors: Kim, Yong-Chan; Lenke, Lawrence G.; Bridwell, Keith H.; Hyun, Seung-Jae; You, Ki-Han; Kim, Young-Woo; Chang, Ho-Guen; Kelly, Michael P.; Koester, Linda A.; Blanke, Kathy M.; Bumpass, David B.
• Is Part Of: Spine. Volume 41:Issue 24(2016)
• Page Start: E1444
• Page End: E1452
• Publication Date: 2016-12-15
• Subjects: fracture -- lumbosacral alignment -- posterior segmental instrumentation -- proximal junctional failure -- proximal junctional kyphosis -- revision spine surgery; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000001664
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: A retrospective cohort study. Objectives: The aim of this study was to evaluate radiographic and patient-reported outcomes at minimum 2 years after revision surgery for proximal junctional kyphosis (PJK), correlating these results with PJK etiology. Summary of Background Data: There are no studies detailing the results of revision surgery for PJK following posterior segmental instrumentation. Methods: Thirty-two consecutive patients treated with revision surgery after PJK above posterior fusions (25 women/7 men, average age at surgery 60.6 yrs) were reviewed for radiographic and patient-reported outcomes (mean follow-up, 4.5 yrs; range, 2–10 yrs). Patients were subdivided into fracture (F) and nonfracture (NF) groups on the basis of PJK etiology. Results: Radiographic severity of PJK improved significantly with revision surgery and was maintained at ultimate follow-up ( P < 0.001). However, initial sagittal vertical axis (SVA) correction was not maintained through ultimate follow-up ( P = 0.04). There were significant postrevision improvements in mean Oswestry scores ( P < 0.001) and SRS total scores ( P < 0.001) in all patients. In patients with pelvic incidence-lumbar lordosis (PI-LL) mismatch < 11°, final PJK measurement was smaller than in patients with mismatch ≥11° (9.4° vs . 19.8°, P = 0.009). Six patients (19%) developed new postrevision PJK, with two (6%) requiring additional surgery. Patients who sustained PJK through a fracture had greater improvements in Oswestry ( P = 0.004), total SRS ( P = 0.04), pain ( P < 0.001), and satisfaction ( P = 0.05) scores, although the fracture patients had less maintained SVA correction ( P = 0.002). Conclusion: Revision surgery for PJK following posterior instrumentation achieved acceptable radiographic and clinical outcomes at minimum 2-year follow-up. Patients with PI-LL mismatch <11° experienced more ultimate PJK correction than patients with mismatch ≥11°. Although the NF group experienced more sustained correction of sagittal balance, the F group reported greater improvements in patient-reported outcomes. Ultimate clinical outcomes after revision surgery for PJK were similar between patients with and without compression fractures. Level of Evidence: 3