TY - JOUR
T1 - Clinical and radiographic presentation and treatment of patients with cervical deformity secondary to thoracolumbar proximal junctional kyphosis are distinct despite achieving similar outcomes
T2 - Analysis of 123 prospective CD cases
AU - International Spine Study Group (ISSG)
AU - Passias, Peter G.
AU - Horn, Samantha R.
AU - Poorman, Gregory W.
AU - Daniels, Alan H.
AU - Hamilton, D. Kojo
AU - Kim, Han Jo
AU - Diebo, Bassel G.
AU - Steinmetz, Leah
AU - Bortz, Cole A.
AU - Segreto, Frank A.
AU - Sciubba, Daniel M.
AU - Smith, Justin S.
AU - Neuman, Brian J.
AU - Shaffrey, Christopher I.
AU - Lafage, Renaud
AU - Lafage, Virginie
AU - Ames, Christopher
AU - Hart, Robert
AU - Mundis, Gregory
AU - Eastlack, Robert K.
AU - Schwab, Frank J.
N1 - Funding Information:
The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes and individual donations, and supported the current work.
Publisher Copyright:
© 2018
PY - 2018/10
Y1 - 2018/10
N2 - CD development secondary to PJK was recently documented in adult spinal deformity patients after surgical correction for thoracolumbar ASD. This study analyzes surgical management of patients with CD secondary to proximal junctional kyphosis (PJK) versus patients with primary CD. Retrospective review of multicenter cervical deformity (CD) database. CD defined as at least one of the following: C2–C7 coronal Cobb > 10° cervical lordosis (CL) > 10° cervical sagittal vertical axis (cSVA) > 4cm, CBVA > 25°. Patients were grouped into those with PJK (UIV +2 < −10°) prior to cervical surgery versus who don't (Non-PJK). Independent t-tests and chi-squared tests compared radiographic, clinical, and surgical metrics between PJK and non-PJK groups. Of 123 eligible CD patients, 26(21.1%) had radiographic PJK prior to cervical surgery. PJK patients had significantly greater T2–T12 thoracic kyphosis (−58.8° vs −45.0° p = 0.002), cSVA (49.1 mm vs 38.9 mm, p = 0.020), T1 Slope (42.6° vs 28.4° p < 0.001), TS-CL (44.1° vs 35.6° p = 0.048), C2-T3 SVA (98.8 mm vs 75.8 mm, p = 0.015), C2 Slope (45.4° vs 36.0° p = 0.043), and CTPA (6.4° vs 4.6° p = 0.005). Comparing their surgeries, the PJK group had significantly more levels fused (10.7 vs 7.4, p = 0.01). There was significantly greater blood loss in PJK patients (1158 ± 1063vs 738 ± 793 cc, p = 0.028); operative time, surgical approach, and BMP-2 use were similar (all p > 0.05). PJK patients experienced higher rates of complications 30 and 90 days post-operatively (23.1% vs. 5.2%, p = 0.004; 30.8% vs. 19.6%, p = 0.026), and more instrumentation failure 30 days postoperatively (7.8% vs. 1.0%, p = 0.004). Patients with cervical deformity secondary to PJK had worse baseline CD, despite no differences in HRQL or demographics. Surgical correction of CD associated with PJK required more invasive surgery and had higher complication rates than non-PJK patients, despite achieving similar clinical outcomes.
AB - CD development secondary to PJK was recently documented in adult spinal deformity patients after surgical correction for thoracolumbar ASD. This study analyzes surgical management of patients with CD secondary to proximal junctional kyphosis (PJK) versus patients with primary CD. Retrospective review of multicenter cervical deformity (CD) database. CD defined as at least one of the following: C2–C7 coronal Cobb > 10° cervical lordosis (CL) > 10° cervical sagittal vertical axis (cSVA) > 4cm, CBVA > 25°. Patients were grouped into those with PJK (UIV +2 < −10°) prior to cervical surgery versus who don't (Non-PJK). Independent t-tests and chi-squared tests compared radiographic, clinical, and surgical metrics between PJK and non-PJK groups. Of 123 eligible CD patients, 26(21.1%) had radiographic PJK prior to cervical surgery. PJK patients had significantly greater T2–T12 thoracic kyphosis (−58.8° vs −45.0° p = 0.002), cSVA (49.1 mm vs 38.9 mm, p = 0.020), T1 Slope (42.6° vs 28.4° p < 0.001), TS-CL (44.1° vs 35.6° p = 0.048), C2-T3 SVA (98.8 mm vs 75.8 mm, p = 0.015), C2 Slope (45.4° vs 36.0° p = 0.043), and CTPA (6.4° vs 4.6° p = 0.005). Comparing their surgeries, the PJK group had significantly more levels fused (10.7 vs 7.4, p = 0.01). There was significantly greater blood loss in PJK patients (1158 ± 1063vs 738 ± 793 cc, p = 0.028); operative time, surgical approach, and BMP-2 use were similar (all p > 0.05). PJK patients experienced higher rates of complications 30 and 90 days post-operatively (23.1% vs. 5.2%, p = 0.004; 30.8% vs. 19.6%, p = 0.026), and more instrumentation failure 30 days postoperatively (7.8% vs. 1.0%, p = 0.004). Patients with cervical deformity secondary to PJK had worse baseline CD, despite no differences in HRQL or demographics. Surgical correction of CD associated with PJK required more invasive surgery and had higher complication rates than non-PJK patients, despite achieving similar clinical outcomes.
KW - Cervical deformity
KW - Clinical outcomes
KW - Complications
KW - Proximal junctional kyphosis
KW - Radiographic evaluation
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U2 - 10.1016/j.jocn.2018.06.040
DO - 10.1016/j.jocn.2018.06.040
M3 - Article
C2 - 30042069
AN - SCOPUS:85049311898
SN - 0967-5868
VL - 56
SP - 121
EP - 126
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
ER -