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Clinical and radiographic presentation and treatment of patients with cervical deformity secondary to thoracolumbar proximal junctional kyphosis are distinct despite achieving similar outcomes: Analysis of 123 prospective CD cases.

Publication ,  Journal Article
Passias, PG; Horn, SR; Poorman, GW; Daniels, AH; Hamilton, DK; Kim, HJ; Diebo, BG; Steinmetz, L; Bortz, CA; Segreto, FA; Sciubba, DM; Ames, C ...
Published in: J Clin Neurosci
October 2018

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.

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Published In

J Clin Neurosci

DOI

EISSN

1532-2653

Publication Date

October 2018

Volume

56

Start / End Page

121 / 126

Location

Scotland

Related Subject Headings

  • Thoracic Vertebrae
  • Radiography
  • Postoperative Complications
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Kyphosis
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Passias, P. G., Horn, S. R., Poorman, G. W., Daniels, A. H., Hamilton, D. K., Kim, H. J., … International Spine Study Group (ISSG), . (2018). Clinical and radiographic presentation and treatment of patients with cervical deformity secondary to thoracolumbar proximal junctional kyphosis are distinct despite achieving similar outcomes: Analysis of 123 prospective CD cases. J Clin Neurosci, 56, 121–126. https://doi.org/10.1016/j.jocn.2018.06.040
Passias, Peter G., Samantha R. Horn, Gregory W. Poorman, Alan H. Daniels, D Kojo Hamilton, Han Jo Kim, Bassel G. Diebo, et al. “Clinical and radiographic presentation and treatment of patients with cervical deformity secondary to thoracolumbar proximal junctional kyphosis are distinct despite achieving similar outcomes: Analysis of 123 prospective CD cases.J Clin Neurosci 56 (October 2018): 121–26. https://doi.org/10.1016/j.jocn.2018.06.040.
Passias PG, Horn SR, Poorman GW, Daniels AH, Hamilton DK, Kim HJ, Diebo BG, Steinmetz L, Bortz CA, Segreto FA, Sciubba DM, Smith JS, Neuman BJ, Shaffrey CI, Lafage R, Lafage V, Ames C, Hart R, Mundis G, Eastlack RK, Schwab FJ, International Spine Study Group (ISSG). Clinical and radiographic presentation and treatment of patients with cervical deformity secondary to thoracolumbar proximal junctional kyphosis are distinct despite achieving similar outcomes: Analysis of 123 prospective CD cases. J Clin Neurosci. 2018 Oct;56:121–126.
Journal cover image

Published In

J Clin Neurosci

DOI

EISSN

1532-2653

Publication Date

October 2018

Volume

56

Start / End Page

121 / 126

Location

Scotland

Related Subject Headings

  • Thoracic Vertebrae
  • Radiography
  • Postoperative Complications
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Kyphosis
  • Humans
  • Female