Factors associated with timing for revision surgery for proximal junctional kyphosis (PJK)

BACKGROUND CONTEXT: Proximal junctional kyphosis (PJK) is a radiographic complication following adult spinal deformity (ASD) surgery. The decision-making process for PJK revision surgery is multi-faceted, involving the evaluation of clinical symptoms, radiographic findings, and patient-specific factors. PURPOSE: To compare characteristics between ASD patients who received PJK revision at various time points and who did not receive PJK revision at all. STUDY DESIGN/SETTING: Prospective, multicenter cohort of ASD patients with PJK. PATIENT SAMPLE: A total of 113 ASD patients who underwent surgery for complex spinal correction and developed PJK postoperatively. OUTCOME MEASURES: Spinopelvic parameters associated with the timing for revision surgery in patients who develop PJK following ASD surgery. METHODS: Data was obtained from a multicenter database. Patients with ASD diagnosed with PJK were identified; those who had a revision within 6W were excluded due to the lack of postoperative films before 6W. The remaining patients were separated into groups: received revision surgery within two years, between two and four years, or no revision surgery within four years. Demographic variables were included. The SRS-22 questionnaire was used to assess health-related quality-of-life (HRQOL) at baseline. Spinopelvic parameters at 6W were collected, including C2-pelvic angle (C2PA), T4-pelvic angle (T4PA), L1-pelvic angle (L1PA), and T4PA-L1PA mismatch. Additionally, the incidence of preceding neurologic complications (within one year of PJK diagnosis) was determined. Hart-PJK severity score (PJKSS) was calculated without instrumentation or fracture components due to a lack of specific data. Bivariate analysis was performed with the Kruskal-Wallis and chi-squared tests. RESULTS: A total of 113 patients diagnosed with PJK were included. Six patients who had revision before six weeks postoperatively were excluded. Forty-seven patients (41.6%) had a revision surgery between 6 weeks and 2 years, 18 had a revision between 2 and 4 years (15.9%), and 48 patients (42.5%) had no revision surgery within 4 years. There were no significant differences between C2PA (p = 0.719), T4PA (p = 0.701), L1PA (p = 0.934), and T4PA-L1PA mismatch (p = 0.613) at 6W between the three groups. Likewise, the incidence of neurologic complications was not significantly different (p = 0.797). CONCLUSIONS: Early 6W postoperative spinopelvic parameters and the incidence of neurologic complications do not explain the timing of revision surgery. Additionally, demographics and HRQOL are similar among patients who received revision surgery for PJK and those who did not. Surgeons may be utilizing different variables for early risk stratification of PJK revision. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.

Duke Scholars

Author Peter Passias Orthopaedic Surgery

Author Christopher Ignatius Shaffrey Orthopaedic Surgery