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Proximal junction kyphosis

Martin H Pham, Alexander Tuchman, Lance Smith, Andre M Jakoi, Neil N Patel, Vivek A Mehta, Frank L Acosta
Proximal junctional kyphosis is an increasingly recognized complication following long-segment posterior spinal fusion for adult spinal deformity. The authors describe a novel technique for interspinous ligament reinforcement at the proximal adjacent levels using a cadaveric semitendinosus tendon graft secured with an Ethibond No. 2 double filament (Ethicon, Somerville, New Jersey) via the Krackow suture weave. A retrospective review identified 4 patients who had received this graft. No proximal junctional kyphosis was seen at a mean short-term follow-up of 5...
October 13, 2016: Orthopedics
Arnaud Dubory, Lotfi Miladi, Brice Ilharreborde, Jean-Marie Gennari, Jihane Rouissi, Christophe Glorion, Charles Henri Flouzat Lachaniette, Thierry Odent
PURPOSE: Anterior fusion is a well-established procedure for the treatment of Lenke 5C adolescent idiopathic scoliosis (AIS). This retrospective study aimed to assess preoperative and postoperative radiographic differences between the conventional anterior fusion and anterior short fusions (ASF) in Lenke 5C AIS. METHODS: Radiographic data of 42 consecutive cases of Lenke 5C AIS, which were surgically treated through anterior segmental fusion, were analyzed retrospectively...
October 4, 2016: European Spine Journal
Donita I Bylski-Austrow, David L Glos, Anne C Bonifas, Max F Carvalho, Matthew C Coombs, Peter F Sturm
BACKGROUND: Surgical treatments for early onset scoliosis (EOS) correct curvatures and improve respiratory function but involve many complications. A distractible, or 'growing rod,' implant construct that is more flexible than current metal rod systems may sufficiently correct curves in small children and reduce complications due to biomechanical factors. The purpose of this pilot study was to determine ranges of motion (ROM) after implantation of simulated growing rod constructs with a range of clinically relevant structural properties...
2016: Scoliosis and Spinal Disorders
Shay Bess, Jeffrey E Harris, Alexander W L Turner, Virginie LaFage, Justin S Smith, Christopher I Shaffrey, Frank J Schwab, Regis W Haid
OBJECTIVE Proximal junctional kyphosis (PJK) remains problematic following multilevel instrumented spine surgery. Previous biomechanical studies indicate that providing less rigid fixation at the cranial aspect of a long posterior instrumented construct, via transition rods or hooks at the upper instrumented vertebra (UIV), may provide a gradual transition to normal motion and prevent PJK. The purpose of this study was to evaluate the ability of posterior anchored polyethylene tethers to distribute proximal motion segment stiffness in long instrumented spine constructs...
September 9, 2016: Journal of Neurosurgery. Spine
W Thompson, C Thakar, D J Rolton, J Wilson-MacDonald, C Nnadi
AIMS: We undertook a prospective non-randomised radiological study to evaluate the preliminary results of using magnetically-controlled growing rods (MAGEC System, Ellipse technology) to treat children with early-onset scoliosis. PATIENTS AND METHODS: Between January 2011 and January 2015, 19 children were treated with magnetically-controlled growing rods (MCGRs) and underwent distraction at three-monthly intervals. The mean age of our cohort was 9.1 years (4 to 14) and the mean follow-up 22...
September 2016: Bone & Joint Journal
Peng Yan, Hongda Bao, Yong Qiu, Mike Bao, Jeffrey J Varghese, Xu Sun, Zhen Liu, Zezhang Zhu, Bangping Qian, Minghao Zheng, Feng Zhu
STUDY DESIGN: A retrospective study. OBJECTIVE: To investigate whether the mismatch between proximal junctional angle (PJA) and the proximal rod contouring contributed to the occurrence of post-operative PJK in degenerative scoliosis. SUMMARY OF BACKGROUND DATA: Proximal junctional kyphosis (PJK) is one of the complications in the treatment of degenerative scoliosis, the post-operative PI-LL mismatch and the increased rod stiffness are supposed to be the etiology of PJK...
August 24, 2016: Spine
Jamal McClendon, Timothy R Smith, Patrick A Sugrue, Sara E Thompson, Brian A O'Shaughnessy, Tyler R Koski
OBJECTIVE: To evaluate spinal implant density and proximal junctional kyphosis (PJK) in adult spinal deformity (ASD). METHODS: Consecutive ASD patients receiving >5 level fusions were retrospectively analyzed between 2007 and 2010. INCLUSION CRITERIA: ASD, elective fusions, minimum 2-year follow-up. EXCLUSION CRITERIA: Age < 18 years, neuromuscular or congenital scoliosis, cervical or cervicothoracic fusions, non-elective conditions (infection, tumor, trauma)...
August 12, 2016: World Neurosurgery
Hui Wang, Lei Ma, Dalong Yang, Tao Wang, Sidong Yang, Yanhong Wang, Qian Wang, Feng Zhang, Wenyuan Ding
The aim of this study was to identify the prevalence of proximal junctional kyphosis (PJK) in degenerative lumbar scoliosis (DLS) following long instrumented posterior spinal fusion, and to search for predictable risk factors for the progression of junctional kyphosis.In total 98 DLS patients with a minimum 2-year follow-up were reviewed prospectively. According to the occurrence of PJK at the last follow-up, patients were divided into 2 groups: PJK group and non-PJK group. To investigate risk values for the progression of PJK, 3 categorized factors were analyzed statistically: patient characteristics-preoperative data of age, sex, body mass index (BMI), bone mineral density (BMD) were investigated; surgical variables-the most proximal and distal levels of the instrumentation, the number of instrumented levels; pre- and postoperative radiographic parameters include the scoliotic angle, sagittal vertical axis, thoracic kyphosis, thoracolumbar junctional angle, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope...
August 2016: Medicine (Baltimore)
Themistocles S Protopsaltis, Anthony J Boniello, Frank J Schwab
A wide range of neuromuscular diseases, including Parkinson disease, cerebral palsy, multiple sclerosis, and myopathy, are associated with spinal deformities. The most common postural deformities include anterocollis, Pisa syndrome (pleurothotonus), scoliosis, and camptocormia. Nonsurgical management of spinal deformity in patients with neuromuscular disease centers on maximizing the medical management of the underlying neurodegenerative pathology before surgical intervention is contemplated. Surgical management can include decompression alone, or decompression and fusion with short or long fusion constructs...
September 2016: Journal of the American Academy of Orthopaedic Surgeons
Themistocles Protopsaltis, Nicolas Bronsard, Alex Soroceanu, Jensen K Henry, Renaud Lafage, Justin Smith, Eric Klineberg, Gregory Mundis, Han Jo Kim, Richard Hostin, Robert Hart, Christopher Shaffrey, Shay Bess, Christopher Ames
PURPOSE: To describe reciprocal changes in cervical alignment after adult spinal deformity (ASD) correction and subsequent development of proximal junctional kyphosis (PJK). This study also investigated these changes using two novel global sagittal angular parameters, cervical-thoracic pelvic angle (CTPA) and the T1 pelvic angle (TPA). METHODS: Multicenter, retrospective consecutive case series of ASD patients undergoing thoracolumbar three-column osteotomy (3CO) with fusion to the pelvis...
July 20, 2016: European Spine Journal
P Inaparthy, J C Queruz, D Bhagawati, C Thakar, T Subramanian, C Nnadi
BACKGROUND: The introduction of magnetic expansion control growth rods for the surgical management of EOS has gained popularity. However, there are no published studies on the incidence of proximal junctional kyphosis (PJK) using this technique. PURPOSE: The aim of this study is to report the incidence of PJK following treatment with magnetic growth rods in EOS. METHODS: Retrospective review of data from 21 cases (12 males, 9 females) over 3 years...
October 2016: European Spine Journal
Chun-Po Yen, Yusef I Mosley, Juan S Uribe
With the aging population, there is a rising prevalence of degenerative spinal deformity and need of surgical care for these patients. Surgical treatment for adult spinal deformity (ASD) is often fraught with a high rate of complications. Minimally invasive surgery (MIS) has for the past decade been adopted by spine surgeons to treat ASD in the hopes of reducing access-related morbidity and perioperative complications. The benefits of MIS approach in general and recent development of MIS techniques to avoid long-term complications such as pseudoarthrosis or proximal junctional kyphosis are reviewed...
September 2016: Current Reviews in Musculoskeletal Medicine
Senol Bekmez, Halil G Demirkiran, Ozgur Dede, Vusal Ismayilov, Muharrem Yazici
BACKGROUND: According to the current literature, the recommended surgical treatment is circumferential spinal fusion, including both anterior and posterior procedures, for progressive thoracolumbar kyphosis in mucopolysaccharidosis (MPS). The purpose of this study was to report our experience with the posterior-only approach and instrumented fusion for MPS kyphosis. METHODS: Six consecutive patients with MPS and thoracolumbar junctional kyphosis managed with the posterior-only approach were included...
July 11, 2016: Journal of Pediatric Orthopedics
Ming Luo, Wengang Wang, Mingkui Shen, Lei Xia
BACKGROUND: Radiological outcomes between anterior and posterior approach in Lenke 5C curves were still controversial. Meta-analysis on published articles to compare fusion segments and radiological outcomes between the two surgical approaches was performed. METHODS: Electronic database was conducted for searching studies concerning the anterior versus posterior approach in Lenke 5C curves. After quality assessment, data of means, standard deviations, and sample sizes were extracted...
2016: Journal of Orthopaedic Surgery and Research
Cao Yun, Cai Liang Shen
PURPOSE: Anterior release for Scheuermann's disease was considered an important technique for decades. However, posterior-only surgery for Scheuermann's disease has shown a promising potential to manage this deformity, as well. Correction loss could happen post-operatively, especially when posterior-only surgery is performed in the early days. Therefore, a dispute regarding anterior release for Scheuermann's disease exists. METHODS: We performed a systematic review of studies, reporting the outcomes of anterior release and posterior fusion surgery (AP group) or posterior-only surgery (PO group) for Scheuermann's disease...
July 6, 2016: European Spine Journal
Michael D Daubs
Commentary On Basques BA, Long WD, 3rd, Golinvaux NS, Bohl DD, Samuel AM, Lukasiewicz AM, et al. Poor visualization limits diagnosis of proximal junctional kyphosis in adolescent idiopathic scoliosis. Spine J 2015. doi:10.1016/j.spinee.2015.10.040.
June 2016: Spine Journal: Official Journal of the North American Spine Society
M Yagi, H Ohne, T Konomi, K Fujiyoshi, S Kaneko, T Komiyama, M Takemitsu, Y Yato, M Machida, T Asazuma
: We conducted a prospective comparative study of the effect of teriparatide therapy for preventing vertebral-failure-type PJK after reconstructive surgery for adult spinal deformity. Prophylactic teriparatide improved the volumetric bone mineral density and fine bone structure of the vertebra above the upper-instrumented vertebra and reduced the incidence of vertebral-failure-type PJK. INTRODUCTION: Proximal junctional kyphosis (PJK) is a complication after corrective surgery for spinal deformity...
June 24, 2016: Osteoporosis International
Jaewon Lee, Ye-Soo Park
Proximal junctional kyphosis (PJK) is a common radiographic finding after long spinal fusion. A number of studies on the causes, risk factors, prevention, and treatment of PJK have been conducted. However, no clear definition of PJK has been established. In this paper, we aimed to clarify the diagnosis, prevention, and treatment of PJK by reviewing relevant papers that have been published to date. A literature search was conducted on PubMed using "proximal junctional", "proximal junctional kyphosis", and "proximal junctional failure" as search keywords...
June 2016: Asian Spine Journal
Yingsong Wang, Noriaki Kawakami, Taichi Tsuji, Tetsuya Ohara, Yoshitaka Suzuki, Toshiki Saito, Ayato Nohara, Ryoji Tauchi, Kazuki Kawakami
STUDY DESIGN: A retrospective study. OBJECTIVE: To investigate whether PJK or obvious proximal junctional angle (PJA) changes in the sagittal plane develops following short fusion in children younger than 10 years of age with congenital scoliosis, and to investigate the possible risk factors. SUMMARY OF BACKGROUND DATA: Proximal junctional kyphosis (PJK) following long spinal fusion in adolescents and adults is a serious postoperative complication...
June 20, 2016: Clinical Spine Surgery
Ngoc-Lam M Nguyen, Christopher Y Kong, Robert A Hart
Technical advancements have enabled the spinal deformity surgeon to correct severe spinal mal-alignment. However, proximal adjacent segment pathology (ASP) remains a significant issue. Examples include proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Agreement on the definition, classification, and pathophysiology of PJK and PJF remains incomplete, and an understanding of the risk factors, means of prevention, and treatment of this problem remains to be elucidated. In general, PJK is a relatively asymptomatic radiographic diagnosis managed with patient reassurance and monitoring...
September 2016: Current Reviews in Musculoskeletal Medicine
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