Proximal junctional kyphosis in pediatric spinal deformity surgery: a systematic review and critical analysis.
Adolescent idiopathic scoliosis
Early-onset scoliosis
Pediatric
Proximal junctional kyphosis
Spine
Journal
Spine deformity
ISSN: 2212-1358
Titre abrégé: Spine Deform
Pays: England
ID NLM: 101603979
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
01
04
2021
accepted:
16
10
2021
pubmed:
28
10
2021
medline:
17
3
2022
entrez:
27
10
2021
Statut:
ppublish
Résumé
Proximal junctional kyphosis (PJK) is a commonly encountered clinical and radiographic phenomenon after pediatric and adolescent spinal deformity surgery that may lead to post-operative deformity, pain, and dissatisfaction. Understanding the risk factors of PJK can be useful for pre-operative informed consent as well as to identify any potential preventative strategies. We performed a systematic review and critical analysis following the PRISMA statement in July 2019 by searching the PubMed, Scopus, and Embase databases, including all prior published studies. We included articles with data on PJK in patients with operative pediatric and adolescent scoliosis and those that detailed risk factors and/or preventative strategies for PJK. Levels of evidence were determined based on consensus. Findings were summarized and grades of recommendation were assigned by consensus. This study was registered in the PROSPERO database; 202,457. Six hundred and thirty five studies were identified. Thirty-seven studies met criteria for inclusion into the analysis. No studies including neuromuscular scoliosis met inclusion criteria. No findings had Grade A evidence. There were 4 findings found to contribute to PJK with Grade B evidence in EOS: higher number of distractions, disruption of posterior elements, greater sagittal plane correction. There was no difference in incidence noted between etiology of the curvature. Five findings with Grade B evidence were found to contribute to PJK in AIS populations: higher pre-operative thoracic kyphosis, higher pre-operative lumbar lordosis, longer fusion constructs, greater sagittal plane correction, and posterior versus anterior fusion constructs. Greater sagittal plane correction has Grade B evidence as a risk factor for PJK in both EOS and AIS populations. In EOS patients, an increased number of distractions and posterior element disruption are Grade B risk factors. In AIS patients, longer fusion constructs, higher pre-operative thoracic kyphosis and lumbar lordosis, and posterior (as opposed to anterior) constructs also contributed to PJK with Grade B evidence. These findings can guide informed consent and surgical management, and provide the foundation for future studies.
Identifiants
pubmed: 34704232
doi: 10.1007/s43390-021-00429-w
pii: 10.1007/s43390-021-00429-w
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
257-266Subventions
Organisme : NIAMS NIH HHS
ID : R21 AR075971
Pays : United States
Informations de copyright
© 2021. Scoliosis Research Society.
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