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CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 106-112
DOI: 10.4103/ajns.AJNS_311_20
Original Article

Proximal junctional kyphosis after pediatric angular kyphotic deformity correction: Are we missing something?

Abhinandan Mallepally
Indian Spinal Injuries Centre, New Delhi
,
Rajat Mahajan
Indian Spinal Injuries Centre, New Delhi
,
Nandan Marathe
Indian Spinal Injuries Centre, New Delhi
,
Ankur Nanda
Indian Spinal Injuries Centre, New Delhi
,
Tarush Rustagi
Indian Spinal Injuries Centre, New Delhi
,
Harvinder Chhabra
Indian Spinal Injuries Centre, New Delhi
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Purpose: Corrective maneuvers in an angular kyphotic deformity have its own problems including early complications such as neurological deficit and late complications such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). This article discusses the probable mechanisms, leading to PJK in pediatric severe angular kyphotic deformities and preventive strategies for the same. We will also assess natural course of untreated PJK and its devastating consequences. Materials and Methods: Three patients, two 13-year males presented with progressive, painless thoracolumbar kyphoscoliotic deformity, with segmental kyphosis 100° and 140° and scoliosis of 33° and 78°, respectively, and one 14-year-old female presented with angular kyphotic deformity of 60° with apex at D11-12 level. Results: Posterior vertebral column resection with segmental deformity correction with good coronal and sagittal balance was done. In the follow-up, PJF was seen. Second surgery was done with the extension of instrumentation to D4 along with deformity correction in both the male patients. The female patient did not opt for a revision surgery, and we are following the natural history of this case. Conclusion: In severe thoracolumbar angular kyphotic deformities with normal or negative sagittal balance, it might be a safer option to select the sagittal stable vertebra as upper instrumented vertebra based on the C2 plumb line on the preoperative standing lateral radiographs. However, a study with a larger sample size is needed to validate our hypothesis.

Key-words:

Angular kyphosis - proximal junctional kyphosis - vertebral column resection

Financial support and sponsorship

Nil.




Publication History

Received: 22 January 2020

Accepted: 13 October 2020

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Shands AR Jr., Bundens WD. Congenital deformities of the spine; an analysis of the roentgenograms of 700 children. Bull Hosp Joint Dis 1956;17:110-33.
  • 2 Winter RB. Congenital scoliosis. Orthop Clin North Am 1998 19:395-408.
  • 3 Marks DS, Qaimkhani SA. The natural history of congenital scoliosis and kyphosis. Spine (Phila Pa 1976) 2009;34:1751-5.
  • 4 Rajasekaran S. Kyphotic deformity in spinal tuberculosis and its management. Int Orthop 2012;36:359-65.
  • 5 Tikoo A, Kothari MK, Shah K, Nene A. Current concepts - Congenital scoliosis. Open Orthop J 2017;11:337-45.
  • 6 Wang Y, Kawakami N, Tsuji T, Ohara T, Suzuki Y, Saito T, et al. Proximal junctional kyphosis following posterior hemivertebra resection and short fusion in children younger than 10 years. Clin Spine Surg 2017;30:E370-6.
  • 7 Chang DG, Kim JH, Ha KY, Lee JS, Jang JS, Suk SI. Posterior hemivertebra resection and short segment fusion with pedicle screw fixation for congenital scoliosis in children younger than 10 years: Greater than 7-year follow-up. Spine (Phila Pa 1976) 2015;40:E484-91.
  • 8 Bess S, Akbarnia BA, Thompson GH, Sponseller PD, Shah SA, El Sebaie H, et al. Complications of growing-rod treatment for early-onset scoliosis: Analysis of one hundred and forty patients. J Bone Joint Surg Am 2010;92:2533-43.
  • 9 Atici Y, Sökücü S, Uzümcügil O, Albayrak A, Erdoğan S, Kaygusuz MA. The results of closing wedge osteotomy with posterior instrumented fusion for the surgical treatment of congenital kyphosis. Eur Spine J 2013;22:1368-74.
  • 10 Javidan P, Kabirian N, Mundis GM Jr, Akbarnia BA. Delayed postoperative neurological complication in a patient with congenital kyphoscoliosis: Recovered by revision of the 4-rod instrumentation technique: Case report. J Neurosurg Spine 2013;19:595-9.
  • 11 Wang S, Aikenmu K, Zhang J, Qiu G, Guo J, Zhang Y, et al. The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis. Eur Spine J 2017;26:1817-25.
  • 12 Wang Y. History of spine osteotomy. In: Spinal Osteotomy. Dordrecht: Springer Netherlands; 2015. p. 1-0.
  • 13 Maruo K, Ha Y, Inoue S, Samuel S, Okada E, Hu SS, et al. Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity. Spine (Phila Pa 1976) 2013;38:E1469-76.
  • 14 Lau D, Clark AJ, Scheer JK, Daubs MD, Coe JD, Paonessa KJ, et al. Proximal junctional kyphosis and failure after spinal deformity surgery: A systematic review of the literature as a background to classification development. Spine (Phila Pa 1976) 2014;39:2093-102.
  • 15 Yan C, Li Y, Yu Z. Prevalence and consequences of the proximal junctional kyphosis after spinal deformity surgery. Medicine (United States) 2016;95:1-6.
  • 16 Chen X, Chen ZH, Qiu Y, Zhu ZZ, Li S, Xu L, et al. Proximal junctional kyphosis after posterior spinal instrumentation and fusion in young children with congenital scoliosis: A preliminary report on its incidence and risk factors. Spine (Phila Pa 1976) 2017;42:E1197-203.
  • 17 Kim DK, Kim JY, Kim DY, Rhim SC, Yoon SH. Risk factors of proximal junctional kyphosis after multilevel fusion surgery: More than 2 years follow-up data. J Korean Neurosurg Soc 2017;60:174-80.
  • 18 Roussouly P, Gollogly S, Noseda O, Berthonnaud E, Dimnet J. The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: A radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine (Phila Pa 1976) 2006;31:E320-5.
  • 19 El Fegoun AB, Schwab F, Gamez L, Champain N, Skalli W, Farcy JP. Center of gravity and radiographic posture analysis: A preliminary review of adult volunteers and adult patients affected by scoliosis. Spine (Phila Pa 1976) 2005;30:1535-40.
  • 20 Acar N, Karakasli A, Karaarslan AA, Ozcanhan MH, Ertem F, Erduran M. The mechanical effect of rod contouring on rod-screw system strength in spine fixation. J Korean Neurosurg Soc 2016;59:425-9.
  • 21 Dubousset J, Challier V, Farcy JP, Schwab FJ, Lafage V. Spinal alignment versus spinal balance. In: Haid RW, Schwab FJ, Shaffrey CI, Youssef JA, editors. Global Spinal Alignment: Principles, Pathologies, and Procedures. St. Louis: Quality Medical Publishing; 2015. p. 3-9.