Chief of Spine Surgery University of Minnesota University of Minnesota Minneapolis, MN, US
Disclosure(s):
David W. Polly, MD, Jr.: No relevant disclosure to display
Introduction: : Proximal junctional kyphosis (PJK) is a common complication following lumbar fusion surgery for adult spinal deformity. Despite its prevalence, its current radiographic definition dichotomizes a continuous variable and is not directly correlated to patient outcomes. Accurate patient risk stratification and patient specific surgical strategy guidance to mitigate PJK risk is also not yet fully optimized. This review attempts to elucidate the most relevant patient risk factors for PJK development.
Methods: 18 studies were included in the meta-analysis following the PRISMA guidelines. Data was collected pre and post operatively for patients that did and did not develop PJK. Variables examined were sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), pelvic incidence-lumbar lordosis (PI-LL) mismatch, Hounsfield units (HU), and paraspinal muscle relative cross-sectional area (CSA). Statistically significant differences were further analyzed in a mean difference forest plot (p < 0.05).
Results: There were no significant differences either pre or post operatively between the PJK and NPJK groups regarding mechanical factors (SVA, PI, PT, LL, and PI-LL). Significant differences were found between groups in regards to BMD as Hounsfield Units (mean difference PJK -NPJK cohorts was -32.92 (p < 0.001) and T-Score mean difference PJK -NPJK was -0.67 (p < 0.001). Muscle CSA relative to vertebral body CSA was also significant, mean difference PJK - NPJK was -0.34 (p <.001).
Conclusion : Biological parameters like BMD and paraspinal muscle CSA have significant association with PJK development. Studies examining biological tissue quality parameters alongside radiographic metrics should be undertaken to inform risk and guide operative strategies
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