Neurosurgeon King Abdulaziz University Milwaukee, WI, US
Introduction: Distal junctional kyphosis (DJK) and distal junctional failure (DJF) are significant postoperative complications in adult cervical spine deformity surgery. DJK and DJF at the cervicothoracic (CT) junction present challenging complications that can significantly impact patients' quality of life. This systematic review aims to summarize the current literature on DJK and DJF in the cervicothoracic junction, identify knowledge gaps, and suggest directions for future research.
Methods: We conducted a systematic review following PRISMA guidelines to include studies that discussed DJK/DJF at CT junction. Our systematic review focused on risk factors, clinical presentation, workup, management, and prevention strategies for DJK and DJF in the CT junction.
Results: Risk factors for DJK include patient’s risk factors such as preoperative neurological symptoms, higher frailty, and poor bone quality. Radiographic factors such as a preoperative C2-7 sagittal vertical axis, T1 slope, and thoracic kyphosis were significantly associated with the risk of developing DJK. Proper evaluation and selection of the lower instrumented vertebrae (LIV) plays a major factor in developing DJK in CT junction and was discussed in details in the manuscript. Thorough preoperative clinical evaluation, including meticulous assessment of cervical and global spinal alignment and optimizing the patient’s general health, is essential to prevent the development of DJK. When managing DJK and DJF, considering bone quality and careful surgical planning is crucial to ensure optimal deformity correction and realignment, preventing further complications.
Conclusion : Comprehensive preoperative risk assessment and strategic surgical planning are crucial to prevent DJK and DJF. Future research should focus on higher-level clinical studies and leverage AI to improve our understanding of DJK risk factors and enhance surgical outcomes.
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