The Och Spine Hospital at New York-Presbyterian/Columbia University Medical Center, 5141 Broadway, New York, NY, 10034, USA.
Eur Spine J. 2020 Feb;29(Suppl 1):78-85. doi: 10.1007/s00586-020-06320-y. Epub 2020 Feb 3.
Proximal junctional kyphosis (PJK) is a relatively common complication following spinal deformity surgery that may require reoperation. Although isolating the incidence is highly variable, in part due to the inconsistency in how PJK is defined, previous studies have reported the incidence to be as high as 39% with revision surgery performed in up to 47% of those with PJK. Despite the discordance in reported incidence, PJK remains a constant challenge that can result in undesirable outcomes following adult spine deformity surgery.
A comprehensive literature review using Medline and PubMed was performed. Keywords included "proximal junctional kyphosis," "postoperative complications," "spine deformity surgery," "instrumentation failure," and "proximal junctional failure" used separately or in conjunction.
While the characterization of PJK is variable, a postoperative proximal junction sagittal Cobb angle at least 10°, 15°, or 20° greater than the measurement preoperatively, it is a consistent radiographic phenomenon that is well defined in the literature. While particular studies in the current literature may ascertain certain variables as significantly associated with the development of proximal junctional kyphosis where other studies do not, it is imperative to note that they are not all one in the same. Different patient populations, outcome variables assessed, statistical methodology, surgeon/surgical characteristics, etc. often make these analyses not completely comparable nor generalizable.
The goal of adult spine deformity surgery is to optimize patient outcomes and mitigate postoperative complications whenever possible. Due to the multifactorial nature of this complication, further research is required to enhance our understanding and eradicate the pathology. Patient optimization is the principal guideline in not only PJK prevention, but overall postoperative complication prevention. These slides can be retrieved under Electronic Supplementary Material.
近端交界性后凸（PJK）是脊柱畸形手术后一种较为常见的并发症，可能需要再次手术。尽管发病率的界定存在很大差异，部分原因是 PJK 的定义不一致，但既往研究报道发病率高达 39%，其中高达 47%的患者需要进行翻修手术。尽管报道的发病率存在差异，但 PJK 仍然是一个持续存在的挑战，可能导致成人脊柱畸形手术后出现不良结果。
使用 Medline 和 PubMed 进行全面的文献复习。关键词包括“近端交界性后凸”、“术后并发症”、“脊柱畸形手术”、“器械失败”和“近端交界性失败”，单独或联合使用。
尽管 PJK 的特征存在差异，但术后近端交界区矢状位 Cobb 角比术前至少增加 10°、15°或 20°，这是一种在文献中定义明确的一致的影像学现象。虽然当前文献中的某些研究确定了某些变量与近端交界性后凸的发生显著相关，但其他研究则没有，需要注意的是，这些研究并不完全相同。不同的患者人群、评估的结局变量、统计方法、外科医生/手术特点等因素常常使这些分析无法完全可比或推广。
成人脊柱畸形手术的目标是优化患者的结局，并尽可能减少术后并发症。由于这种并发症的多因素性质，需要进一步研究以增强我们的理解并消除其病理。患者的优化是预防 PJK 以及总体术后并发症的主要指导原则。这些幻灯片可以在电子补充材料中找到。
