Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
California Northstate University College of Medicine, Elk Grove, California, USA.
World Neurosurg. 2022 May;161:179-189.e1. doi: 10.1016/j.wneu.2022.02.063. Epub 2022 Feb 21.
Proximal junctional kyphosis (PJK) is a widely recognized complication of adult spinal deformity surgery, and various PJK prevention strategies have been reported in recent years. The goal of the present study was to perform a systematic review of the PJK prevention strategies, report on their effectiveness, and delineate future directions for investigation regarding PJK prevention.
A systematic review was conducted using PubMed, Embase, and Scopus to identify studies examining PJK prevention techniques. The titles and abstracts were screened, and those studies progressing to the full text review were screened using prespecified inclusion and exclusion criteria. The studies were organized thematically for analysis.
The search identified a total of 382 studies, 23 of which were included. The overall quality of evidence was level III. The reported PJK prevention strategies included optimization of postoperative sagittal alignment by avoiding over- or undercorrection, prophylactic vertebral cement augmentation, the use of a transverse process hook at upper instrumented vertebra, the use of more flexible rod constructs, novel pedicle screw insertion techniques, the use of junctional tethers, and teriparatide therapy, which seemed to reduce the PJK rates.
The reports of PJK prevention strategies were heterogeneous, and high-level evidence regarding any particular technique remains limited. Further development of additional PJK prevention techniques and validation of their efficacy in clinical practice are needed to optimize the outcomes of adult spinal deformity surgery.
近端交界性后凸（PJK）是成人脊柱畸形手术中广泛认识到的一种并发症，近年来已经报道了各种 PJK 预防策略。本研究的目的是对 PJK 预防策略进行系统回顾，报告其有效性，并为 PJK 预防的进一步研究勾勒方向。
使用 PubMed、Embase 和 Scopus 进行系统综述，以确定研究 PJK 预防技术的研究。筛选标题和摘要，并使用预设的纳入和排除标准对进展到全文审查的研究进行筛选。研究按主题进行组织以进行分析。
搜索共确定了 382 项研究，其中 23 项被纳入。证据的总体质量为 III 级。报告的 PJK 预防策略包括通过避免过度或不足矫正来优化术后矢状位排列、预防性椎骨水泥增强、在上位器械椎体使用横突钩、使用更灵活的杆结构、新型椎弓根螺钉插入技术、使用连接体和特立帕肽治疗，这些似乎可以降低 PJK 发生率。
关于 PJK 预防策略的报告存在异质性，任何特定技术的高级别证据仍然有限。需要进一步开发其他 PJK 预防技术并验证其在临床实践中的疗效，以优化成人脊柱畸形手术的结果。
