Hostin Richard A, Yeramaneni Samrat, Gum Jeffrey L, Smith Justin S
Department of Orthopedic Surgery, Medical City Dallas, Dallas, TX, USA.
Department of Orthopedic Surgery, Medical City Dallas, Dallas, TX, USA
Int J Spine Surg. 2023 Oct;17(S2):S9-S17. doi: 10.14444/8518. Epub 2023 Oct 5.
The common goal of pediatric and adult spinal reconstructive procedures is to minimize long-term risk of disability, pain, and mortality. A common complication that has proved particularly problematic in the adult spinal deformity population and that has been an area of increased research and clinical focus is proximal junctional kyphosis (PJK). The incidence of PJK ranges from 10%-40% based on criteria used to define the condition. Clinically, PJK complication is associated with increased pain, decreased self-image and Scoliosis Research Society scores, and severe neurological injuries affecting the patient's quality of life. Economically, direct costs of PJK complication-associated revision surgery ranges from $20,000 to $120,000, which places an enormous burden on patients, providers, and payers. To mitigate the risk of PJK occurrence postoperatively, it is paramount to develop consistent guidelines in defining and classifying PJK in addition to extensive preoperative planning and risk stratification that is patient specific. This article will provide an overview on the clinical and economic impact of PJK in pediatric and adult spine deformity patients with an emphasis on the role of patient factors and predictive analytics, challenges in developing a consistent PJK classification, and current treatment and prevention strategies.
儿科和成人脊柱重建手术的共同目标是将残疾、疼痛和死亡的长期风险降至最低。近端交界性后凸畸形（PJK）是一种常见并发症，在成人脊柱畸形患者中已被证明特别棘手，并且一直是研究和临床关注增加的领域。根据用于定义该病症的标准，PJK的发生率在10%至40%之间。临床上，PJK并发症与疼痛加剧、自我形象和脊柱侧弯研究学会评分降低以及影响患者生活质量的严重神经损伤有关。在经济方面，与PJK并发症相关的翻修手术直接费用在20,000美元至120,000美元之间，这给患者、医疗服务提供者和付款人带来了巨大负担。为了降低术后发生PJK的风险，除了进行广泛的术前规划和针对患者的风险分层外，制定一致的PJK定义和分类指南至关重要。本文将概述PJK对儿科和成人脊柱畸形患者的临床和经济影响，重点关注患者因素和预测分析的作用、制定一致的PJK分类面临的挑战以及当前的治疗和预防策略。
