Alharran Abdullah M, Alotaibi Muteb N, Algarni Nizar, Mohammad Mohammad A M A, Alajmi Mohammed T M H, Alahmad Ahmad A, Marwan Yousef
College of Medicine, Arabian Gulf University, Manama, Kingdom of Bahrain.
College of Medicine, AL Faisal University, Riyadh, Saudi Arabia.
Spine Deform. 2025 Jun 18. doi: 10.1007/s43390-025-01117-9.
Adult spinal deformity surgery is frequently performed to address degenerative conditions and scoliosis, but postoperative complications such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common. These conditions can lead to neurological deficits and compromised surgical outcomes. This systematic review and meta-analysis aimed to evaluate the prevalence of neurological deficits associated with PJK and PJF.
A systematic review and meta-analysis was conducted following PRISMA guidelines. A comprehensive search was performed across multiple databases, including PubMed, Web of Science, Cochrane, Embase, and Scopus, with no language restrictions. Studies that reported neurological deficits following PJK or PJF after adult spinal deformity surgery were included. Data extraction and quality assessment were performed by two independent authors using NIH quality assessment tools. Meta-analysis was conducted using random-effect models, and heterogeneity was evaluated using I.
Thirteen eligible studies were identified involving 2846 patients. Of these, 777 patients developed PJK or PJF, with 61 patients experiencing neurological deficits. The pooled prevalence of neurological deficits was 6.2% for PJF (95% CI: 0.062-0.192; p < 0.001) and 7.1% for PJK (95% CI: 0.027-0.115; p < 0.001). Heterogeneity amongst the studies was high for PJF (I = 70.25%) and low for PJK (I = 14.47%).
This study highlights the incidence of neurological deficits following PJK and PJF in adult spinal deformity surgeries. Future research should focus on identifying the risk factors and utilising evidence-based strategies that can improve postoperative care and reduce complication rates.
成人脊柱畸形手术常用于治疗退行性疾病和脊柱侧弯，但术后并发症如近端交界性后凸（PJK）和近端交界性失败（PJF）很常见。这些情况可能导致神经功能缺损并影响手术效果。本系统评价和荟萃分析旨在评估与PJK和PJF相关的神经功能缺损的患病率。
按照PRISMA指南进行系统评价和荟萃分析。在多个数据库中进行全面检索，包括PubMed、科学网、Cochrane、Embase和Scopus，无语言限制。纳入报道成人脊柱畸形手术后PJK或PJF后神经功能缺损的研究。由两名独立作者使用美国国立卫生研究院质量评估工具进行数据提取和质量评估。使用随机效应模型进行荟萃分析，并使用I²评估异质性。
确定了13项符合条件的研究，涉及2846例患者。其中，777例患者发生PJK或PJF，61例患者出现神经功能缺损。PJF的神经功能缺损合并患病率为6.2%（95%CI：0.062 - 0.192；p < 0.001），PJK为7.1%（95%CI：0.027 - 0.115；p < 0.001）。PJF研究间的异质性较高（I² = 70.25%），PJK较低（I² = 14.47%）。
本研究强调了成人脊柱畸形手术中PJK和PJF后神经功能缺损的发生率。未来的研究应侧重于识别危险因素并采用循证策略，以改善术后护理并降低并发症发生率。
