Shaw K Aaron, Woodhams William, Smith John, Sponseller Paul, Pahys Josh, Vitale Michael, Ramo Brandon
Spine Division, Children's Mercy Kansas City, Kansas City, MO, USA.
Department of Orthopaedic Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Spine Deform. 2025 Aug 19. doi: 10.1007/s43390-025-01164-2.
Proximal junctional kyphosis (PJK) is a condition frequently encountered in children with early onset scoliosis (EOS) undergoing growth-friendly instrumentation (GFI). Previous studies have identified risk factors but have not compared the rate of PJK between children with connective tissue disease (CTD) and idiopathic EOS (iEOS).
Retrospective review of a multicenter spine database was performed. Patients with EOS undergoing GFI with a minimum of 5 years follow-up were identified and isolated to those with CTD (Marfan, Loeys-Dietz, Ehlers-Danlos, Soto, and Larsen) and idiopathic etiologies. PJK was defined as requiring revision surgery or as having > 10 degree change in proximal junctional angle (PJA). Surgical factors and implant variables were recorded. Radiographic parameters and complication development were compared between groups.
A total of 253 children (mean 5.7 years, 57% female) were identified (CTD:49, iEOS:204). A total of 58 patients developed radiographic PJK (23%) with only 11 (18.9%, 4% of total cohort) undergoing revision surgery at 5 years following implantation. There were no identified surgical factors or radiographic variables associated with the development of PJK. In comparing the CTD and iEOS cohorts, there was no difference in PJK (CTD:26.5%, iEOS:22.1%; P = 0.5). Additionally, there were no significant differences between groups for preoperative or 5-year follow-up radiographic parameters, although there was a trend toward greater increase in PJA from post-implant to 5 years in CTD patients (CTD: 2.5 ± 13.8° vs - 0.01 ± 9.9; P = 0.08). CTD and iEOS patients gained similar thoracic heights, 26.6 ± 20.7 mm vs 26.9 ± 21.7 mm (P = 0.8). There was no difference in overall complication rate but CTD patients experienced a greater number of complications/patient (3.1 vs 2.0; P = 0.004).
PJK is a pervasive complication in EOS, occurring in 23% of patients undergoing GFI. Having an underlying CTD did not increase the risk of PJK development within 5 years of treatment.
近端交界性后凸畸形（PJK）是早发性脊柱侧凸（EOS）患儿在接受生长友好型内固定术（GFI）时经常遇到的一种情况。既往研究已确定了风险因素，但尚未比较结缔组织病（CTD）患儿与特发性EOS（iEOS）患儿之间的PJK发生率。
对一个多中心脊柱数据库进行回顾性研究。确定接受GFI且至少随访5年的EOS患者，并将其分为CTD（马凡综合征、洛伊斯-迪茨综合征、埃勒斯-丹洛斯综合征、索托综合征和拉森综合征）组和特发性病因组。PJK定义为需要翻修手术或近端交界角（PJA）变化>10度。记录手术因素和植入物变量。比较两组之间的影像学参数和并发症发生情况。
共确定253例患儿（平均5.7岁，57%为女性）（CTD组：49例，iEOS组：204例）。共有58例患者出现影像学PJK（23%），仅11例（18.9%，占整个队列的4%）在植入后5年接受了翻修手术。未发现与PJK发生相关的手术因素或影像学变量。比较CTD组和iEOS组，PJK发生率无差异（CTD组：26.5%，iEOS组：22.1%；P=0.5）。此外，术前或5年随访时的影像学参数在两组之间无显著差异，尽管CTD患者从植入后到5年PJA有更大增加的趋势（CTD组：2.5±13.8° vs -0.01±9.9°；P=0.08）。CTD组和iEOS组患者的胸廓高度增加相似，分别为26.6±20.7mm和26.9±21.7mm（P=0.8）。总体并发症发生率无差异，但CTD组患者的并发症/患者数量更多（3.1 vs 2.0；P=0.004）。
PJK是EOS中普遍存在的并发症，在接受GFI的患者中发生率为23%。患有潜在的CTD并不会增加治疗5年内PJK发生的风险。
