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Ogura Y, Glassman SD, Sucato D, et al. Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. Global Spine J. 2020;11(7):1019-1024doi: 10.1177/2192568220935107.
Ogura, Y., Glassman, S. D., Sucato, D., Hresko, M. T., & Carreon, L. Y. (2021). Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. Global spine journal, 11(7), 1019-1024. https://doi.org/10.1177/2192568220935107
Ogura, Yoji, et al. "Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis." Global spine journal vol. 11,7 (2021): 1019-1024. doi: https://doi.org/10.1177/2192568220935107
Ogura Y, Glassman SD, Sucato D, Hresko MT, Carreon LY. Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. Global Spine J. 2021 Sep;11(7):1019-1024. doi: 10.1177/2192568220935107. Epub 2020 Jul 07. PMID: 32677526; PMCID: PMC8351071.
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Global Spine J. 2021 Sep;11(7):1019-1024. doi: 10.1177/2192568220935107. Epub 2020 Jul 07.

Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis.

Global spine journal

Yoji Ogura, Steven D Glassman, Daniel Sucato, M Timothy Hresko, Leah Y Carreon

Affiliations

  1. 483075Norton Leatherman Spine Center, Louisville, KY, USA.
  2. University of Louisville School of Medicine, Louisville, KY, USA.
  3. yTexas Scottish Rite Hospital for Children, Dallas, TX, USA.
  4. 1811Harvard Medical School and Boston Children's Hospital, Boston, MA, USA.

PMID: 32677526 PMCID: PMC8351071 DOI: 10.1177/2192568220935107

Abstract

STUDY DESIGN: Longitudinal cohort.

OBJECTIVES: Posterior spinal fusion (PSF) using all-pedicle screw constructs has become the standard procedure in the treatment of adolescent idiopathic scoliosis (AIS). However, there have been several reports that all-pedicle screw constructs or the use of pedicle screws at the upper instrumented vertebrae (UIV) increases the incidence of proximal junctional kyphosis (PJK). We aimed to evaluate the impact of instrumentation type on the incidence of PJK following PSF for AIS.

METHODS: We performed a stratified random sampling from 3654 patients enrolled in a multicenter database of surgically treated AIS to obtain a representative sample from all Lenke types. Patients were then allocated into 3 groups based on the instrumentation type: all-pedicle screw (PS), hook at UIV with pedicle screws distally (HT), and hybrid constructs (HB). We measured proximal junctional angle (PJA) and defined PJK as PJA ≥ 10° and PJA progression of >10° at the final follow-up.

RESULTS: Fifteen (4.3%) of 345 cases had PJK. PJK was significantly more common in PS (11%) compared with HB (1%) and HT (0%) (

CONCLUSION: The incidence of PJK was 4.3% and was more common in all-pedicle screw constructs. Using hooks at UIV might be a treatment strategy to limit PJK.

Keywords: adolescent idiopathic scoliosis; hook; hybrid; instrumentation type; pedicle screw; proximal junctional kyphosis

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