Online citations, reference lists, and bibliographies.
← Back to Search

Proximal Junctional Kyphosis And Proximal Junctional Failure Following Adult Spinal Deformity Surgery

Seung-Jae Hyun, Byoung Hun Lee, Jonghwa Park, K. Kim, tae-ahn Jahng, H. Kim
Published 2017 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy
Share
The purpose of this review is the current understanding of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following adult spinal deformity (ASD) surgery. We carried out a systematic search of PubMed for literatures published up to September 2017 with “proximal junctional kyphosis,” “proximal junctional failure,” and “adult spinal deformity” as search terms. A total of 98 literatures were searched. The 37 articles were included in this review. PJK is multifactorial in origin and likely results from variable risk factors. PJF is a progressive form of the PJK spectrum including bony fracture, subluxation between UIV and UIV+1, failure of fixation, neurological deficit, which may require revision surgery for proximal extension of fusion. Soft tissue protections, adequate selection of the UIV, prophylactic rib fixation, hybrid instrumentation such as hooks, vertebral cement augmentation at UIV and UIV+1, adequate selection material of rods and age-appropriate spinopelvic alignment goals are strategies to minimize PJK and PJF. The ability to perform aggressive global realignment of spinal deformities has also led to the discovery of new complications such as the PJK and PJF. Continuous research on PJK and PJF should be proceeded in order to comprehend the pathophysiology of these complications.
This paper references
10.1097/BRS.0000000000000246
Patients With Proximal Junctional Kyphosis Requiring Revision Surgery Have Higher Postoperative Lumbar Lordosis and Larger Sagittal Balance Corrections
H. Kim (2014)
10.1227/NEU.0000000000001240
Different Risk Factors of Proximal Junctional Kyphosis and Proximal Junctional Failure Following Long Instrumented Fusion to the Sacrum for Adult Spinal Deformity: Survivorship Analysis of 160 Patients
S. Park (2017)
10.1016/j.wneu.2017.04.031
Comparative Study Between Cobalt Chrome and Titanium Alloy Rods for Multilevel Spinal Fusion: Proximal Junctional Kyphosis More Frequently Occurred in Patients Having Cobalt Chrome Rods.
Sanghyun Han (2017)
10.1097/BRS.0b013e31828826dd
Comparison of Teriparatide and Bisphosphonate Treatment to Reduce Pedicle Screw Loosening After Lumbar Spinal Fusion Surgery in Postmenopausal Women With Osteoporosis From a Bone Quality Perspective
S. Ohtori (2013)
10.1016/j.jspd.2013.01.005
Preliminary Results of the Effect of Prophylactic Vertebroplasty on the Incidence of Proximal Junctional Complications After Posterior Spinal Fusion to the Low Thoracic Spine.
C. Martin (2013)
10.1097/BRS.0b013e3182815b42
Proximal Junctional Kyphosis Results in Inferior SRS Pain Subscores in Adult Deformity Patients
H. Kim (2013)
10.1097/BRS.0b013e3181c77f8c
Evaluation of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Following Pedicle Screw, Hook, or Hybrid Instrumentation
Melvin D. Helgeson (2010)
10.1016/j.injury.2010.01.001
Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis.
Jing-Jie Wang (2010)
10.1227/NEU.0b013e31828bacd8
Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle.
K. Bridwell (2013)
10.1097/01.brs.0000179084.45839.ad
Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Following Segmental Posterior Spinal Instrumentation and Fusion: Minimum 5-Year Follow-up
Y. Kim (2005)
10.1016/j.spinee.2016.05.008
Patients with proximal junctional kyphosis after stopping at thoracolumbar junction have lower muscularity, fatty degeneration at the thoracolumbar area.
Seung-Jae Hyun (2016)
10.1097/BRS.0b013e3181a13c08
Sagittal Plane Considerations and the Pelvis in the Adult Patient
F. Schwab (2009)
10.1097/BRS.0000000000001043
Prevention of Acute Proximal Junctional Fractures After Long Thoracolumbar Posterior Fusions for Adult Spinal Deformity Using 2-level Cement Augmentation at the Upper Instrumented Vertebra and the Vertebra 1 Level Proximal to the Upper Instrumented Vertebra
A. Theologis (2015)
10.1097/00007632-199904150-00011
Proximal kyphosis after posterior spinal fusion in patients with idiopathic scoliosis.
G. A. Lee (1999)
10.5435/JAAOS-D-14-00393
Proximal Junctional Kyphosis
H. Kim (2016)
10.1097/BRS.0b013e318271319c
Incidence, Mode, and Location of Acute Proximal Junctional Failures After Surgical Treatment of Adult Spinal Deformity
Richard A. Hostin (2013)
10.1016/j.nec.2013.01.001
Proximal junctional kyphosis and proximal junctional failure.
R. Hart (2013)
10.1097/BRS.0b013e31826ca2a8
Teriparatide Accelerates Lumbar Posterolateral Fusion in Women With Postmenopausal Osteoporosis: Prospective Study
S. Ohtori (2012)
10.1007/s11999-011-2179-1
Combined Anterior-Posterior Surgery is the Most Important Risk Factor for Developing Proximal Junctional Kyphosis in Idiopathic Scoliosis
H. Kim (2012)
10.1055/s-0034-1386755
Predictive Factors for Acute Proximal Junctional Failure after Adult Deformity Surgery with Upper Instrumented Vertebrae in the Thoracolumbar Spine*
P. Annis (2014)
10.1016/j.spinee.2013.06.039
Use of vertebroplasty to prevent proximal junctional fractures in adult deformity surgery: a biomechanical cadaveric study.
Khaled M. Kebaish (2013)
10.1097/BRS.0b013e3181b2e17e
Risk Factors and Outcomes for Catastrophic Failures at the Top of Long Pedicle Screw Constructs: A Matched Cohort Analysis Performed at a Single Center
Patrick T. O'leary (2009)
10.3171/2014.3.FOCUS13541
Long fusion from sacrum to thoracic spine for adult spinal deformity with sagittal imbalance: upper versus lower thoracic spine as site of upper instrumented vertebra.
T. Fujimori (2014)
10.1097/BRS.0b013e31815a7ead
Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis After 3 Different Types of Posterior Segmental Spinal Instrumentation and Fusions: Incidence and Risk Factor Analysis of 410 Cases
Y. Kim (2007)
10.1097/BRS.0b013e31829fedde
Identification of Decision Criteria for Revision Surgery Among Patients With Proximal Junctional Failure After Surgical Treatment of Spinal Deformity
R. Hart (2013)
10.1097/BRS.0b013e31817c0428
Proximal Junctional Kyphosis in Adult Spinal Deformity After Segmental Posterior Spinal Instrumentation and Fusion: Minimum Five-Year Follow-up
Y. Kim (2008)
10.1016/j.spinee.2017.02.005
Rod stiffness as a risk factor of proximal junctional kyphosis after adult spinal deformity surgery: comparative study between cobalt chrome multiple-rod constructs and titanium alloy two-rod constructs.
Sanghyun Han (2017)
10.1097/BRS.0000000000002355
Low Bone-Mineral Density Is a Significant Risk for Proximal Junctional Failure After Surgical Correction of Adult Spinal Deformity: A Propensity Score-Matched Analysis
M. Yagi (2018)
10.3109/02688697.2013.835369
Analysis of the incidence and risk factors for the progression of proximal junctional kyphosis following surgical treatment for lumbar degenerative kyphosis: minimum 2-year follow-up
J. Lee (2014)
10.1016/j.spinee.2008.01.015
Proximal junctional acute collapse cranial to multi-level lumbar fusion: a cost analysis of prophylactic vertebral augmentation.
R. Hart (2008)
10.1097/BRS.0b013e3182376414
Does a Long-Fusion “T3-Sacrum” Portend a Worse Outcome Than a Short-Fusion “T10-Sacrum” in Primary Surgery for Adult Scoliosis?
B. O'shaughnessy (2012)
10.1016/j.spinee.2015.05.028
Acute proximal junctional failure in patients with preoperative sagittal imbalance.
M. W. Smith (2015)
ximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery : a systematic review
HJ Kim (2012)
10.1016/j.jspd.2013.05.008
Type of Anchor at the Proximal Fusion Level Has a Significant Effect on the Incidence of Proximal Junctional Kyphosis and Outcome in Adults After Long Posterior Spinal Fusion.
H. Hassanzadeh (2013)
10.1007/s12178-016-9353-8
Proximal junctional kyphosis and failure—diagnosis, prevention, and treatment
Ngoc-Lam M. Nguyen (2016)
10.1097/BRS.0b013e3181eeaee2
Incidence, Risk Factors and Classification of Proximal Junctional Kyphosis: Surgical Outcomes Review of Adult Idiopathic Scoliosis
M. Yagi (2011)
10.1097/01.brs.0000169451.76359.49
Proximal Junctional Kyphosis in Adult Spinal Deformity Following Long Instrumented Posterior Spinal Fusion: Incidence, Outcomes, and Risk Factor Analysis
R. Glattes (2005)
10.3340/jkns.2010.47.2.95
Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients : a long-term follow-up data.
Seung-Jae Hyun (2010)
10.1007/s00586-014-3531-4
Proximal junctional kyphosis following adult spinal deformity surgery
S. Cho (2014)
10.1097/BRS.0b013e3181ae2ab2
Incidence and Risk Factors for Proximal and Distal Junctional Kyphosis Following Surgical Treatment for Scheuermann Kyphosis: Minimum Five-Year Follow-up
F. Denis (2009)
dictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity
K Maruo (2013)
Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis
M Yagi (1976)
10.1097/BRS.0000000000001171
Defining Spino-Pelvic Alignment Thresholds: Should Operative Goals in Adult Spinal Deformity Surgery Account for Age?
R. Lafage (2016)
10.1097/BRS.0000000000000627
Proximal Junctional Kyphosis and Failure After Spinal Deformity Surgery: A Systematic Review of the Literature as a Background to Classification Development
D. Lau (2014)
10.1097/BRS.0b013e31826d611b
Proximal Junctional Kyphosis as a Distinct Form of Adjacent Segment Pathology After Spinal Deformity Surgery: A Systematic Review
H. Kim (2012)
10.1097/BRS.0b013e31819d0c86
Role of Pelvic Incidence, Thoracic Kyphosis, and Patient Factors on Sagittal Plane Correction Following Pedicle Subtraction Osteotomy
P. Rose (2009)
Proximal junctional kyphosis in adult reconstructive spine surgery results from incomplete restoration of the lumbar lordosis relative to the magnitude of the thoracic kyphosis.
Sergio A Mendoza-Lattes (2011)
10.1097/BRS.0b013e3181c8f35d
Proximal Junctional Vertebral Fracture in Adults After Spinal Deformity Surgery Using Pedicle Screw Constructs: Analysis of Morphological Features
K. Watanabe (2010)
10.1097/BRS.0000000000000266
Characterization and Surgical Outcomes of Proximal Junctional Failure in Surgically Treated Patients With Adult Spinal Deformity
M. Yagi (2014)
10.1097/BRS.0b013e31815a7ece
Thoracolumbar Deformity Arthrodesis Stopping at L5: Fate of the L5-S1 Disc, Minimum 5-Year Follow-up
C. Kuhns (2007)
O: Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up
M Yagi (1976)
Kebaish KM: Type of anchor at the proximal fusion level has a significant effect on the incidence of proximal junctional kyphosis and outcome in adults after long posterior spinal fusion
H Hassanzadeh (2013)
10.1055/s-0033-1357366
Early Proximal Junctional Failure in Patients with Preoperative Sagittal Imbalance
M. W. Smith (2013)
10.3171/2013.5.SPINE12737
Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae.
Y. Ha (2013)
10.1097/BRS.0000000000000222
Biomechanical Risk Factors for Proximal Junctional Kyphosis: A Detailed Numerical Analysis of Surgical Instrumentation Variables
M. Cammarata (2014)
10.1097/BRS.0b013e3182a51d43
Predictive Factors for Proximal Junctional Kyphosis in Long Fusions to the Sacrum in Adult Spinal Deformity
K. Maruo (2013)
10.1007/s00586-014-3391-y
Maintenance of radiographic correction at 2 years following lumbar pedicle subtraction osteotomy is superior with upper thoracic compared with thoracolumbar junction upper instrumented vertebra
J. Scheer (2014)
10.1097/BRS.0b013e31824e4888
Incidence, Risk Factors, and Natural Course of Proximal Junctional Kyphosis: Surgical Outcomes Review of Adult Idiopathic Scoliosis. Minimum 5 Years of Follow-up
M. Yagi (2012)



This paper is referenced by
10.3340/jkns.2018.0150
Spinal Deformity Surgery : It Becomes an Essential Part of Neurosurgery
Seung-Jae Hyun (2018)
10.1016/j.wneu.2020.04.024
Assessment of Patient Outcomes and Proximal Junctional Failure Rate of Adult Spinal Deformity Patients Undergoing Caudal Extension of Previous Spinal Fusion.
A. Daniels (2020)
10.31616/asj.2019.0060
Changes in Thoracic Kyphosis and Thoracolumbar Kyphosis in Asymptomatic Korean Male Subjects Aged >50 Years: Do They Progress Above T5, T10, T12, or L2?
Jaehong Park (2019)
10.1007/s00586-019-05955-w
Predictive formula of ideal lumbar lordosis and lower lumbar lordosis determined by individual pelvic incidence in asymptomatic elderly population
Seung-Jae Hyun (2019)
10.3340/jkns.2019.0218
Surgical Outcomes and Complications Following All Posterior Approach for Spinal Deformity Associated with Neurofibromatosis Type-1
B. Park (2020)
10.18019/1028-4427-2018-24-3-393-403
The use of LLIF technology in adult patients with degenerative scoliosis: retrospective cohort analysis and literature review
V. Klimov (2018)
10.1590/s1808-185120201904230798
LLIF IN THE CORRECTION OF DEGENERATIVE SCOLIOSIS IN ELDERLY PATIENTS
Vladimir Sergeevich Klimov (2020)
10.1016/j.wneu.2018.12.113
Effect of Vertebroplasty at the Upper Instrumented Vertebra and Upper Instrumented Vertebra +1 for Prevention of Proximal Junctional Failure in Adult Spinal Deformity Surgery: A Comparative Matched-Cohort Study.
Sanghyun Han (2019)
10.3340/jkns.2018.0177
Surgical Outcomes According to Dekyphosis in Patients with Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine
S. Kim (2019)
10.14245/ns.1938100.050
Bicortical Screw Purchase at Upper Instrumented Vertebra (UIV) Can Cause UIV Fracture After Adult Spinal Deformity Surgery: A Finite Element Analysis Study
Seong-Hyun Wui (2019)
10.1007/978-3-030-50722-0_20
Complex Reconstruction in Tumor Patients
A. Vaccaro (2020)
10.3171/2019.3.SPINE1966
Surgical correction of severe adult lumbar scoliosis (major curves ≥ 75°): retrospective analysis with minimum 2-year follow-up.
Thomas J. Buell (2019)
10.3928/01477447-20170606-02
Adult Degenerative Lumbar Scoliosis.
E. Wong (2017)
10.14245/ns.2040464.232
Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders
Jong Eun Lee (2020)
10.3340/jkns.2018.0125
Total Deformity Angular Ratio as a Risk Factor for Complications after Posterior Vertebral Column Resection Surgery
B. Lee (2018)
10.3171/2019.10.SPINE19831
Surgery-related predictable risk factors influencing postoperative clinical outcomes for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: a multicenter retrospective study.
H. Saiwai (2019)
10.3340/jkns.2017.0404.013
Restoration of Sagittal Balance in Spinal Deformity Surgery
Melvin C. Makhni (2018)
10.1093/ons/opz128
Incidence of Acute, Progressive, and Delayed Proximal Junctional Kyphosis Over an 8-Year Period in Adult Spinal Deformity Patients.
Frank A. Segreto (2019)
10.1007/s00381-019-04217-w
Kyphectomy and interbody fixation using lag screws in a child with myelomeningocele kyphosis: a technical case report
Seong-Hyun Wui (2019)
10.1007/978-3-030-50722-0
Surgical Spinal Oncology: Contemporary Multidisciplinary Strategies
K. Singh (2020)
10.1016/j.wneu.2018.02.088
Relationship Between Cervical Sagittal Alignment and Patient Outcomes After Anterior Cervical Fusion Surgery Involving 3 or More Levels.
Se-Il Jeon (2018)
10.1186/s13018-019-1170-5
Comparison of loss of correction between PSO and VCD technique in treating thoracolumbar kyphosis secondary to ankylosing spondylitis, a minimum 2 years follow-up
Yao Wang (2019)
10.3171/2019.9.SPINE19913
Rod fracture after multiple-rod constructs for adult spinal deformity.
Jong-myung Jung (2019)
10.3171/2020.5.FOCUS20192
The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional kyphosis in adult spinal deformity surgery with a minimum 2-year follow-up.
P. Duan (2020)
10.1016/j.wneu.2020.03.071
Association of frailty and self-care activity with sagittal spinopelvic alignment in the elderly.
T. Kim (2020)
10.3171/2020.7.SPINE20920
Correlation of vertebral trabecular attenuation in Hounsfield units and the upper instrumented vertebra with proximal junctional failure after surgical treatment of degenerative lumbar disease.
Q. Wang (2020)
10.1016/j.wneu.2019.05.198
Anatomical trajectory screw fixation at upper instrumented vertebra is a substantial risk factor for proximal junctional kyphosis.
Jong-myung Jung (2019)
10.3340/jkns.2018.0170
Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data
Ho Yong Choi (2019)
10.3340/jkns.2017.0287
Clinical Efficacy of Intra-Operative Cell Salvage System in Major Spinal Deformity Surgery
Ho Yong Choi (2019)
10.1016/j.inat.2020.100957
Revision surgery of postoperative kyphotic deformity : A case report and review of the literature
Ozak Ahmet (2021)
10.1016/j.semss.2020.100831
Management of Adult Spine Deformity in the Elderly
R. Sachdev (2020)
Semantic Scholar Logo Some data provided by SemanticScholar