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Updated: Mar 22, 2026
Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
Published on: September 16, 2022
Results of Revision Surgery for Proximal Junctional Kyphosis Following Posterior Segmental Instrumentation: Minimum
Yong-Chan Kim1, Lawrence G Lenke2, Keith H Bridwell3
1Department of Orthopaedic Surgery, Spine Center, Hallym University Sacred Heart Hospital, Hallym University, School of Medicine, Anyangsi, South Korea.
Study Design:
A retrospective cohort study.
Objectives:
The aim of this study was to evaluate radiographic and patient-reported outcomes at minimum 2 years after revision surgery for proximal junctional kyphosis (PJK), correlating these results with PJK etiology.
Summary Of Background Data:
There are no studies detailing the results of revision surgery for PJK following posterior segmental instrumentation.
Methods:
Thirty-two consecutive patients treated with revision surgery after PJK above posterior fusions (25 women/7 men, average age at surgery 60.6 yrs) were reviewed for radiographic and patient-reported outcomes (mean follow-up, 4.5 yrs; range, 2-10 yrs). Patients were subdivided into fracture (F) and nonfracture (NF) groups on the basis of PJK etiology.
Results:
Radiographic severity of PJK improved significantly with revision surgery and was maintained at ultimate follow-up (P < 0.001). However, initial sagittal vertical axis (SVA) correction was not maintained through ultimate follow-up (P = 0.04). There were significant postrevision improvements in mean Oswestry scores (P < 0.001) and SRS total scores (P < 0.001) in all patients. In patients with pelvic incidence-lumbar lordosis (PI-LL) mismatch < 11°, final PJK measurement was smaller than in patients with mismatch ≥11° (9.4° vs. 19.8°, P = 0.009). Six patients (19%) developed new postrevision PJK, with two (6%) requiring additional surgery. Patients who sustained PJK through a fracture had greater improvements in Oswestry (P = 0.004), total SRS (P = 0.04), pain (P < 0.001), and satisfaction (P = 0.05) scores, although the fracture patients had less maintained SVA correction (P = 0.002).
Conclusion:
Revision surgery for PJK following posterior instrumentation achieved acceptable radiographic and clinical outcomes at minimum 2-year follow-up. Patients with PI-LL mismatch <11° experienced more ultimate PJK correction than patients with mismatch ≥11°. Although the NF group experienced more sustained correction of sagittal balance, the F group reported greater improvements in patient-reported outcomes. Ultimate clinical outcomes after revision surgery for PJK were similar between patients with and without compression fractures.
Level Of Evidence:
3.
