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Updated: Dec 29, 2025
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Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
Published on: September 16, 2022
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Revision surgery in distal junctional kyphosis
Pedro Berjano1, Marco Damilano2, Matteo Pejrona2
1IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. pberjano@gmail.com.
Summary
Distal junctional kyphosis and failure (DJK/DJF) are complications following spinal surgery. Strategies to prevent DJK/DJF involve careful selection of the distal fixation point and ensuring stable construct alignment.
Area of Science:
- Spine Surgery
- Orthopedics
- Biomechanical Engineering
Background:
- Distal junctional kyphosis and failure (DJK/DJF) are less studied complications compared to proximal issues.
- DJK/DJF can occur in adolescent idiopathic scoliosis, Scheuermann's kyphosis, and adult deformity surgery.
Purpose of the Study:
- To provide an overview of DJK/DJF in various spinal conditions.
- To identify risk factors associated with DJK/DJF.
- To propose a strategy for prevention and treatment of DJK/DJF.
Main Methods:
- A narrative literature review was performed.
- The review focused on identifying evidence regarding risk factors for DJK/DJF.
Main Results:
- In adolescent idiopathic scoliosis and Scheuermann's kyphosis, instrumentation terminating proximal to the sagittal stable vertebra increases DJK/DJF incidence.
- In adult spine deformity surgery, constructs ending with S1 pedicle screws show a higher DJK/DJF rate than those with S1 pedicle plus iliac screws.
Conclusions:
- Prevention and treatment strategies for DJK/DJF are proposed.
- Key elements include restoring sagittal alignment, selecting a stable distal fixation, and ensuring construct integrity.
