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Updated: Dec 6, 2025
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Published on: September 16, 2022
Surgical Design Optimization of Proximal Junctional Kyphosis
Li Peng1, Guangming Zhang1, Heng Zuo1,2
1West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, China.
Purpose:
The objective of this study was to construct a procedural planning tool to optimize the proximal junction angle (PJA) to prevent postoperative proximal junctional kyphosis (PJK) for each scoliosis patient.
Methods:
Twelve patients (9 patients without PJK and 3 patients with PJK) who have been followed up for at least 2 years after surgery were included. After calculating the loading force on the cephalad intervertebral disc of upper instrumented vertebra of each patient, the finite-element method (FEM) was performed to calculate the stress of each element. The stress information was summarized into the difference value before and after operation in different regions of interest. A two-layer fully connected neural network method was applied to model the relationship between the stress information and the risk of PJK. Leave-one-out cross-validation and sensitivity analysis were implemented to assess the accuracy and stability of the trained model. The optimal PJA was predicted based on the learned model by optimization algorithm.
Results:
The mean prediction accuracy was 83.3% for all these cases, and the area under the curve (AUC) of prediction was 0.889. And the output variance of this model was less than 5% when the important factor values were perturbed in a range of 5%.
Conclusion:
Our approach integrated biomechanics and machine learning to support the surgical decision. For a new individual, the risk of PJK and optimal PJA can be simultaneously predicted based on the learned model.
