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Proximal Junctional Kyphosis after Pediatric Angular Kyphotic Deformity Correction: Are we Missing Something?

Abhinandan Reddy Mallepally1, Rajat Mahajan1, Nandan Marathe1

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Asian Journal of Neurosurgery
|July 2, 2021
PubMed
Summary

Proximal junctional failure (PJF) can occur after corrective surgery for severe pediatric angular kyphotic deformities. Careful selection of the upper instrumented vertebra may help prevent PJF.

Keywords:
Angular kyphosisproximal junctional kyphosisvertebral column resection

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Area of Science:

  • Orthopedics
  • Pediatric Spine Surgery
  • Spinal Deformities

Background:

  • Corrective maneuvers for angular kyphotic deformities carry risks of early and late complications.
  • Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are significant late complications.
  • Understanding PJK mechanisms in pediatric severe angular kyphotic deformities is crucial for prevention.

Purpose of the Study:

  • To discuss probable mechanisms leading to PJK in pediatric severe angular kyphotic deformities.
  • To explore preventive strategies for PJK.
  • To assess the natural course and consequences of untreated PJK.

Main Methods:

  • Study involved three pediatric patients with severe thoracolumbar kyphotic deformities.
  • Posterior vertebral column resection and segmental deformity correction were performed.
  • Follow-up included monitoring for complications like PJF and assessing natural history in one case.

Main Results:

  • PJF occurred in two male patients post-initial surgery.
  • Revision surgery with extended instrumentation was performed in these two patients.
  • One female patient with angular kyphotic deformity is being monitored without revision surgery.

Conclusions:

  • Selecting the sagittal stable vertebra as the upper instrumented vertebra may be a safer option for severe thoracolumbar angular kyphotic deformities.
  • This selection should be based on the C2 plumb line on preoperative lateral radiographs.
  • Further studies with larger sample sizes are required to validate this hypothesis.