Proximal Junctional Kyphosis in Modern Spine Surgery: Why Is it So Common?

Area of Science:

• Spine surgery
• Orthopedics
• Biomechanical engineering

Background:

• Proximal junctional kyphosis (PJK) is an increasingly recognized complication after spinal fusion.
• PJK incidence has risen with advancements in spinal instrumentation and deformity correction techniques.
• It affects both adult and pediatric patients with spinal deformities.

Purpose of the Study:

• To review the mechanical and biological etiologies of PJK.
• To recommend evidence-based strategies for PJK prevention.

Main Methods:

• Literature review of mechanical and biological factors contributing to PJK.
• Analysis of current surgical techniques and instrumentation related to PJK.
• Synthesis of data to formulate prevention guidelines.

Main Results:

• Mechanical factors include implant construct properties, stress risers, and adjacent segment degeneration.
• Biological factors involve bone quality, fusion mass integrity, and patient-specific biomechanics.
• Specific surgical techniques and instrumentation choices significantly influence PJK risk.

Conclusions:

• Understanding the multifactorial causes of PJK is crucial for effective prevention.
• Implementing targeted strategies addressing mechanical and biological factors can reduce PJK incidence.
• Further research is needed to optimize surgical approaches and minimize PJK complications.