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Can placement of hook at the upper instrumented level decrease the proximal junctional kyphosis risk in adolescent
Mehmet Erkilinc1,2, Melanie Coathup3, Michael Grant Liska4
1Department of Orthopedics, Johns Hopkins University, Baltimore, MD, USA. mehmet_erkilinc@yahoo.com.
Summary
Transverse process hooks may prevent proximal junctional kyphosis (PJK) after spinal fusion in adolescent idiopathic scoliosis (AIS) patients. This surgical technique showed a lower PJK incidence compared to pedicle screws.
Area of Science:
- Orthopedics
- Spinal Surgery
- Pediatric Surgery
Background:
- Proximal junctional kyphosis (PJK) is a frequent complication following spinal deformity surgery in pediatric and adolescent patients.
- PJK can lead to significant postoperative issues, including worsening deformity, pain, and patient dissatisfaction.
Purpose of the Study:
- To evaluate the efficacy of transverse process hooks in preventing PJK after posterior spinal fusion for adolescent idiopathic scoliosis (AIS).
Main Methods:
- Retrospective analysis of AIS patients undergoing posterior spinal fusion (November 2015 - May 2019) with a minimum 2-year follow-up.
- Patients were stratified based on instrumentation at the upper instrumented vertebra (UIV) level: transverse process hooks versus pedicle screws.
- Radiographic parameters including proximal junctional angle (PJA) were assessed.
Main Results:
- PJK occurred in 8.9% of 337 analyzed patients.
- The incidence of PJK was significantly lower in the hook group (3.2%) compared to the screw group (13.3%).
- Higher preoperative thoracic kyphosis and greater kyphosis correction were associated with PJK development.
Conclusions:
- Transverse process hooks at the UIV level are associated with a reduced risk of PJK in AIS patients undergoing posterior spinal fusion.
- Preoperative kyphosis and the extent of correction are risk factors for PJK.
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