Risk Factors and Three Radiological Predictor Models for the Progression of Proximal Junctional Kyphosis in Adult Degenerative Scoliosis Following Posterior Corrective Surgery: 113 Cases With 2-years Minimum Follow-Up.

ABSTRACT

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To identify risk factors and predictive models for proximal junctional kyphosis (PJK) in a long-term follow-up of patients with adult degenerative scoliosis (ADS) following posterior corrective surgeries. MATERIALS AND METHODS: A consecutive 113 ADS patients undergoing posterior corrective surgery between January 2008 and April 2019 with minimum 2-year follow-up were included. All patients underwent preoperative, postoperative, and final follow-up by X-ray imaging. Multivariate logistic analysis was performed on various risk factors and radiological predictor models. RESULTS: PJK was identified radiographically in 46.9% of patients. Potential risk factors for PJK included postoperative thoracic kyphosis (TK) (P < .05), final follow-up Pelvic Tilt (PT) (P < .05), PT changes at final follow-up (P < .05), age over 55 years old at the surgery (P < .05), theoretical thoracic kyphosis-actual thoracic kyphosis mismatch (TK mismatch) (P < .05) and theoretical lumbar lordosis-acutal lumbar lordosis mismatch (LL mismatch) (P < .05). As for the predictive models, PJK was predictive by the following indicators preoperative global sagittal alignment ≥45° (Model 1), postoperative pelvic incidence-lumbar lordosis mismatch (PI-LL)≤10° and postoperative PI-LL overcorrection (Model 2), and TK+LL≥0° (Model 3) (P < .05). Postoperative TK mismatch (OR = 1.064) was independent as risk factors for PJK, with the cut-off values respectively set at -28.56° to predict occurrence of PJK. CONCLUSION: The risk of radiographic PJK increases with an age over 55 years old and higher postoperative TK. In addition, postoperative TK mismatch is an independent risk factor for developing PJK. All three predictive models could effectively indicate the occurrence of PJK.