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Incidence and risk factors of proximal junctional kyphosis after internal fixation for adult spinal deformity: a systematic evaluation and meta-analysis

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Abstract

To investigate the factors associated with proximal junctional kyphosis (PJK). A systematic search was performed. The weighted mean difference (WMD) was pooled for continuous variables, and the odds ratio (OR) was calculated for dichotomous variables. The PJK group had higher values for age (WMD = 2.53, 95%CI = 1.38 ~ 3.68, P < 0.001), female gender (OR = 1.56, 95%CI = 1.29 ~ 1.87, P < 0.001), and diagnosed osteoporosis (OR = 1.58, 95%CI = 1.11 ~ 2.26, P = 0.01). Preoperatively, significant differences were detected in sagittal vertical axis (SVA) (WMD = 19.29, 95%CI = 16.60 ~ 21.98, P < 0.001), pelvic incidence minus lumbar lordosis (PI-LL) (WMD = 2.71, 95%CI = 0.25 ~ 5.18, P = 0.03), pelvic tilt (PT) (WMD = 2.64, 95%CI = 1.38 ~ 3.90, P < 0.001), lumbar lordosis (LL) (WMD = − 1.76, 95%CI = − 2.73 ~ −0.79, P < 0.001), and sacral slope (SS) (WMD = − 2.80, 95%CI = − 5.57 ~ −0.04, P = 0.001). At follow-up, the following were higher in the PJK group: thoracic kyphosis (TK) (WMD = 5.51, 95%CI = 2.23 ~ 8.80, P < 0.001), proximal junctional angle (PJA) (WMD = 9.07, 95%CI = 4.21 ~ 13.92, P < 0.001), and PT (WMD = 1.51, 95%CI = 0.31 ~ 2.72, P = 0.01). However, there was no significant difference in SS (P = 0.49), and SVA (P = 0.11) between groups. Fusion to S1 or pelvis significantly increased the risk of PJK (OR = 2.08, P < 0.001). Ligament augmentation reduced the risk of PJK (OR = 0.34, 95%CI = 0.21 ~ 0.53, P < 0.001) better than the use of laminar hook (OR = 0.46, P < 0.001). Although no difference was detected for preoperative SRS-22 score (P = 0.056), a lower score (WMD = − 0.24, 95%CI = − 0.35 ~ −0.14, P < 0.001) was detected in PJK group at follow-up. The elderly female ASD patients were more susceptible to PJK, especially for those with osteoporosis, high preoperative SVA, low LL, large PT, and LIV extended to pelvis. The use of laminar hook and ligament reinforcement at the proximal end might prevent PJK.

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  1. Jian Zhao, Kai Chen and Xiao Zhai contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Shanghai Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China

    Jian Zhao, Kai Chen, Xiao Zhai, Kai Chen & Ming Li

  2. Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China

    Yanghu Lu

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Ming Li designed this study. Jian Zhao and Kai Chen performed the systematic literature search. Jian Zhao, Kai Chen, and Xiao Zhai extracted the information from the included studies. Jian Zhao and Kai Chen wrote the manuscript. Jian Zhao and Yanghu Lu revised the manuscript.

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Correspondence to Ming Li or Yanghu Lu.

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Ethical approval was not necessary, for that the data were extracted from the published papers and that no human or animal subjects were involved in the current study.

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The data were extracted from the published papers, and the datasets analyzed during the current study are available from the first author on reasonable request.

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Zhao, J., Chen, K., Zhai, X. et al. Incidence and risk factors of proximal junctional kyphosis after internal fixation for adult spinal deformity: a systematic evaluation and meta-analysis. Neurosurg Rev 44, 855–866 (2021). https://doi.org/10.1007/s10143-020-01309-z

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