Evaluation of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Following Pedicle Screw, Hook, or Hybrid Instrumentation

• DOI: 10.1097/brs.0b013e3181c77f8c
• Publication Date: 2010-01-11T23:44:35Z
• Authors: Melvin D. Helgeson; Suken A. Shah; Peter O. Newton; David H. Clements; Randal R. Betz; Michelle C. Marks; Tracey Bastrom
• Keywords: Kyphosis; Hook; Idiopathic scoliosis; Spinal Deformity

In Brief Study Design. Retrospective review. Objective. To compare the incidence of and risk factors for proximal junctional kyphosis (PJK) in adolescent idiopathic scoliosis (AIS) following posterior spinal fusion using hook, pedicle screw, or hybrid constructs. Summary Background Data. Proximal is a recently recognized phenomenon adults adolescents after AIS surgery. The postoperative effect on PJK with use hooks, constructs, screws has not been compared multicenter study to date. Methods. From database, preoperative 2-year follow-up radiographic measurements from 283 patients treated hooks (group 1, n = 51), constructs 2, 177), 3, 37), only at top level 4, 18) were compared. Results. average 2 years surgery was 8.2° (range −1 all screw representing significant increase when hook 5.7° (P 0.02) 5.0° 0.014), respectively. Conversely, T5–T12 significantly less 0.016) group group. Of potential interest, but currently statistically significant, trend towards decrease except most cephalad segment, 6.4°. (assuming kyphotic deformity greater than 15°) 0% 2.3% 8.1% 5.6% 4 0.18). Patients had an increased body mass index those who did meet criteria 0.013). Conclusion. Adjacent screws, clinical significance this unclear. A solution substitution upper-instrumented vertebrae, further investigation required. review cases instrumentation,