Under-contouring of rods: a potential risk factor for proximal junctional kyphosis after posterior correction of Scheuermann kyphosis

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  • 1 Department of Neurosurgery, Dijon University Hospital, Dijon, France; and
  • 2 Department of Spine Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, People’s Republic of China
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OBJECTIVE

Scheuermann kyphosis (SK) could require surgical treatment in certain situations. A posterior reduction is the most widespread treatment so far, although the development of proximal junctional kyphosis (PJK) is one of the possible complications of this procedure. The contour of the proximal part of the rod could influence the occurrence of PJK in SK patients. The objective of this study was to analyze the impact of the proximal rod contour on the occurrence of a PJK complication in SK patients.

METHODS

This retrospective monocentric study was performed in the Nanjing Spine Surgery Department. All eligible patients had undergone posterior correction surgery with pedicle screws only between 2002 and 2017 and had at least 24 months of follow-up. The presence of PJK was quantified on radiographs using the proximal junctional angle (PJA > 10° at the last follow-up). The authors propose a new radiological parameter to measure the angulation of the proximal part of the instrumentation: the proximal contouring rod angle (PCRA) is the angle between the upper endplate of the upper instrumented vertebra (UIV) and the lower endplate of the second vertebra caudal to the UIV. The patients were analyzed according to the presence or absence of PJK. A t-test, receiver operating characteristic (ROC) curve analysis, and logistic regression analysis were performed for statistical analysis.

RESULTS

Sixty-two patients treated for SK were included in this study. The mean age was 18.6 ± 8.5 years, and the mean follow-up was 42.5 ± 16.4 months. The mean correction rate of global kyphosis was 46.4% ± 13.7%. At the last follow-up, 17 patients (27.4%) presented with PJK. No significant difference was found between the PJK and non-PJK groups in terms of age and other preoperative variables. A significant difference in the postoperative PCRA was found between the PJK and non-PJK groups (8.2° ± 4.9° vs 15.7° ± 6.6°, respectively; p = 0.001). A postoperative PCRA less than 10.1° predicted a significantly higher risk for PJK (p = 0.002, OR 2.431, 95% CI 1.781–4.133).

CONCLUSIONS

Under-contouring of the proximal part of the rods (lower than 10°) is a risk factor for PJK after posterior correction of SK.

ABBREVIATIONS GK = global kyphosis; LL = lumbar lordosis; ODI = Oswestry Disability Index; PCRA = proximal contouring rod angle; PI = pelvic incidence; PI-LL = PI minus LL; PJA = proximal junctional angle; PJK = proximal junctional kyphosis; PT = pelvic tilt; ROC = receiver operating characteristic; SK = Scheuermann kyphosis; SRS-22 = 22-Item Scoliosis Research Society Patient Questionnaire; SS = sacral slope; SVA = sagittal vertical axis; TK = thoracic kyphosis; TPA = T1 pelvic angle; UIV = upper instrumented vertebra.

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Contributor Notes

Correspondence Yong Qiu: Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, People’s Republic of China. scoliosis2002@sina.com.

INCLUDE WHEN CITING Published online August 7, 2020; DOI: 10.3171/2020.5.SPINE20229.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Makurthou AA, Oei L, El Saddy S, Scheuermann disease: evaluation of radiological criteria and population prevalence. Spine (Phila Pa 1976). 2013;38(19):16901694.

    • Search Google Scholar
    • Export Citation
  • 2

    Scheuermann H. Kyphosis dorsalis juvenilis. Orthop Chir. 1921;41:305317.

  • 3

    Geck MJ, Macagno A, Ponte A, Shufflebarger HL. The Ponte procedure: posterior only treatment of Scheuermann’s kyphosis using segmental posterior shortening and pedicle screw instrumentation. J Spinal Disord Tech. 2007;20(8):586593.

    • Search Google Scholar
    • Export Citation
  • 4

    Lee SS, Lenke LG, Kuklo TR, Comparison of Scheuermann kyphosis correction by posterior-only thoracic pedicle screw fixation versus combined anterior/posterior fusion. Spine (Phila Pa 1976). 2006;31(20):23162321.

    • Search Google Scholar
    • Export Citation
  • 5

    Lim M, Green DW, Billinghurst JE, Scheuermann kyphosis: safe and effective surgical treatment using multisegmental instrumentation. Spine (Phila Pa 1976). 2004;29(16):17891794.

    • Search Google Scholar
    • Export Citation
  • 6

    Lonner BS, Parent S, Shah SA, Reciprocal changes in sagittal alignment with operative treatment of adolescent Scheuermann kyphosis-prospective evaluation of 96 patients. Spine Deform. 2018;6(2):177184.

    • Search Google Scholar
    • Export Citation
  • 7

    Graat HCA, Schimmel JJP, Hoogendoorn RJW, Poor radiological and good functional long-term outcome of surgically treated Scheuermann patients. Spine (Phila Pa 1976). 2016;41(14):E869E878.

    • Search Google Scholar
    • Export Citation
  • 8

    Arlet V, Aebi M. Junctional spinal disorders in operated adult spinal deformities: present understanding and future perspectives. Eur Spine J. 2013;22(2)(suppl 2):S276S295.

    • Search Google Scholar
    • Export Citation
  • 9

    Denis F, Sun EC, Winter RB. Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spine (Phila Pa 1976). 2009;34(20):E729E734.

    • Search Google Scholar
    • Export Citation
  • 10

    Nasto LA, Perez-Romera AB, Shalabi ST, Correlation between preoperative spinopelvic alignment and risk of proximal junctional kyphosis after posterior-only surgical correction of Scheuermann kyphosis. Spine J. 2016;16(4)(suppl):S26S33.

    • Search Google Scholar
    • Export Citation
  • 11

    Yan P, Bao H, Qiu Y, Mismatch between proximal rod contouring and proximal junctional angle: a predisposed risk factor for proximal junctional kyphosis in degenerative scoliosis. Spine (Phila Pa 1976). 2017;42(5):E280E287.

    • Search Google Scholar
    • Export Citation
  • 12

    Lonner BS, Ren Y, Newton PO, Risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis—the pelvis and other considerations. Spine Deform. 2017;5(3):181188.

    • Search Google Scholar
    • Export Citation
  • 13

    Zhu Z-Z, Chen X, Qiu Y, Adding satellite rods to standard two-rod construct with the use of duet screws: an effective technique to improve surgical outcomes and preventing proximal junctional kyphosis in posterior-only correction of Scheuermann kyphosis. Spine (Phila Pa 1976). 2018;43(13):E758E765.

    • Search Google Scholar
    • Export Citation
  • 14

    Dikici F, Akgul T, Sariyilmaz K, Selection of distal fusion level in terms of distal junctional kyphosis in Scheuermann kyphosis. A comparison of 3 methods. Acta Orthop Traumatol Turc. 2018;52(1):711.

    • Search Google Scholar
    • Export Citation
  • 15

    Mikhaylovskiy MV, Sorokin AN, Novikov VV, Vasyura AS. Selection of the optimal level of distal fixation for correction of Scheuermann’s hyperkyphosis. Folia Med (Plovdiv). 2015;57(1):2936.

    • Search Google Scholar
    • Export Citation
  • 16

    Glattes RC, Bridwell KH, Lenke LG, Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976). 2005;30(14):16431649.

    • Search Google Scholar
    • Export Citation
  • 17

    Koller H, Lenke LG, Meier O, Comparison of anteroposterior to posterior-only correction of Scheuermann’s kyphosis: a matched-pair radiographic analysis of 92 patients. Spine Deform. 2015;3(2):192198.

    • Search Google Scholar
    • Export Citation
  • 18

    Riouallon G, Morin C, Charles Y-P, Posterior-only versus combined anterior/posterior fusion in Scheuermann disease: a large retrospective study. Eur Spine J. 2018;27(9):23222330.

    • Search Google Scholar
    • Export Citation
  • 19

    Ashraf A, Noelle Larson A, Polly DW, Change in sagittal plane alignment following surgery for Scheuermann’s kyphosis. Spine Deform. 2014;2(5):404409.

    • Search Google Scholar
    • Export Citation
  • 20

    Koller H, Juliane Z, Umstaetter M, Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases. Eur Spine J. 2014;23(1):180191.

    • Search Google Scholar
    • Export Citation
  • 21

    Cobden A, Albayrak A, Camurcu Y, Posterior-only approach with pedicle screws for the correction of Scheuermann’s kyphosis. Asian Spine J. 2017;11(4):513519.

    • Search Google Scholar
    • Export Citation
  • 22

    Lafage R, Line BG, Gupta S, Orientation of the upper-most instrumented segment influences proximal junctional disease following adult spinal deformity surgery. Spine (Phila Pa 1976). 2017;42(20):15701577.

    • Search Google Scholar
    • Export Citation
  • 23

    Safaee MM, Osorio JA, Verma K, Proximal junctional kyphosis prevention strategies: a video technique guide. Oper Neurosurg (Hagerstown). 2017;13(5):581585.

    • Search Google Scholar
    • Export Citation

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