A SURGICAL ERROR RESULTING IN PROXIMAL JUNCTIONAL KYPHOSIS IN TREATMENT OF ADOLESCENT IDIOPATHIC SCOLIOSIS

Objective: The study aimed to investigate the incidence of painful proximal junctional kyphosis (PJK) after posterior fusion surgery in patients with adolescent idiopathic scoliosis (AIS) and their clinical results. Materials and Methods: A total of 220 patients diagnosed with AIS (180 females and 40 males) were reviewed retrospectively. PJK was defined as the development of kyphosis more than 10 degrees between the upper instrumented end vertebra and the proximal adjacent vertebra. Visual analogue score (VAS) and the Scoliosis Research Society (SRS)-24 questionnaire were used for clinical evaluations. Thoracic kyphosis (TK) and lumbar lordosis (LL) were measured on the sagittal spinal radiograph pre and postoperatively. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed on patients with pain and worst disability scores. Results: The mean age was 15±2.4 years and the mean follow-up period was 24.27±11.69 months. PJK was detected in 20 of the 220 patients. TK changed from 35.5º±13.6º to 25º±7.3º postoperatively (p=0.001) while on observation, LL decreased from 53º±10º to 44.4º±7.8º postoperatively (p=0.001). The average score of the VAS average score was 3.2 (3-8), the mean SRS-24 pain was 2.5 and the self-image score was 4.1 in patients with PJK. In three of the 20 patients with PJK, the pain was severe (VAS=8), SRS-24 pain was on average 5 and the self-image score was three in patients who had disc penetration. CT and MRI evaluations in these three patients manifested severe disc degeneration and disc space collapse caused by pedicle screw penetration through the endplate and disc. Conclusion: Upper disc penetration with pedicle screw at the upper instrumented end vertebra leads to symptomatic disc degeneration and development of PJK. The proper placement and perfect trajectory of the most proximal pedicle screw is crucial and mandator

Kaynakça

1. Kim YJ, Bridwell KH, Lenke LG, Kim J, Cho SK. Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: Minimum 5-year followup. Spine (Phila Pa 1976). 2005;30:2045-50.

2. Kim YJ, Lenke LG, Bridwell KH, Bridwell KH, Kim, Cho SK, et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types ofposterior segmental spinal instrumentation and fusions: Incidence and risk factor analysis of 410 cases. Spine (Phila Pa 1976). 2007;32:2731-8.

3. Hollenbeck SM, Glattes RC, Asher MA, Lai SM, Burton DC. The prevalence of increased proximal junctional flexion following posterior instrumentation and arthrodesis for adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2008;33:1675-81.

4. Wang J, Zhao Y, Shen B, Wang C, Li M. Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis. Injury. 2010;41:415-20.

5. Helgeson MD, Shah SA, Newton PO, Clements DH, Betz RR, Marks MC, et al. Harms Study Group: Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation. Spine (Phila Pa 1976). 2010;35:177-81.

6. Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C II. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: Incidence,outcomes, and risk factor analysis. Spine (Phila Pa 1976). 2005;30:1643-9.

7. Lee GA, Betz RR, Clements DH III, Huss GK. Proximal kyphosis after posterior spinal fusion in patients with idiopathic scoliosis. Spine (Phila Pa 1976). 1999;24:795-9.

8. Cho SK, Kim YJ, Lenke LG. Proximal Junctional Kyphosis Following Spinal Deformity Surgery in the Pediatric Patient. J Am Acad Orthop Surg. 2015;23:408-14.

9. Kim YJ, Bridwell KH, Lenke LG, Glattes CR, Rhim S, Cheh G. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up. Spine (Phila Pa 1976). 2008;33:2179-84.

10. Meter JJ, Polly DW, Miller DW, Popovic NA, Ondra SL. A method for radiographic evaluation of pedicle screw violation of the vertebral Endplate Spine (Phila Pa 1976). 1996;13:1587-92.

11. Melrose J, Shu C, Young C, Ho R, Smith MM, Young AA et al. Mechanical destabilization induced by controlled annular incision of the intervertebral disc dysregulates metalloproteinase expression and induces disc degeneration. Spine (Phila Pa 1976). 2012;37:18-25

Kaynak Göster

  • ISSN: 2147-5903
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1989
  • Yayıncı: Galenos Yayınevi

2.8b 2b

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