In:
Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 6 ( 2020-07), p. 261-266
Kurzfassung:
Proximal junctional kyphosis (PJK) is a major complication after posterior spinal surgery. It is diagnosed radiographically based on a proximal junctional angle (PJA) and clinically when proximal extension is required. We hypothesized that abnormal spinopelvic alignment will increase the risk of PJK in children with early-onset scoliosis (EOS). Methods: A retrospective study of 135 children with EOS from 2 registries, who were treated with distraction-based implants. Etiologies included 54 congenital, 10 neuromuscular, 37 syndromic, 32 idiopathic, and 2 unknown. A total of 89 rib-based and 46 spine-based surgeries were performed at a mean age of 5.3±2.83 years. On sagittal radiographs, spinopelvic parameters were measured preoperatively and at last follow-up: scoliosis angle (Cobb method, CA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope and PJA. Radiographic PJK was defined as PJA≥10 degrees and PJA≥10 degrees greater than preoperative measurement. The requirement for the proximal extension of the upper instrumented vertebrae was considered a proximal junctional failure (PJF). Analysis of risk factors for the development of PJK and PJF was performed. Results: At final follow-up (mean: 4.5±2.6 y), CA decreased ( P 〈 0.005), LL ( P =0.029), and PI ( P 〈 0.005) increased, whereas PI−LL (pelvic incidence minus lumbar lordosis) did not change ( P =0.706). Overall, 38% of children developed radiographic PJK and 18% developed PJF. Preoperative TK 〉 50 degrees was a risk factor for the development of radiographic PJK (relative risk: 1.67, P =0.04). Children with high postoperative CA [hazard ratio (HR): 1.03, P =0.015], postoperative PT≥30 degrees (HR: 2.77, P =0.043), PI−LL 〉 20 degrees (HR: 2.92, P =0.034), as well as greater preoperative to postoperative changes in PT (HR: 1.05, P =0.004), PI (HR: 1.06, P =0.0004) and PI−LL (HR: 1.03, P =0.013) were more likely to develop PJF. Children with rib-based constructs were less likely to develop radiographic PJK compared with children with spine-based distraction constructs (31% vs. 54%, respectively, P =0.038). Conclusions: In EOS patients undergoing growth-friendly surgery for EOS, preoperative TK 〉 50 degrees was associated with increased risk for radiographic PJK. Postoperative PI−LL 〉 20 degrees, PT≥30 degrees, and overcorrection of PT and PI−LL increased risk for PJF. Rib-based distraction construct decreased the risk for radiographic PJK in contrast with the spine-based constructs. Level of Evidence: Level III.
Materialart:
Online-Ressource
ISSN:
0271-6798
DOI:
10.1097/BPO.0000000000001516
Sprache:
Englisch
Verlag:
Ovid Technologies (Wolters Kluwer Health)
Publikationsdatum:
2020
ZDB Id:
604642-3
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