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More correction can lead to additional proximal junctional kyphosis
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The causes of proximal junctional kyphosis need to be evaluated to minimize or treat the disorder in patients, according to a speaker at the Congress of Neurological Surgeons Annual Meeting.
Daniel M. Sciubba, MD, said the factors of proximal junctional kyphosis (PJK) are many, and more than one factor can lead to the development of the complication.
“In terms of evaluating drivers of PJK, this is multi-factorial. All of us say, ‘I always do this now because it prevents PJK,’ or ‘I don’t do this,’ but the fact of the matter is, there are multiple things happening at once,” Sciubba said.
PJK is a broadly defined complication, according to Sciubba. In terms of junctional complications, it is defined as a progressive loss of stability or fixation, or a line with or without neural compression. If the complication leads to surgery, it is defined as a proximal junctional failure. However, the terms are still being defined in the literature, he said.
Complicating treatment, Sciubba said it has been observed that the more correction a surgeon makes in the spinal alignment, the more PJK can occur.
“PJK is a real problem. We’re all dealing with it and if you’re not seeing it, you’ll start to notice it as you do more and more of these corrections because … the more we correct, the more PJK we see,” Sciubba said. “You have to think about multiple factors, such as the bone, soft tissue and your overall alignment — not too much or not too little — and obviously always consider local spinal alignment as the key.”
Reference:
Sciubba DM. Proximal junctional kyphosis: Can anything be done? Presented at: Congress of Neurological Surgeons Annual Meeting. Oct. 18-22, 2014; Boston.
Disclosure: Sciubba is the recipient of a research grant from Depuy Spine and has consulting relationships with Medtronic, Nuvasiv, Globus and Depuy.