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Sagittal balance is more than just alignment: why PJK remains an unresolved problem

BACKGROUND: The durability of adult spinal deformity surgery remains problematic. Revision rates above 20 % have been reported, with a range of causes including wound infection, nonunion and adjacent level pathology. While some of these complications have been amenable to changes in patient selectio...

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Autores principales: Glassman, Steven D., Coseo, Mark P., Carreon, Leah Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888517/
https://www.ncbi.nlm.nih.gov/pubmed/27252982
http://dx.doi.org/10.1186/s13013-016-0064-0
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author Glassman, Steven D.
Coseo, Mark P.
Carreon, Leah Y.
author_facet Glassman, Steven D.
Coseo, Mark P.
Carreon, Leah Y.
author_sort Glassman, Steven D.
collection PubMed
description BACKGROUND: The durability of adult spinal deformity surgery remains problematic. Revision rates above 20 % have been reported, with a range of causes including wound infection, nonunion and adjacent level pathology. While some of these complications have been amenable to changes in patient selection or surgical technique, Proximal Junctional Kyphosis (PJK) remains an unresolved challenge. This study examines the contributions of non-mechanical factors to the incidence of postoperative sagittal imbalance and PJK after adult deformity surgery. METHODS: We reviewed a consecutive series of adult spinal deformity patients who required revision for PJK from 2013 to 2015 and examined in their medical records in detail. RESULTS: Neurologic disorders were identified in 22 (76 %) of the 29 PJK cases reviewed in this series. Neurologic disorders included Parkinson’s disease (1), prior stroke (5), metabolic encephalopathy (2), seizure disorder (1), cervical myelopathy (7), thoracic myelopathy (1), diabetic neuropathy (5) and other neuropathy (4). Other potential comorbidities affecting standing balance included untreated cataracts (9), glaucoma (1) and polymyositis (1). Eight patients were documented to have frequent falls, with twelve cases having a fall right before symptoms related to the PJK were noted. CONCLUSION: PJK is an important contributing factor to the substantial and unsustainable rate of revision surgery following adult deformity correction. Multiple efforts to avoid PJK via alterations in surgical technique have been largely unsuccessful. This study suggests that non-mechanical neuromuscular co-morbidities play an important role in post-operative sagittal imbalance and PJK. Recognizing the multi-factorial etiology of PJK may lead to more successful strategies to avoid PJK and improve surgical outcomes.
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spelling pubmed-48885172016-06-01 Sagittal balance is more than just alignment: why PJK remains an unresolved problem Glassman, Steven D. Coseo, Mark P. Carreon, Leah Y. Scoliosis Spinal Disord Research BACKGROUND: The durability of adult spinal deformity surgery remains problematic. Revision rates above 20 % have been reported, with a range of causes including wound infection, nonunion and adjacent level pathology. While some of these complications have been amenable to changes in patient selection or surgical technique, Proximal Junctional Kyphosis (PJK) remains an unresolved challenge. This study examines the contributions of non-mechanical factors to the incidence of postoperative sagittal imbalance and PJK after adult deformity surgery. METHODS: We reviewed a consecutive series of adult spinal deformity patients who required revision for PJK from 2013 to 2015 and examined in their medical records in detail. RESULTS: Neurologic disorders were identified in 22 (76 %) of the 29 PJK cases reviewed in this series. Neurologic disorders included Parkinson’s disease (1), prior stroke (5), metabolic encephalopathy (2), seizure disorder (1), cervical myelopathy (7), thoracic myelopathy (1), diabetic neuropathy (5) and other neuropathy (4). Other potential comorbidities affecting standing balance included untreated cataracts (9), glaucoma (1) and polymyositis (1). Eight patients were documented to have frequent falls, with twelve cases having a fall right before symptoms related to the PJK were noted. CONCLUSION: PJK is an important contributing factor to the substantial and unsustainable rate of revision surgery following adult deformity correction. Multiple efforts to avoid PJK via alterations in surgical technique have been largely unsuccessful. This study suggests that non-mechanical neuromuscular co-morbidities play an important role in post-operative sagittal imbalance and PJK. Recognizing the multi-factorial etiology of PJK may lead to more successful strategies to avoid PJK and improve surgical outcomes. BioMed Central 2016-01-22 /pmc/articles/PMC4888517/ /pubmed/27252982 http://dx.doi.org/10.1186/s13013-016-0064-0 Text en © Glassman et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Glassman, Steven D.
Coseo, Mark P.
Carreon, Leah Y.
Sagittal balance is more than just alignment: why PJK remains an unresolved problem
title Sagittal balance is more than just alignment: why PJK remains an unresolved problem
title_full Sagittal balance is more than just alignment: why PJK remains an unresolved problem
title_fullStr Sagittal balance is more than just alignment: why PJK remains an unresolved problem
title_full_unstemmed Sagittal balance is more than just alignment: why PJK remains an unresolved problem
title_short Sagittal balance is more than just alignment: why PJK remains an unresolved problem
title_sort sagittal balance is more than just alignment: why pjk remains an unresolved problem
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888517/
https://www.ncbi.nlm.nih.gov/pubmed/27252982
http://dx.doi.org/10.1186/s13013-016-0064-0
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