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Proximal Junctional Kyphosis after Pediatric Angular Kyphotic Deformity Correction: Are we Missing Something?

PURPOSE: Corrective maneuvers in an angular kyphotic deformity have its own problems including early complications such as neurological deficit and late complications such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). This article discusses the probable mechanisms, lea...

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Autores principales: Mallepally, Abhinandan Reddy, Mahajan, Rajat, Marathe, Nandan, Nanda, Ankur, Rustagi, Tarush, Chhabra, Harvinder Singh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202394/
https://www.ncbi.nlm.nih.gov/pubmed/34211876
http://dx.doi.org/10.4103/ajns.AJNS_311_20
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author Mallepally, Abhinandan Reddy
Mahajan, Rajat
Marathe, Nandan
Nanda, Ankur
Rustagi, Tarush
Chhabra, Harvinder Singh
author_facet Mallepally, Abhinandan Reddy
Mahajan, Rajat
Marathe, Nandan
Nanda, Ankur
Rustagi, Tarush
Chhabra, Harvinder Singh
author_sort Mallepally, Abhinandan Reddy
collection PubMed
description PURPOSE: Corrective maneuvers in an angular kyphotic deformity have its own problems including early complications such as neurological deficit and late complications such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). This article discusses the probable mechanisms, leading to PJK in pediatric severe angular kyphotic deformities and preventive strategies for the same. We will also assess natural course of untreated PJK and its devastating consequences. MATERIALS AND METHODS: Three patients, two 13-year males presented with progressive, painless thoracolumbar kyphoscoliotic deformity, with segmental kyphosis 100° and 140° and scoliosis of 33° and 78°, respectively, and one 14-year-old female presented with angular kyphotic deformity of 60° with apex at D11-12 level. RESULTS: Posterior vertebral column resection with segmental deformity correction with good coronal and sagittal balance was done. In the follow-up, PJF was seen. Second surgery was done with the extension of instrumentation to D4 along with deformity correction in both the male patients. The female patient did not opt for a revision surgery, and we are following the natural history of this case. CONCLUSION: In severe thoracolumbar angular kyphotic deformities with normal or negative sagittal balance, it might be a safer option to select the sagittal stable vertebra as upper instrumented vertebra based on the C2 plumb line on the preoperative standing lateral radiographs. However, a study with a larger sample size is needed to validate our hypothesis.
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spelling pubmed-82023942021-06-30 Proximal Junctional Kyphosis after Pediatric Angular Kyphotic Deformity Correction: Are we Missing Something? Mallepally, Abhinandan Reddy Mahajan, Rajat Marathe, Nandan Nanda, Ankur Rustagi, Tarush Chhabra, Harvinder Singh Asian J Neurosurg Original Article PURPOSE: Corrective maneuvers in an angular kyphotic deformity have its own problems including early complications such as neurological deficit and late complications such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). This article discusses the probable mechanisms, leading to PJK in pediatric severe angular kyphotic deformities and preventive strategies for the same. We will also assess natural course of untreated PJK and its devastating consequences. MATERIALS AND METHODS: Three patients, two 13-year males presented with progressive, painless thoracolumbar kyphoscoliotic deformity, with segmental kyphosis 100° and 140° and scoliosis of 33° and 78°, respectively, and one 14-year-old female presented with angular kyphotic deformity of 60° with apex at D11-12 level. RESULTS: Posterior vertebral column resection with segmental deformity correction with good coronal and sagittal balance was done. In the follow-up, PJF was seen. Second surgery was done with the extension of instrumentation to D4 along with deformity correction in both the male patients. The female patient did not opt for a revision surgery, and we are following the natural history of this case. CONCLUSION: In severe thoracolumbar angular kyphotic deformities with normal or negative sagittal balance, it might be a safer option to select the sagittal stable vertebra as upper instrumented vertebra based on the C2 plumb line on the preoperative standing lateral radiographs. However, a study with a larger sample size is needed to validate our hypothesis. Wolters Kluwer - Medknow 2021-02-23 /pmc/articles/PMC8202394/ /pubmed/34211876 http://dx.doi.org/10.4103/ajns.AJNS_311_20 Text en Copyright: © 2021 Asian Journal of Neurosurgery https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Mallepally, Abhinandan Reddy
Mahajan, Rajat
Marathe, Nandan
Nanda, Ankur
Rustagi, Tarush
Chhabra, Harvinder Singh
Proximal Junctional Kyphosis after Pediatric Angular Kyphotic Deformity Correction: Are we Missing Something?
title Proximal Junctional Kyphosis after Pediatric Angular Kyphotic Deformity Correction: Are we Missing Something?
title_full Proximal Junctional Kyphosis after Pediatric Angular Kyphotic Deformity Correction: Are we Missing Something?
title_fullStr Proximal Junctional Kyphosis after Pediatric Angular Kyphotic Deformity Correction: Are we Missing Something?
title_full_unstemmed Proximal Junctional Kyphosis after Pediatric Angular Kyphotic Deformity Correction: Are we Missing Something?
title_short Proximal Junctional Kyphosis after Pediatric Angular Kyphotic Deformity Correction: Are we Missing Something?
title_sort proximal junctional kyphosis after pediatric angular kyphotic deformity correction: are we missing something?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202394/
https://www.ncbi.nlm.nih.gov/pubmed/34211876
http://dx.doi.org/10.4103/ajns.AJNS_311_20
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