Volume 10 Supplement 1

IRSSD 2014 Meeting Abstracts

Open Access

Is there a correlation between pelvic incidence and proximal junctional kyphosis (PJK) after surgery for adult scoliosis?

  • Stefano Giacomini1,
  • Mario Di Silvestre1,
  • Francesco Lolli1,
  • Francesco Vommaro1,
  • Konstantinos Martikos1,
  • Elena Maredi1,
  • Andrea Baioni1 and
  • Tiziana Greggi1
Scoliosis201510(Suppl 1):O53

https://doi.org/10.1186/1748-7161-10-S1-O53

Published: 19 January 2015

Background

The proximal junctional kyphosis (PJK) occurs from 17% to 39% after posterior arthrodesis for spinal deformity. The aim of this study is to verify a possible correlation between PJK and pelvic incidence (PI) in the treatment of adult scoliosis.

Materials and methods

78 consecutive patients (63 women - 15 men) were included in the study, mean age of 66 years (range 60-77), surgically treated at our Division between 2000 and 2005. In all cases the diagnosis was idiopathic scoliosis, with positive sagittal imbalance. In 29 cases (37.2 %) a previous arthrodesis was performed. All patients were treated with posterior arthrodesis with pedicle instrumentation and a pedicle subtraction osteotomy (PSO) in 17 cases and Smith Petersen osteotomy ( SPO ) at multiple levels in 25 cases. The clinical and radiographic questionnaires (Oswestry, VAS) filled in before and after surgery and at final follow-up were evaluated.

Results

After a mean follow-up of 3.8 years (range, 2-8) 18 cases of PJK occurred (23.7 %). In case of "short" synthesis (upper instrumented vertebra " UIV " between T10 and L1), the incidence increased to 50% (9 cases). PJK always occurred within 2 months after primary surgery, all cases symptomatic and evolutionary and required a surgery recovery. Considering the value of pelvic incidence (PI), patients were divided into 2 groups: Group A (IP<55 ° : 48 cases) and Group B (PI > 55 ° : 30 cases). In Group B we found a greater loss of lumbar lordosis (19.2 ° vs. 7.7 °), sagittal balance correction (28.7 % vs. 8.4 %) and we found also a higher incidence of PJK (40% vs. 12.5 %) at final follow-up.

Conclusions

The PJK is an important and not so rare complication in spinal deformities surgery. Our data showed that a "short" synthesis (UIV between T10 and L1) and a high PI (> 55 °) is associated with a high risk of developing PJK. Patients with high pelvic incidence, thus requiring a more aggressive surgical treatment, such as with osteotomies, to achieve greater lumbar lordosis and correct sagittal balance.

Figure 1

Figure 2

Authors’ Affiliations

(1)
Deformities of Spine Surgery, Rizzoli Orthopaedic Institute

Copyright

© Giacomini et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

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