Proximal junctional kyphosis and failure-diagnosis, prevention, and treatment

Ngoc-Lam M Nguyen; Christopher Y Kong; Robert A Hart

doi:10.1007/s12178-016-9353-8

Proximal junctional kyphosis and failure-diagnosis, prevention, and treatment

Curr Rev Musculoskelet Med. 2016 Sep;9(3):299-308. doi: 10.1007/s12178-016-9353-8.

Authors

Ngoc-Lam M Nguyen¹, Christopher Y Kong¹, Robert A Hart²

Affiliations

¹ Department of Orthopaedic Surgery and Rehabilitation, Oregon Health and Science University, Mail Code OP31, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
² Department of Orthopaedic Surgery and Rehabilitation, Oregon Health and Science University, Mail Code OP31, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. hartro@ohsu.edu.

Abstract

Technical advancements have enabled the spinal deformity surgeon to correct severe spinal mal-alignment. However, proximal adjacent segment pathology (ASP) remains a significant issue. Examples include proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Agreement on the definition, classification, and pathophysiology of PJK and PJF remains incomplete, and an understanding of the risk factors, means of prevention, and treatment of this problem remains to be elucidated. In general, PJK is a relatively asymptomatic radiographic diagnosis managed with patient reassurance and monitoring. On the other hand, PJF is characterized by mechanical instability, pain, and more severe kyphosis, with potential for neurologic compromise. Patients who develop PJF more often require revision surgery than those with PJK. This chapter will review the current understanding of PJK and PJF.

Keywords: Acute proximal junctional collapse; Acute proximal junctional failure; Adjacent segment degeneration; Proximal junctional failure; Proximal junctional kyphosis; Topping off syndrome.

Publication types

Review