Proximal Junctional Kyphosis in Surgically Treated Young Children
- Slides: 25
Proximal Junctional Kyphosis in Surgically Treated Young Children With Scoliosis: Incidence, Risk Factors, and Management Bang-ping QIAN, Xu SUN, Xi CHEN, Yong QIU Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, China Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
PJK in children treated with GR surgery Ø 88 patients with EOS treated with dual growing rods Ø PJK developed in 23 patients (26%) Ø The significant independent risk factors for PJK: Ø an LIV at or cranial to L 3, Ø a proximal thoracic scoliosis of 40° or more, Ø and a main thoracic kyphosis of 60° or more. Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
A total of 68 patients underwent VEPTR treatment at a single institution Four patients developed PJK (6%). Patients with preoperative thoracic hyperkyphosis may be at higher risk. PJK can develop within the first year of VEPTR treatment. Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
PJK in children treated with fusion surgery # 9634 M 7 y # 6770 F 6 y 6 m-Po-op CS, T 10 -L 2, T 12’ HV VCR 3 m-Po-op 6 m-post-op 14 m-post-op CS, PSF T 7 -L 1 Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Natural Course of PJK in AIS l Most of PJK was progressed within 3 months after surgery and did not progress significantly after 2 years postoperatively l The incidence of PJK at 7. 3 years postoperation was 26% (50 of 193 patients). l The average PJA increased 15. 2° until 2 years postoperatively and then increased 1. 7 °until final follow -up in the PJK group. Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Prevalence of PJK AIS Adults Lee 46% Kim 39% Kim 28% Mendoza. Lattes 35% Hollenbeck 9. 2% Bridwell 27. 8% Helgeson 8. 1% (PS) Misuru -yagi 26% Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Objective To determine the incidence, risk factors, and behavior of proximal junctional kyphosis (PJK) in young children undergoing posterior instrumented spinal fusion. Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Material and Methods Inclusion criteria Age at surgery less than 10 yrs Diagnosed with congenital scoliosis Surgery: posterior fusion≥ 4 levels Follow-up>2 y UIV location: T 1 -T 11 Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Proximal junctional angle measurement PJA 20 ° Ø The proximal junction was defined as the caudal endplate of the UIV to the cephalad endplate of 2 proximal vertebrae. # 9634 M 7 y Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Results 61 consecutive patients Age Follow-up • From 2009 to 2011 in our institution • 5. 4 years (2 -10 years) • 2. 7 years (2 -4 years) Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Results Incidence of PJK 18. 0% 28. 21% 61 consecutive young children with scoliosis were included Overall incidence of PJK was 18. 0% (11/61) at follow-up 3 m-po-op: 10 PJK 3 -6 m: 11 PJK 2 y-po-op: 9 PJK Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Results Progression of PJA in PJK group 20. 6° 23. 1° 3 m-Post-op 2 y-post-op 6. 2° Pre-op Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Radiographic Findings of PJK Kyphotic deformity Bone implant interface failure 36° Bone failure Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
# 9094 M 6 y Bone fuilure of UIV 38° Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
#6700 F 7 y Dislodgement of upmost screws 24° Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
No clinical symptoms #9094 M 6 y PJK #8535 M 9 y Non-PJK Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Discussion Hyperkyphosis #8689 F 8 Y Po-op 75 ° PJA: 7 ° 2 y-Po-op 17° PJA: 21 ° PJA: 27° Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
p Proximal instrumentation failure #7021 M 6 y Po-op Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA 2 y-Po-op
p Un-matching of rod contour #6670 M 8 y 3 m-Po-op 9 m-Po-op Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Bracing for PJK #5746 M 6 y Po-op 3 m-Po-op Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
9 m-Po-op Begin bracing 24 m-Po-op 36 m-Po-op 42 m-Po-op Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Occurrence of DJK after Bracing #8994 F 5 y Po-op 6 m-Po-op PJK 19° Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
2 y+3 m-Po-op 6 m-Po-B 2 y-Po-op 3 m-Po-B PJK: 10° PJK: 16° DJK: 16° Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Conclusion Not a lower incidence of PJK in children with fusion surgery. PJK mainly occurred within 6 months postoperatively, and its risk factors included preoperative hyperkyphosis , proximal instrumentation failure, and un-matching of rod contour. Bracing served as a salvage option for PJK in young children. Spine Surgery, Drum Tower Hospital, Nanjing University, CHINA
Thank you for your attention! Spine Surgery, Drum Tower Hospital, Nanjing University, The Joint Scoliosis Research Center of the Chinese University of Hong. CHINA Kong & Nanjing
- Kyphosis
- Piccolo stretch arms
- Art. intervertebralis
- Scheuermann's kyphosis
- Thoracic kyphoscoliosis definition
- Junctional emergency treatment tool
- Valves of heister ultrasound
- Unifocal pvc
- 6515-01-618-7475
- Causes of junctional rhythm
- Quadrageminy
- Paso 3
- Sinus brady with pjc
- Apakah junctional complex yang paling rapat
- Junctional epitel
- Arteria toracica superior
- Dentoperiosteal fibers
- Hampshire early years moodle
- Working with young children/answer key chapter 1
- Unit 10 caring for children and young people
- Tscyc screening form
- Alcohol consumption causes blood vessels to contract
- Prephonemic stage
- Each packet is treated independently
- Normal blood pressure
- Surface-treated pigments