Risk factors for proximal junctional kyphosis after spinal
deformity surgery: a meta-analysis

doi:10.3969/j.issn.2095-4344.2420

Abstract

Abstract:

BACKGROUND: Proximal junctional kyphosis is a common complication after spinal deformity surgery, which can lead to a variety of adverse clinical outcomes. Therefore, it is necessary to analyze the risk factors that may lead to proximal junctional kyphosis after surgery, in order to expand our understanding of proximal junctional kyphosis and provide guidance for its prevention.

OBJECTIVE: To evaluate the risk factors of proximal junctional kyphosis after spinal deformity surgery using meta-analysis.

METHODS: A systematic literature search was performed using PubMed, EMbase, Cochrane, CNKI and Wanfang Medical Database (up to May 2019). The quality of literatures was assessed and selected according to the inclusion criteria and exclusion criteria. Relevant data were extracted. RevMan 5.3 software was used for data analysis and the data were dealt by meta-analysis. The meta-analysis results were evaluated.

RESULTS AND CONCLUSION: (1) This study included 26 studies involving 4 498 patients of whom 921 with proximal junctional kyphosis. The incidence of proximal junctional kyphosis after spinal orthopedic surgery was 25%. (2) There were significant differences between the proximal junctional kyphosis and non-proximal junctional kyphosis groups in age, body mass index, osteoporosis, number of surgical vertebral bodies, the upper instrumented vertebra to the thoracolumbar segment (T₁₀-L₁), the lower instrumented vertebra to the sacrum/pelvis/ilium, postoperative proximal kyphosis angle, lumbar lordosis and sagittal vertical axis, changes in proximal kyphosis angle, lumbar lordosis and sagittal vertical axis (P < 0.05). (3) There were no significant differences in gender, osteotomy, combined surgery, preoperative proximal kyphosis angle or preoperative lumbar lordosis (P > 0.05). (4) Our meta-analysis showed that age, body mass index, osteoporosis, the number of operative vertebrae > 5 at fixation segment, the upper instrumented vertebra internal fixation to thoracolumbar segment (T₁₀-L₁), the lower instrumented vertebra fixation to sacrum/pelvis/ilium, postoperative proximal kyphosis angle, lumbar lordosis and sagittal vertical axis, changes in proximal kyphosis angle, lumbar lordosis and sagittal vertical axis were the main risk factors for proximal junctional kyphosis. The incidence of proximal junctional kyphosis can be reduced by intervening the high-risk population and making the suitable surgical procedures. Proximal junctional kyphosis was due to a variety of non-surgical and surgical factors. More rigorous epidemiological studies are needed to provide reliable evidence for reducing the incidence of proximal junctional kyphosis.

Key words: spinal deformity surgery, proximal junctional kyphosis, deformity, risk factors, meta-analysis, the National Natural Science Foundation of China

CLC Number:

R459.9

R318

R687

Zhang Jian, Wang Xiaojian, Qin Dean, Zhao Zhongtao, Liang Qingyuan, An Qijun, Song Jiefu. Risk factors for proximal junctional kyphosis after spinal deformity surgery: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(3): 460-468.

Figures/Tables 8

References

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