Proximal Junctional Kyphosis and/or Failure—Part 3: Prevention and Treatment

Abstract

Proximal junctional kyphosis (PJK) is a specifi c form of adjacent segment pathology (ASP) that most commonly occurs after long-segment fusions for spine deformity treatment. Junctional kyphosis at the transition from fused to mobile segments is a common radiographic fi nding. In adult spinal deformity surgery, the reported incidence ranges from 11.0% to 52.9%; however, the description and criteria for defi ning PJK and its clinical impact vary in the literature. Although many initial reports suggested that PJK was a benign radiographic fi nding with minimal clinical signifi cance, more recent reports suggest it can be associated with greater pain and poorer function and increased likelihood of reoperation. Proximal junctional failure (PJF) represents a more severe form of junctional pathology associated with mechanical failure, increased risk of neurologic injury, deformity, and pain, and frequently requires revision surgery. In the second section of this 3-part series, we reviewed general concepts in the prevention and treatment of ASP after lumbar spine surgery. In this section, we review specifi c strategies for the prevention and management of PJK and/or PJF, a subtype of ASP, which may occur following surgery for spine deformity.