NDLI: Unmatched rod contouring at the proximal end predisposes to occurrence of junctional kyphosis in early-onset scoliosis patients undergoing traditional growing rods treatment

Content Provider	Springer Nature : BioMed Central
Author	Yang, Bo Xu, Liang Wang, Muyi Wang, Bin Zhu, Zezhang Qiu, Yong Sun, Xu
Abstract	Study design A retrospective case series. Objective To investigate whether unmatched rod contouring at the proximal end predisposed to the occurrence of proximal junctional kyphosis (PJK) in early-onset scoliosis (EOS) patients after traditional growing rods (TGR) treatment. Summary of background data TGR treatment has become a mainstay of treatment for EOS patients. PJK is one of the most common alignment-related complications. Methods A consecutive series of EOS patients who had undergone TGR treatment were retrospectively reviewed. They were divided into PJK and non-PJK groups according to the occurrence of PJK or not. Demographic data, surgical strategies, and radiographic parameters were recorded and compared between groups. Proximal junctional angle (PJA) was defined as the angle between the caudal endplate of the UIV and the cephalad endplate of the second supradjacent vertebra above the UIV, while proximal rod contouring angle (PRCA) was defined as the angle of proximal rod contouring, which was represented by the angle between the cephalad endplate of the UIV and the caudal endplate of the second vertebra caudal to the UIV. Unmatched proximal rod contouring was regarded if the postoperative PRCA-PJA difference was greater than 5°. Results This study finally included 73 patients. The mean age at the index surgery was 6.5 ± 2.2 years (range, 2–10 years). Mean follow-up lasted 5.0 ± 1.7 years (range, 2–9 years). They received mean 4.6 ± 1.6 lengthening procedures. There were 13 patients who were observed with PJK (18%). In comparison with the non-PJK group, the PJK group showed a larger preoperative major curve (82 ± 21° vs 70 ± 17°, P = 0.041) and global kyphosis (57 ± 6° vs. 44 ± 15°, P = 0.044). In addition, the PJK group had significantly larger postoperative PJA (10 ± 3 vs. 5 ± 3, P<0.001) and greater postoperative PJA-PRCA (6 ± 3 vs. 3 ± 3, P = 0.031). The proportion of patients with unmatched proximal rod contouring in PJK group was significantly higher than that in the non-PJK group (69% vs. 25%). Multiple logistic regression showed that preoperative GK>50°, postoperative PJA>10 and postoperative unmatched proximal rod contouring were the risk factors in predicting PJK after TGR treatment. Conclusion Approximately 18% EOS patients experienced PJK after TGR treatment. Unmatched proximal rod contouring may be an independent risk factor of PJK occurrence, in addition to greater preoperative GK and larger postoperative PJA. Level of evidence 3.
Related Links	https://bmcmusculoskeletdisord.biomedcentral.com/counter/pdf/10.1186/s12891-022-05564-7.pdf
Ending Page	9
Page Count	9
Starting Page	1
File Format	HTM / HTML
ISSN	14712474
DOI	10.1186/s12891-022-05564-7
Journal	BMC Musculoskeletal Disorders
Issue Number	1
Volume Number	23
Language	English
Publisher	BioMed Central
Publisher Date	2022-06-29
Access Restriction	Open
Subject Keyword	Orthopedics Rehabilitation Rheumatology Sports Medicine Internal Medicine Epidemiology Early-onset scoliosis Traditional growing rods treatment Proximal rod contouring angle Proximal junctional kyphosis
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Rheumatology
Journal Impact Factor	2.2/2023
5-Year Journal Impact Factor	2.6/2023

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