Proximal Junctional Kyphosis: Diagnosis, Pathogenesis, and Treatment

• Published in: Asian spine journal Vol. 10; no. 3; pp. 593 - 600
• Main Authors: Lee, Jaewon, Park, Ye-Soo
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Spine Surgery 01.06.2016; Korean Spine Society; 대한척추외과학회
• Subjects: Back surgery; Diagnosis; Epidemiology; Fractures; Kyphosis; Pain; Pathogenesis; Patients; Proximal junctional kyphosis; Reproducibility; Review; Risk factor; Risk factors; Scoliosis; Spinal deformity; Treatment; Vertebrae; 정형외과학; Treatment; Epidemiology; Spinal deformity; Risk factor; Proximal junctional kyphosis
• ISSN: 1976-1902; 1976-7846; 1976-7846
• DOI: 10.4184/asj.2016.10.3.593

Proximal junctional kyphosis (PJK) is a common radiographic finding after long spinal fusion. A number of studies on the causes, risk factors, prevention, and treatment of PJK have been conducted. However, no clear definition of PJK has been established. In this paper, we aimed to clarify the diagnosis, prevention, and treatment of PJK by reviewing relevant papers that have been published to date. A literature search was conducted on PubMed using "proximal junctional", "proximal junctional kyphosis", and "proximal junctional failure" as search keywords. Only studies that were published in English were included in this study. The incidence of PJK ranges from 5% to 46%, and it has been reported that 66% of cases occur 3 months after surgery and approximately 80% occur within 18 months. A number of studies have reported that there is no significantly different clinical outcome between PJK patients and non-PJK patients. One study showed that PJK patients expressed more pain than non-PJK patients. However, recent studies focused on proximal junctional failure (PJF), which is accepted as a severe form of PJK. PJF showed significant adverse impact in clinical aspect such as pain, neurologic deficit, ambulatory difficulties, and social isolation. Numerous previous studies have identified various risk factors and reported on the treatment and prevention of PJK. Based on these studies, we determined the clinical significance and impact of PJK. In addition, it is important to find a strategic approach to the proper treatment of PJK.