Risk factors for proximal junctional kyphosis associated with dual-rod growing-rod surgery for early-onset scoliosis

Koota Watanabe, Koki Uno, Teppei Suzuki, Noriaki Kawakami, Taichi Tsuji, Haruhisa Yanagida, Manabu Ito, Toru Hirano, Ken Yamazaki, Shohei Minami, Hiroshi Taneichi, Shiro Imagama, Katsushi Takeshita, Takuya Yamamoto, Morio Matsumoto

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

STUDY DESIGN: A retrospective, multicenter study. OBJECTIVE: To identify risk factors for proximal junctional kyphosis (PJK) when treating early-onset scoliosis (EOS) with dual-rod growing-rod (GR) procedure. SUMMARY OF BACKGROUND DATA: The risk factors for PJK associated with GR treatment for EOS have not been adequately studied. METHODS: We evaluated clinical and radiographic results from 88 patients with EOS who underwent dual-rod GR surgery in 12 spine centers in Japan. The mean age at the time of the initial surgery was 6.5±2.2 years (range, 1.5-9.8{medium shade}y), and the mean follow-up period was 3.9±2.6 years (range, 2.0-12.0{medium shade}y). Risk factors for PJK were analyzed by binomial multiple logistic regression analysis. The potential factors analyzed were gender, etiology, age, the number of rod-lengthening procedures, coronal and sagittal parameters on radiographs, the type of foundation (pedicle screws or hooks), the uppermost level of the proximal foundation, and the lowermost level of the distal foundation. RESULTS: PJK developed in 23 patients (26%); in 19 of these, the proximal foundation became dislodged following PJK. Binomial multiple logistic regression analysis identified the following significant independent risk factors for PJK: a lower instrumented vertebra (LIV) at or cranial to L3 (odds ratio; OR, 3.32), a proximal thoracic scoliosis of 40° or more (OR, 2.95), and a main thoracic kyphosis of 60° or more (OR, 5.08). CONCLUSIONS: The significant independent risk factors for PJK during dual-rod GR treatment for EOS were an LIV at or cranial to L3, a proximal thoracic scoliosis of 40° or more, and a main thoracic kyphosis of 60° or more.

Original languageEnglish
JournalJournal of Spinal Disorders and Techniques
DOIs
Publication statusAccepted/In press - 2014 Jul 11

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Kyphosis
Scoliosis
Thorax
Spine
Logistic Models
Regression Analysis
Multicenter Studies
Japan
Retrospective Studies
Odds Ratio

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery
  • Clinical Neurology

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Risk factors for proximal junctional kyphosis associated with dual-rod growing-rod surgery for early-onset scoliosis. / Watanabe, Koota; Uno, Koki; Suzuki, Teppei; Kawakami, Noriaki; Tsuji, Taichi; Yanagida, Haruhisa; Ito, Manabu; Hirano, Toru; Yamazaki, Ken; Minami, Shohei; Taneichi, Hiroshi; Imagama, Shiro; Takeshita, Katsushi; Yamamoto, Takuya; Matsumoto, Morio.

In: Journal of Spinal Disorders and Techniques, 11.07.2014.

Research output: Contribution to journalArticle

Watanabe, K, Uno, K, Suzuki, T, Kawakami, N, Tsuji, T, Yanagida, H, Ito, M, Hirano, T, Yamazaki, K, Minami, S, Taneichi, H, Imagama, S, Takeshita, K, Yamamoto, T & Matsumoto, M 2014, 'Risk factors for proximal junctional kyphosis associated with dual-rod growing-rod surgery for early-onset scoliosis', Journal of Spinal Disorders and Techniques. https://doi.org/10.1097/BSD.0000000000000127
Watanabe, Koota ; Uno, Koki ; Suzuki, Teppei ; Kawakami, Noriaki ; Tsuji, Taichi ; Yanagida, Haruhisa ; Ito, Manabu ; Hirano, Toru ; Yamazaki, Ken ; Minami, Shohei ; Taneichi, Hiroshi ; Imagama, Shiro ; Takeshita, Katsushi ; Yamamoto, Takuya ; Matsumoto, Morio. / Risk factors for proximal junctional kyphosis associated with dual-rod growing-rod surgery for early-onset scoliosis. In: Journal of Spinal Disorders and Techniques. 2014.
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abstract = "STUDY DESIGN: A retrospective, multicenter study. OBJECTIVE: To identify risk factors for proximal junctional kyphosis (PJK) when treating early-onset scoliosis (EOS) with dual-rod growing-rod (GR) procedure. SUMMARY OF BACKGROUND DATA: The risk factors for PJK associated with GR treatment for EOS have not been adequately studied. METHODS: We evaluated clinical and radiographic results from 88 patients with EOS who underwent dual-rod GR surgery in 12 spine centers in Japan. The mean age at the time of the initial surgery was 6.5±2.2 years (range, 1.5-9.8{medium shade}y), and the mean follow-up period was 3.9±2.6 years (range, 2.0-12.0{medium shade}y). Risk factors for PJK were analyzed by binomial multiple logistic regression analysis. The potential factors analyzed were gender, etiology, age, the number of rod-lengthening procedures, coronal and sagittal parameters on radiographs, the type of foundation (pedicle screws or hooks), the uppermost level of the proximal foundation, and the lowermost level of the distal foundation. RESULTS: PJK developed in 23 patients (26{\%}); in 19 of these, the proximal foundation became dislodged following PJK. Binomial multiple logistic regression analysis identified the following significant independent risk factors for PJK: a lower instrumented vertebra (LIV) at or cranial to L3 (odds ratio; OR, 3.32), a proximal thoracic scoliosis of 40° or more (OR, 2.95), and a main thoracic kyphosis of 60° or more (OR, 5.08). CONCLUSIONS: The significant independent risk factors for PJK during dual-rod GR treatment for EOS were an LIV at or cranial to L3, a proximal thoracic scoliosis of 40° or more, and a main thoracic kyphosis of 60° or more.",
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T1 - Risk factors for proximal junctional kyphosis associated with dual-rod growing-rod surgery for early-onset scoliosis

AU - Watanabe, Koota

AU - Uno, Koki

AU - Suzuki, Teppei

AU - Kawakami, Noriaki

AU - Tsuji, Taichi

AU - Yanagida, Haruhisa

AU - Ito, Manabu

AU - Hirano, Toru

AU - Yamazaki, Ken

AU - Minami, Shohei

AU - Taneichi, Hiroshi

AU - Imagama, Shiro

AU - Takeshita, Katsushi

AU - Yamamoto, Takuya

AU - Matsumoto, Morio

PY - 2014/7/11

Y1 - 2014/7/11

N2 - STUDY DESIGN: A retrospective, multicenter study. OBJECTIVE: To identify risk factors for proximal junctional kyphosis (PJK) when treating early-onset scoliosis (EOS) with dual-rod growing-rod (GR) procedure. SUMMARY OF BACKGROUND DATA: The risk factors for PJK associated with GR treatment for EOS have not been adequately studied. METHODS: We evaluated clinical and radiographic results from 88 patients with EOS who underwent dual-rod GR surgery in 12 spine centers in Japan. The mean age at the time of the initial surgery was 6.5±2.2 years (range, 1.5-9.8{medium shade}y), and the mean follow-up period was 3.9±2.6 years (range, 2.0-12.0{medium shade}y). Risk factors for PJK were analyzed by binomial multiple logistic regression analysis. The potential factors analyzed were gender, etiology, age, the number of rod-lengthening procedures, coronal and sagittal parameters on radiographs, the type of foundation (pedicle screws or hooks), the uppermost level of the proximal foundation, and the lowermost level of the distal foundation. RESULTS: PJK developed in 23 patients (26%); in 19 of these, the proximal foundation became dislodged following PJK. Binomial multiple logistic regression analysis identified the following significant independent risk factors for PJK: a lower instrumented vertebra (LIV) at or cranial to L3 (odds ratio; OR, 3.32), a proximal thoracic scoliosis of 40° or more (OR, 2.95), and a main thoracic kyphosis of 60° or more (OR, 5.08). CONCLUSIONS: The significant independent risk factors for PJK during dual-rod GR treatment for EOS were an LIV at or cranial to L3, a proximal thoracic scoliosis of 40° or more, and a main thoracic kyphosis of 60° or more.

AB - STUDY DESIGN: A retrospective, multicenter study. OBJECTIVE: To identify risk factors for proximal junctional kyphosis (PJK) when treating early-onset scoliosis (EOS) with dual-rod growing-rod (GR) procedure. SUMMARY OF BACKGROUND DATA: The risk factors for PJK associated with GR treatment for EOS have not been adequately studied. METHODS: We evaluated clinical and radiographic results from 88 patients with EOS who underwent dual-rod GR surgery in 12 spine centers in Japan. The mean age at the time of the initial surgery was 6.5±2.2 years (range, 1.5-9.8{medium shade}y), and the mean follow-up period was 3.9±2.6 years (range, 2.0-12.0{medium shade}y). Risk factors for PJK were analyzed by binomial multiple logistic regression analysis. The potential factors analyzed were gender, etiology, age, the number of rod-lengthening procedures, coronal and sagittal parameters on radiographs, the type of foundation (pedicle screws or hooks), the uppermost level of the proximal foundation, and the lowermost level of the distal foundation. RESULTS: PJK developed in 23 patients (26%); in 19 of these, the proximal foundation became dislodged following PJK. Binomial multiple logistic regression analysis identified the following significant independent risk factors for PJK: a lower instrumented vertebra (LIV) at or cranial to L3 (odds ratio; OR, 3.32), a proximal thoracic scoliosis of 40° or more (OR, 2.95), and a main thoracic kyphosis of 60° or more (OR, 5.08). CONCLUSIONS: The significant independent risk factors for PJK during dual-rod GR treatment for EOS were an LIV at or cranial to L3, a proximal thoracic scoliosis of 40° or more, and a main thoracic kyphosis of 60° or more.

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