Proximal junctional kyphosis in Lenke 5C adolescent idiopathic scoliosis after selective posterior thoracolumbar/lumbar fusion: risk factors and predictive index

Although several studies have reported that selective posterior thoracolumbar/lumbar (TL/L) fusion can yield satisfactory results in Lenke 5C adolescent idiopathic scoliosis (AIS), the proximal junctional kyphosis (PJK) is still a common complication that occurs after surgery. The purpose of this study is to analyse the risk factors for postoperative proximal junctional kyphosis in Lenke 5C patients who underwent selective posterior TL/L fusion and explore whether PJK can be predicted. A total of 83 AIS patients with Lenke 5C curves who met the inclusion criteria were analysed. All patients were divided into two groups based on the occurrence of postoperative PJK. Univariate and multivariate analyses were used to identify independent factors significantly associated with PJK, and an PJK index was proposed and verified. PJK was observed in 27 of 83 (32.5%) patients in the study. Preoperative thoracic kyphosis (TK) and the immediate postoperative proximal junctional angle (PJA) were the primary factors identified by the binary logistic regression analysis. The PJK index was defined as 1.1× preoperative TK + 2.3× immediate postoperative PJA. The receiver operating characteristics curve indicated that the occurrence rate of PJK was 85% and non-occurrence rate was 82% when the PJK index was greater than 42. Large preoperative TK and a large immediate postoperative PJA play important roles in the development of PJK in Lenke 5C patients treated with selective posterior thoracolumbar/lumbar fusion. The PJK index can be used to predict the occurrence of PJK with high accuracy. To prevent the occurrence of PJK, we should pay attention to the TLK, and preserving more posterior proximal intervertebral elements at the upper instrumented vertebral level would be an important part of corrective surgery; however, moderate correction of the lumbar curve is recommended.