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REVIEW article

Front. Pediatr.
Sec. Pediatric Orthopedics
Volume 12 - 2024 | doi: 10.3389/fped.2024.1387841
This article is part of the Research Topic Adolescent Idiopathic Scoliosis: Advances and new Perspectives View all 10 articles

Systematic review and meta-analysis for the proximal junctional kyphosis in adolescent idiopathic scoliosis

Provisionally accepted
Jian Zhao Jian Zhao 1Chen Huang Chen Huang 2Yifei Liu Yifei Liu 3Dongfa Liao Dongfa Liao 2Da Liu Da Liu 1*
  • 1 Department of Orthopedics, Western Theater General Hospital, Chengdu, China
  • 2 Department of Orthopedics, The General Hospital of Western Theater Command, Cheng Du, China
  • 3 Department of Pain Medicine, Western Theater General Hospital, Chengdu, China

The final, formatted version of the article will be published soon.

    The risk factors of PJK (proximal junctional kyphosis) related to AIS(adolescent idiopathic scoliosis) are inconsistent due to heterogeneity in study design, diagnostic criteria, and population. Therefore, the meta-analysis was conducted to investigate the factors affecting PJK after posterior spinal fusion for AIS patients.We implemented a systematic search to obtain potential literature relevant to PJK in AIS surgery. Then, a meta-analysis was performed to assess the incidence of PJK and its risk factors.We retrieved 542 articles, and 24 articles were included. The PJK incidence was 17.67%.The use of hooks at UIV (upper instrumented vertebrae) (p=0.001) could prevent PJK. Before surgery, the larger TK (thoracic kyphosis) (p<0.001), GTK (global thoracic kyphosis) (p<0.001), and LL (lumbar lordosis) (p<0.001) were presented in the PJK group. Immediately post-operatively, in the PJK group, the following parameters were higher: TK (p=0.001), GTK(p<0.001), LL (p=0.04), PJA (proximal junctional angle) (p<0.001), and PJA-RCA (rod contouring angle) (p=0.001). At the final follow-up, the following parameters were higher in the PJK group: TK (p<0.001), GTK(p<0.001), LL(P<0.001), and PJA (P<0.001). Sub-group analysis detected that before surgery, the following parameters were larger in the PJK group: TK (p<0.001), LL (p=0.005), and PJA (p=0.03) in Lenke type 5 AIS patients. Immediately post-operatively, in the PJK group, the following parameters were higher: TK (p<0.001), LL (p=0.005), and PJA (p<0.001). At the final follow-up, the following parameters were higher in the PJK group: TK (p<0.001), LL (p<0.001), and PJA (p<0.001).The individuals with larger preoperative TK were more susceptible to PJK, and PJA was mainly influenced by the adjacent segments rather than the whole sagittal alignment. Using hooks or claws at UIV should prevent PJK.

    Keywords: Proximal junctional kyphosis, AIS, Adolescent idiopathic scoliosis, Meta-analysis, complication

    Received: 18 Feb 2024; Accepted: 08 Jul 2024.

    Copyright: © 2024 Zhao, Huang, Liu, Liao and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Da Liu, Department of Orthopedics, Western Theater General Hospital, Chengdu, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.