• Peter G Passias, Oscar Krol, Tyler K Williamson, Virginie Lafage, Renaud Lafage, Justin S Smith, Breton Line, Shaleen Vira, Shaina Lipa, Alan Daniels, Bassel Diebo, Andrew Schoenfeld, Jeffrey Gum, Khaled Kebaish, Paul Park, Gregory Mundis, Richard Hostin, Munish C Gupta, Robert Eastlack, Neel Anand, Christopher Ames, Robert Hart, Douglas Burton, Frank J Schwab, Christopher Shaffrey, Eric Klineberg, Shay Bess, and International Spine Study Group.
• Department of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY.
• Spine. 2023 Nov 15; 48 (22): 158115871581-1587.

Study DesignRetrospective cohort study.ObjectiveUnderstand the benefit of addressing malalignment in revision surgery for proximal junctional kyphosis (PJK).Summary Of Background DataPJK is a common cause of revision surgery for adult spinal deformity patients. During a revision, surgeons may elect to perform a proximal extension of the fusion, or also correct the source of the lumbopelvic mismatch.Materials And MethodsRecurrent PJK following revision surgery was the primary outcome. Revision surgical strategy was the primary predictor (proximal extension of fusion alone compared with combined sagittal correction and proximal extension). Multivariable logistic regression determined rates of recurrent PJK between the two surgical groups with lumbopelvic surgical correction assessed through improving ideal alignment in one or more alignment criteria [Global Alignment and Proportionality (GAP), Roussouly-type, and Sagittal Age-Adjusted Score (SAAS)].ResultsA total of 151 patients underwent revision surgery for PJK. PJK occurred at a rate of 43.0%, and PJF at 12.6%. Patients proportioned in GAP postrevision had lower rates of recurrent PJK [23% vs. 42%; odds ratio (OR): 0.3, 95% confidence interval (CI): 0.1-0.8, P =0.024]. Following adjusted analysis, patients who were ideally aligned in one of three criteria (Matching in SAAS and/or Roussouly matched and/or achieved GAP proportionality) had lower rates of recurrent PJK (36% vs. 53%; OR: 0.4, 95% CI: 0.1-0.9, P =0.035) and recurrent PJF (OR: 0.1, 95% CI: 0.02-0.7, P =0.015). Patients ideally aligned in two of three criteria avoid any development of PJF (0% vs. 16%, P <0.001).ConclusionsFollowing revision surgery for PJK, patients with persistent poor sagittal alignment showed increased rates of recurrent PJK compared with patients who had abnormal lumbopelvic alignment corrected during the revision. These findings suggest addressing the root cause of surgical failure in addition to proximal extension of the fusion may be beneficial.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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