• Amer Sebaaly, Guillaume Riouallon, Ibrahim Obeid, Pierre Grobost, Maroun Rizkallah, Fethi Laouissat, Yann-Phillippe Charles, and Pierre Roussouly.
• Department of Orthopedic Surgery, Clinique médico-chirurgicale des Massues, 92 rue Edmond Locard, 65005, Lyon, France. amersebaaly@hotmail.com.
• Eur Spine J. 2018 Mar 1; 27 (3): 613-621.

ObjectiveThe objective of this retrospective study is to identify the best immediate postoperative radiological predictors for the occurrence of proximal junctional kyphosis (PJK). Four proposed methods will be explored.MethodsA homogeneous database of adult scoliosis from multiple centers was used. Patients with whole spine X-rays at the required follow-up (FU) periods were included. Spinal and pelvic parameters were measured and calculated to compare four predictive methods: Method 1: assessment of the global sagittal alignment (GSA); Method 2: restoration of the theoretical values of lumbar lordosis (LL) and thoracic kyphosis (TK) according to pelvic incidence (PI); Method 3: evaluation of TK + LL, and Method 4: restoration of the apex of sagittal LL to its theoretical values according to various spine shapes in Roussouly Classification. PJK occurrence was assessed at the last FU radiograph.Results250 patients were included; mean age was 56.67 years and mean FU was 2.5 years. PJK occurred in 25.6% of cases. PJK occurred in 19.9% in patients with a GSA <45° and in 29.9% where GSA >45° (p = 0.04, OR = 1.71). Restoring the sagittal apex of the LL to its theoretical values according to PI deceased PJK to 13.5% compared to 38.9% in the other cases (p = 0.01, OR = 4.6). The two other described methods (2 and 3) were not significant predictors.DiscussionThe comparison between the four predictive methods showed that a GSA >45° and restoration of sagittal apex of lordosis according to PI, were the most predictive methods for PJK in ASD. The latter had a higher predictive value. Our findings could prove useful in effective preoperative planning in ASD surgery to reduce PJK rates.Level Of EvidenceLevel IV.

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