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Purpose <p>Rate of neurological deficits in patients with PJK/F after adult spinal deformity (ASD) surgery is understudied. In patients undergoing reoperation for proximal junctional kyphosis/failure (PJK/F) after adult spinal deformity (ASD) surgery, we sought to: 1) report the rate of neurological deficit, 2) describe these deficits, and 3) discuss improvement rates after reoperation.</p> Methods <p>A retrospective cohort study (2009–21) included ASD patients with: ≥ five-level fusion, sagittal/coronal deformity, and &gt; 2-year follow-up. PJK was defined as 10º Cobb angle of the&#xa0;upper instrumented vertebra (UIV)–UIV + 2, and 10º increase from preoperative, while PJF was catastrophic PJK requiring reoperation due to screw pullout/fracture. Primary outcome was the presence of neurological deficits and/or worsened motor exam at the time of PJK/F diagnosis, description of deficits, and improvement after reoperation.</p> Results <p>Of 238 ASD patients, 47(19.7%) underwent reoperation for PJK/F (mean age: 69.6 ± 9.4&#xa0;years; mean instrumented levels: 9.4 ± 2.7) at a median of 15.6&#xa0;months (IQR: 9.8–25.5). New motor deficits were seen in 15/47(31.9%) patients at the time of PJK/F diagnosis, and 3&#xa0;(6.4%) endorsed incontinence. Neurological deficits occurred in 8/29&#xa0;(24.1%) PJK and 7/18&#xa0;(44.4%) PJF patients (<i>p</i> = 0.147). Distal motor strength was 0/5 in 1&#xa0;(6.7%), 3/5 in 5 (33.3%), and 4/5 in 9&#xa0;(60.0%). Of 15 patients with new motor deficits, 5&#xa0;(33%) immediately returned-to-baseline, 5&#xa0;(33%) improved but not to baseline, 3&#xa0;(20%) remained unchanged, and 2 (13%) worsened within 3&#xa0;months of reoperation. At the most recent follow-up (median: 3.9&#xa0;years), 13/15&#xa0;(86.7%) patients had no deficits, and 2&#xa0;(13.3%) improved but not to baseline. Notably, 1 patient without neurological deficit preoperatively developed 4/5 motor exam following PJK surgery.</p> Conclusions <p>Among patients reoperated for PJK/F, 32% had motor deficits and 6% had bladder incontinence. Immediately post-surgery, 33% returned-to-baseline, at last follow-up, 87% returned-to-baseline. These results can help patients, families, and surgeons appreciate long-term neurologic function after reoperation for PJK/F.</p>

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Neurologic deficits due to proximal junctional kyphosis after adult spinal deformity surgery: how often do they happen and do they improve?

  • 期刊论文

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  • 发表日期：

    2026年2月18日

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  • Hani Chanbour,
  • Alan R. Tang,
  • Harsh Jain,
  • Alexander T. Lyons,
  • Soren Jonzzon,
  • Iyan Younus,
  • Steven G. Roth,
  • Amir M. Abtahi,
  • Byron F. Stephens,
  • Scott L. Zuckerman

摘要

Purpose

Rate of neurological deficits in patients with PJK/F after adult spinal deformity (ASD) surgery is understudied. In patients undergoing reoperation for proximal junctional kyphosis/failure (PJK/F) after adult spinal deformity (ASD) surgery, we sought to: 1) report the rate of neurological deficit, 2) describe these deficits, and 3) discuss improvement rates after reoperation.

Methods

A retrospective cohort study (2009–21) included ASD patients with: ≥ five-level fusion, sagittal/coronal deformity, and > 2-year follow-up. PJK was defined as 10º Cobb angle of the upper instrumented vertebra (UIV)–UIV + 2, and 10º increase from preoperative, while PJF was catastrophic PJK requiring reoperation due to screw pullout/fracture. Primary outcome was the presence of neurological deficits and/or worsened motor exam at the time of PJK/F diagnosis, description of deficits, and improvement after reoperation.

Results

Of 238 ASD patients, 47(19.7%) underwent reoperation for PJK/F (mean age: 69.6 ± 9.4 years; mean instrumented levels: 9.4 ± 2.7) at a median of 15.6 months (IQR: 9.8–25.5). New motor deficits were seen in 15/47(31.9%) patients at the time of PJK/F diagnosis, and 3 (6.4%) endorsed incontinence. Neurological deficits occurred in 8/29 (24.1%) PJK and 7/18 (44.4%) PJF patients (p = 0.147). Distal motor strength was 0/5 in 1 (6.7%), 3/5 in 5 (33.3%), and 4/5 in 9 (60.0%). Of 15 patients with new motor deficits, 5 (33%) immediately returned-to-baseline, 5 (33%) improved but not to baseline, 3 (20%) remained unchanged, and 2 (13%) worsened within 3 months of reoperation. At the most recent follow-up (median: 3.9 years), 13/15 (86.7%) patients had no deficits, and 2 (13.3%) improved but not to baseline. Notably, 1 patient without neurological deficit preoperatively developed 4/5 motor exam following PJK surgery.

Conclusions

Among patients reoperated for PJK/F, 32% had motor deficits and 6% had bladder incontinence. Immediately post-surgery, 33% returned-to-baseline, at last follow-up, 87% returned-to-baseline. These results can help patients, families, and surgeons appreciate long-term neurologic function after reoperation for PJK/F.