San Diego, CA—March 14, 2017
The surgical correction of adult spinal deformities often involves realigning the lower portion of the spine, or the ‘lumbar’ spine. Yet despite significant advances in spinal surgery, modifying the curvature of the lower spine through surgical fusion increases the risk of abnormal spinal curvature above the level of the operation, a condition called proximal junctional kyphosis – or PJK.
A new study reports for the first time that PJK risk following lumbar spinal fusion depends on the level of the spine fused. Specifically, the authors – which include members of the International Spine Study Group (ISSG) from multiple academic centers – found that fusing the lower portion of lumbar spine results in a decreased risk of PJK. The results were presented today at the American Academy of Orthopaedic Surgeons Annual Meeting in San Diego, California.
In the study, 350 adult patients who had undergone fusion of their lumbar spine spinal abnormalities were divided into those who had developed PJK following their procedures and those that did not. The specific vertebrae fused in their surgeries were then compared, revealing to the authors that more dramatic spinal fusions – those higher up along the spine – may increase the risk of developing PJK.
"This study is unique in the sense that it looks at a very common problem, currently intensively studied around the world, and examines this challenge through an innovative method," says investigator Frank Schwab, MD, chief of Spine at Hospital for Special Surgery.
Dr. Schwab also points out that while numerous theories on PJK risk have been put forth over the years, few orthopedic centers have had enough data or resources to adequately study it.
"Our findings give us a substantial boost in shifting the discussion from expert opinion to a more evidence-based conclusion," he says. "Additionally, they also offer a pragmatic solution that can be applied right away in order to reduce PJK rates."
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic of musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.