Osteotomies in proximal junctional kyphosis in the cervicothoracic area

R. Cecchinato, P. Berjano, R. Bassani, C. Lamartina

Research output: Contribution to journalArticle

Abstract

Introduction: Proximal junctional kyphosis (PJK) of the cervicothoracic spine is a deformity that can affect patients who have undergone long thoracolumbar instrumented fusion. Preoperative hyperkyphosis of the thoracic spine and changes of more than 30° in lumbar lordosis are independent risk factors for the onset of PJK.

Methods: When PJK occurs in the cervicothoracic spine, extension of the fusion with eventual application of osteotomy techniques is frequently necessary to treat symptomatic patients or in case a neurological deficit occurs. Ponte osteotomy and pedicle subtraction osteotomy (PSO) are the two most used techniques to restore a good cervicothoracic alignment, although they are still demanding procedures even for expert surgeons. In junctional fractures, a vertebral column resection can be performed to support the anterior column. Ponte osteotomy ideally restores 10° at each treated level, while PSO allows a segmental correction up to 30°–35°. Adequate preoperative planning is fundamental for outlining the correct surgery and choosing the appropriate osteotomy.

Conclusions: The aim of corrective surgery is to restore the cervicothoracic alignment, obtaining an adequate postoperative sagittal balance and decreasing the risk of further complications and new revision surgeries.

Original languageEnglish
Pages (from-to)31-37
Number of pages7
JournalEuropean Spine Journal
Volume24
Issue number1
DOIs
Publication statusPublished - 2014

Keywords

  • Cervicothoracic spine
  • Pedicle subtraction osteotomy
  • Ponte osteotomy
  • Proximal junctional kyphosis
  • Vertebral column resection

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Medicine(all)

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