Revision surgery in distal junctional kyphosis

Pedro Berjano, Marco Damilano, Matteo Pejrona, Francesco Langella, Claudio Lamartina

Research output: Contribution to journalReview articlepeer-review


Background: Opposed to proximal junctional kyphosis and proximal junctional failure, their distal equivalents, distal junctional kyphosis and failure (DJK/DJF) have received less attention in the literature. The aim of this article is to provide an overview of the problem of DJK–DJF in different clinical scenarios such as adolescent idiopathic scoliosis (AIS), Scheuermann’s kyphosis (SK) and adult deformity surgery and to suggest a strategy for prevention and treatment. Methods: A narrative review of the literature was conducted to identify the best evidence on the risk factors of the problem. Results: DJK/DJF have been described as a complication of AIS, SK and adult spine deformity (ASD). For AIS and SK, the choice of a lower instrumented vertebra more cranial than the sagittal stable vertebra has shown to increase the incidence of DJK and DJF. For ASD, constructs ending with S1 pedicle screws had a higher incidence of DJK/DJF than those ending distally with S1 pedicle plus iliac screws. Conclusion: The proposed strategy of treatment includes restoration of normal sagittal alignment, choice of a distal fixation point stable in the sagittal, coronal and transverse planes, balancing the fusion mass over the distal fixation point and providing solid fixation at the distal end of the construct. Graphic abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)86-102
Number of pages7
JournalEuropean Spine Journal
Issue numbersuppl 1
Publication statusPublished - 2020


  • Distal junctional failure
  • Distal junctional kyphosis
  • Kyphosis
  • Review
  • Revision surgery
  • Scoliosis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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