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Diagnosis and Classification of Proximal Junctional Kyphosis and Proximal Junctional Failure

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Abstract

Technical advancements have allowed the spinal deformity surgeon to achieve newfound abilities to correct severe spinal malalignment. However, proximal adjacent segment pathology (ASP) remains a significant issue. Examples include proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Agreement on the definition, classification, and pathophysiology of PJK and PJF remains elusive, and an understanding of the risk factors, means of prevention, and treatment of this problem remains to be elucidated. In general, PJK is a relatively asymptomatic radiographic diagnosis managed with patient reassurance and monitoring. On the other hand, PJF is a more serious entity on the ASP continuum. PJF is characterized by mechanical instability, pain, and more severe kyphosis, with potential for neurologic compromise. Patients who develop PJF more often require revision surgery than those with PJK. This chapter will review the current understanding of PJK and PJF.

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Authors and Affiliations

  1. Swedish Neuroscience Institute, Seattle, WA, USA

    Ngoc-Lam M. Nguyen MD, Christopher Y. Kong MD & Robert A. Hart MD

  2. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA

    Khaled M. Kebaish MD

  3. Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA

    Michael M. Safaee MD & Christopher P. Ames MD

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  1. Ngoc-Lam M. Nguyen MD
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  2. Christopher Y. Kong MD
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  3. Khaled M. Kebaish MD
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  4. Michael M. Safaee MD
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  5. Christopher P. Ames MD
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  6. Robert A. Hart MD
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Correspondence to Robert A. Hart MD .

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  1. Department of Orthopedic Surgery, University of California - Davis, Sacramento, California, USA

    Eric O. Klineberg

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Nguyen, NL.M., Kong, C.Y., Kebaish, K.M., Safaee, M.M., Ames, C.P., Hart, R.A. (2017). Diagnosis and Classification of Proximal Junctional Kyphosis and Proximal Junctional Failure. In: Klineberg, E. (eds) Adult Lumbar Scoliosis. Springer, Cham. https://doi.org/10.1007/978-3-319-47709-1_17

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