TY - JOUR
T1 - The clinical correlation of the hart-issg proximal junctional kyphosis severity scale with health-related quality-of-life outcomes and need for revision surgery
AU - Lau, Darryl
AU - Funao, Haruki
AU - Clark, Aaron J.
AU - Nicholls, Fred
AU - Smith, Justin
AU - Bess, Shay
AU - Shaffrey, Chris
AU - Schwab, Frank J.
AU - Lafage, Virginie
AU - Deviren, Vedat
AU - Hart, Robert
AU - Kebaish, Khaled M.
AU - Ames, Christopher P.
N1 - Publisher Copyright:
© 2016 Wolters Kluwer Health, Inc.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Study Design. Retrospective analysis of prospective data. Objective. Evaluate the utility of the Hart-International Spine Study Group proximal junctional kyphosis severity scale (Hart-ISSG PJKSS). Summary of Background Data. Proximal junctional kyphosis (PJK) and failure (PJF) are well-described complications after long-segment instrumentation. The Hart-ISSG PJKSS was recently developed and incorporates neurological deficit, pain, instrumentation issues, degree of kyphosis, presence of fracture, and level of upper-most instrumented vertebrae. Methods. All adult spinal deformity patients with PJK or PJF were identified from two academic centers over a 7-year period. Health-related quality-of-life (HRQOL) outcomes were prospectively collected: Oswestry Disability Index (ODI), visual analogue scale (VAS) pain, SF-36 questionnaire, and SRS-30 questionnaire. Patients were retrospectively assigned Hart-ISSG PJKSS scores. Correlation between the Hart-ISSG PJKSS and outcomes was assessed with linear regression, Pearson correlation coefficients, and χ 2 analysis. Results. A total of 184 cases were included; 21.2% were men and mean age was 65.0 years. Weakness and/or myelopathy were present in 11.4% of patients and 88.6% had pain. Instrumentation issues occurred in 44.0% and 64.1% had PJK-associated fractures. PJK occurred in the upper thoracic spine in 21.7% of cases. Mean PJKSS score was 5.9. The Hart-ISSG PJKSS was significantly and strongly associated with ODI (P<0.001, r=0.611), VAS pain (P<0.001, r=0.676), SRS-30 function (P<0.001, r=-0.401), SRS-30 mental health (P<0.001, r=-0.592), SRS-30 self-image (P<0.001, r=-0.511), SRS-30 satisfaction (P<0.001, r=-0.531), and SRS-30 pain (P<0.001, r=-0.445). Higher scores were associated with higher proportion of patients undergoing revision surgery (P<0.001); scores of 9 to 11 and 12 to 15 underwent revision 96.0% and 100.0% of the time, respectively. Conclusion. The Hart-ISSG PJKSS was strongly correlated with validated functional outcomes and higher scores were associated with higher rates of revision surgery. The Hart-ISSG PJKSS may be a useful clinical tool in the treatment of patient with PJK.
AB - Study Design. Retrospective analysis of prospective data. Objective. Evaluate the utility of the Hart-International Spine Study Group proximal junctional kyphosis severity scale (Hart-ISSG PJKSS). Summary of Background Data. Proximal junctional kyphosis (PJK) and failure (PJF) are well-described complications after long-segment instrumentation. The Hart-ISSG PJKSS was recently developed and incorporates neurological deficit, pain, instrumentation issues, degree of kyphosis, presence of fracture, and level of upper-most instrumented vertebrae. Methods. All adult spinal deformity patients with PJK or PJF were identified from two academic centers over a 7-year period. Health-related quality-of-life (HRQOL) outcomes were prospectively collected: Oswestry Disability Index (ODI), visual analogue scale (VAS) pain, SF-36 questionnaire, and SRS-30 questionnaire. Patients were retrospectively assigned Hart-ISSG PJKSS scores. Correlation between the Hart-ISSG PJKSS and outcomes was assessed with linear regression, Pearson correlation coefficients, and χ 2 analysis. Results. A total of 184 cases were included; 21.2% were men and mean age was 65.0 years. Weakness and/or myelopathy were present in 11.4% of patients and 88.6% had pain. Instrumentation issues occurred in 44.0% and 64.1% had PJK-associated fractures. PJK occurred in the upper thoracic spine in 21.7% of cases. Mean PJKSS score was 5.9. The Hart-ISSG PJKSS was significantly and strongly associated with ODI (P<0.001, r=0.611), VAS pain (P<0.001, r=0.676), SRS-30 function (P<0.001, r=-0.401), SRS-30 mental health (P<0.001, r=-0.592), SRS-30 self-image (P<0.001, r=-0.511), SRS-30 satisfaction (P<0.001, r=-0.531), and SRS-30 pain (P<0.001, r=-0.445). Higher scores were associated with higher proportion of patients undergoing revision surgery (P<0.001); scores of 9 to 11 and 12 to 15 underwent revision 96.0% and 100.0% of the time, respectively. Conclusion. The Hart-ISSG PJKSS was strongly correlated with validated functional outcomes and higher scores were associated with higher rates of revision surgery. The Hart-ISSG PJKSS may be a useful clinical tool in the treatment of patient with PJK.
KW - classification
KW - instrumentation
KW - proximal junctional failure
KW - proximal junctional kyphosis
KW - quality of life
KW - revision surgery
KW - severity scale
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U2 - 10.1097/BRS.0000000000001326
DO - 10.1097/BRS.0000000000001326
M3 - Article
C2 - 26641842
AN - SCOPUS:84959483950
SN - 0362-2436
VL - 41
SP - 213
EP - 223
JO - Spine
JF - Spine
IS - 3
ER -