SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025
Risk factors associated with distal junctional kyphosis and failure after surgical management of adult cervical deformity: a systematic review.
Synthesis in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
STUDY
designSystematic review.
objectiveTo characterize risk factors associated with the development of distal junctional kyphosis and failure. Distal junctional kyphosis (DJK) is a significant complication following surgical treatment for adult cervical deformity (ACD). Recent literature has characterized risk factors for DJK development, but no formal systematic review has summarized the available findings to date.
methodsThis systematic review included articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Web of Science, SCOPUS, and MEDLINE databases were searched from inception until December 1, 2023. Articles were included if they reported risk factors associated with the development of DJK or distal junctional failure (DJF) following ACD.
resultsThirteen of the 1619 articles met the criteria. Selected studies included 1395 patients, of which 362 developed DJK and/or DJF. The mean age was 60.7 years, and 561 (40.2%) were male. Neurologic symptoms were associated with DJK development (p = 0.012; OR: 3.71). Surgical factors, including number of fusion levels, combined anterior-posterior approach, and use of posterior osteotomies, were correlated with increased rates of DJK (p < 0.01). T1 slope > 45.5 degrees and C2 slope > 38 degrees increased DJF risk (p = 0.014) and reoperation rate (p < 0.001). DJF rates were lower in ACD patients with C2-T2 compared to C3-T1 posterior spinal fusion (1.0% vs. 20%; p < 0.001).
conclusionsDemographic factors were rarely associated with DJK. Surgical factors, such as combined approach, posterior osteotomies, and construct termination at T1, were associated with DJK but may be confounded by more rigid deformities. Radiographic factors also correlated with DJK, appearing to align with baseline and corrected sagittal balance severity. Given the high incidence of DJK following correction for ACD, further research is essential to identify causal and modifiable risk factors.
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