ArticleSpine deformity2026
Neurologic deficits due to proximal junctional kyphosis after adult spinal deformity surgery: how often do they happen and do they improve?
Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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10 authors.
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Abstract
purposeRate of neurological deficits in patients with PJK/F after adult spinal deformity (ASD) surgery is understudied. In patients undergoing reoperation for proximal junctional kyphosis/failure (PJK/F) after adult spinal deformity (ASD) surgery, we sought to: 1) report the rate of neurological deficit, 2) describe these deficits, and 3) discuss improvement rates after reoperation.
methodsA retrospective cohort study (2009-21) included ASD patients with: ≥ five-level fusion, sagittal/coronal deformity, and > 2-year follow-up. PJK was defined as 10º Cobb angle of the upper instrumented vertebra (UIV)-UIV + 2, and 10º increase from preoperative, while PJF was catastrophic PJK requiring reoperation due to screw pullout/fracture. Primary outcome was the presence of neurological deficits and/or worsened motor exam at the time of PJK/F diagnosis, description of deficits, and improvement after reoperation.
resultsOf 238 ASD patients, 47(19.7%) underwent reoperation for PJK/F (mean age: 69.6 ± 9.4 years; mean instrumented levels: 9.4 ± 2.7) at a median of 15.6 months (IQR: 9.8-25.5). New motor deficits were seen in 15/47(31.9%) patients at the time of PJK/F diagnosis, and 3 (6.4%) endorsed incontinence. Neurological deficits occurred in 8/29 (24.1%) PJK and 7/18 (44.4%) PJF patients (p = 0.147). Distal motor strength was 0/5 in 1 (6.7%), 3/5 in 5 (33.3%), and 4/5 in 9 (60.0%). Of 15 patients with new motor deficits, 5 (33%) immediately returned-to-baseline, 5 (33%) improved but not to baseline, 3 (20%) remained unchanged, and 2 (13%) worsened within 3 months of reoperation. At the most recent follow-up (median: 3.9 years), 13/15 (86.7%) patients had no deficits, and 2 (13.3%) improved but not to baseline. Notably, 1 patient without neurological deficit preoperatively developed 4/5 motor exam following PJK surgery.
conclusionsAmong patients reoperated for PJK/F, 32% had motor deficits and 6% had bladder incontinence. Immediately post-surgery, 33% returned-to-baseline, at last follow-up, 87% returned-to-baseline. These results can help patients, families, and surgeons appreciate long-term neurologic function after reoperation for PJK/F.
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