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. 2023 Apr;13(3):651-658.
doi: 10.1177/21925682211001812. Epub 2021 May 12.

The Impact of Global Alignment and Proportion Score and Bracing on Proximal Junctional Kyphosis in Adult Spinal Deformity

Elizabeth L Lord  1 , Ethan Ayres  2 , Dainn Woo  3 , Dennis Vasquez-Montes  4 , Yesha Parekh  5 , Deeptee Jain  6 , Aaron Buckland  3 , Themistocles Protopsaltis  7
Affiliations

The Impact of Global Alignment and Proportion Score and Bracing on Proximal Junctional Kyphosis in Adult Spinal Deformity

Elizabeth L Lord et al. Global Spine J. 2023 Apr.

Abstract

Study design: Retrospective chart review.

Objective: The goal of this study is to examine the relationship between global alignment and proportion (GAP) score and postoperative orthoses with likelihood of developing proximal junctional kyphosis (PJK).

Methods: Patients who underwent thoracic or lumbar fusions of ≥4 levels for adult spinal deformity (ASD) with 1-year post-operative alignment x-rays were included. Chart review was conducted to determine spinopelvic alignment parameters, PJK, and reoperation.

Results: A total of 81 patients were included; baseline and 1-year postoperative alignment did not differ between patients with and without PJK. There was no PJK in 53.1%, 29.6% had PJK from 10-20°, and 17.3% had severe PJK over 20° (sPJK). At baseline, 80% of patients had severely disproportioned GAP, 13.75% moderate, 6.25% proportioned. GAP improved across the population, but improved GAP was not associated with sPJK. Greater correction of the upper instrumented vertebra to pelvic angle (UIV-PA) was associated with a larger PJK angle (PJKA) change (R = -0.28) as was the 1 year T1-upper instrumented vertebra (T1-UIV) angle (R = 0.30), both P < .05. GAP change was not correlated with PJKA change. Postoperative orthoses were used in 46% of patients and did not impact sPJK.

Conclusions: There was no correlation between PJK and GAP or change in GAP. Greater correction of UIV-PA and larger postop T1-UIV was associated with greater PJKA change; suggesting that the greater alignment correction led to greater likelihood of failure. Postoperative orthoses had no impact on PJK.

Keywords: deformity; degenerative; sagittal alignment.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Methods for calculating the radiographic components of the Global Alignment and Proportion score. Relative pelvic version, relative lumbar lordosis, lordosis distribution index, and relative spinopelvic alignment are calculated based on the measured angle in relation to the ideal angle.
Figure 2.
Figure 2.
Each component of the Global Alignment and Proportion score includes a value based on the radiographic parameters as depicted in Figure 1 and an age component. Patients are given a score of each parameter, which are summarized as a total score (range 0-13) and further subcategorized. RPV, relative pelvic version; RLL, relative lumbar lordosis; LDI, lumbar distribution index; RSA, relative spinopelvic alignment.
Figure 3.
Figure 3.
T1-Upper Instrumented vertebra level and upper instrumented vertebra-pelvic angle were explored as candidate angles that may predict PJK.
See this image and copyright information in PMC

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