Proximal Junction Kyphosis

I first met Barbara, a 54 year old woman, 6 months after her third spinal fusion. She initially felt somewhat better after her last surgery, but the last 3-4 months have been miserable. She has had more back pain and numbness in her legs. I found that she had difficulty standing up straight and walking. We reviewed her imaging together.

Barbara’s X-rays show a condition called proximal junction kyphosis. This means the spine has fallen forward out of alignment just above a fusion.

There are a few things patients should know about proximal junctional kyphosis:

1. Following a spinal fusion, care should be taken to maintain an upright posture. We have used the catch phrase, “Think Tall.”

2. Kyphosis after a fusion occurs more commonly in patients with osteoporosis, fusions stopping between the thoracic and lumbar spine, and long or multilevel fusions.

3. The problem usually occurs within the first few months after surgery.

4. Proximal junctional kyphosis is a significant complication of spine surgery.

We are planning to extend Barbara’s fusion. Unfortunately, her best solution at this point is probably yet another fusion. Fortunately, most patients do not end up having multiple fusions like this. However, for Barbara this has been a very disappointing complication.

Disclaimer: Although this is a real patient, I have used a different name for privacy protection and added a few details for educational purposes. This patient gave consent to have his case shared.

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