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Thread: joints after fusion

  1. #1
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    joints after fusion

    I would like to hear your thoughts on this:
    http://physicaltherapy.rehabedge.com...=1&key=&#51978

    namely:
    "considering the joints above and below will become pivot points"?

    and

    "The areas above and below the spinal fusion (over a period of time) tend to become hypermobile in an effort to compensate for lack of mobility at the fused level. " ??

    is this backed scientifically?

  2. #2
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    Quote Originally Posted by richardis View Post
    I would like to hear your thoughts on this:
    http://physicaltherapy.rehabedge.com...=1&key=&#51978

    namely:
    "considering the joints above and below will become pivot points"?

    and

    "The areas above and below the spinal fusion (over a period of time) tend to become hypermobile in an effort to compensate for lack of mobility at the fused level. " ??

    is this backed scientifically?
    Yes, look at PROXIMAL JUNCTIONAL KYPHOSIS on PubMed. There's enough research to fill a library.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  3. #3
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    Quote Originally Posted by LindaRacine View Post
    Yes, look at PROXIMAL JUNCTIONAL KYPHOSIS on PubMed. There's enough research to fill a library.
    Thanks for the reply, Linda. I wonder if I put too many pillows on my head to read on bed I may contribute to this. Do you think this is a risk factor?

    Changing subjects, is scoliosis more risk prone to flatback or PJK after surgery ?

  4. #4
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    Quote Originally Posted by richardis View Post
    Changing subjects, is scoliosis more risk prone to flatback or PJK after surgery ?
    Linda can answer both questions I think but as to this one, I am pretty sure it depends on which levels are fused.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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    "We are all African."

  5. #5
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    Quote Originally Posted by Pooka1 View Post
    Linda can answer both questions I think but as to this one, I am pretty sure it depends on which levels are fused.
    which ones are related to flatback and PJK?

  6. #6
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    Quote Originally Posted by richardis View Post
    which ones are related to flatback and PJK?
    Once again, Linda would know best. I can tell you what I think I have observed on the group.

    Flatback is relatively rare now with the newer instrumentation but was a problem for the Harrington rods that traversed the lumbar or part of the lumbar.

    PJK seems to be a potential problem for lumbar fusions that end at about T10. I think there have been people on the group who needed revision to end at T4 due to PJK. Also people fused high into the thorax I think are at risk for PJK.

    Let's see what Linda says.

    My daughters are fused T4 to L1 which is not known to be at high risk for PJK. And since they are not fused through the lumbar and have a normal lumbar lordosis, I think PJK is ruled out completely but I really don't know.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  7. #7
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    Not sure why it's important. Are you hoping for one more than another? ;-)

    According to a meta analysis published in August (and available on PubMed), there is about a 30% overall incidence of PJK. That number can vary greatly based on things like age, BMD, BMI, and proximal fusion level.

    As far as I know, there is no meta analysis for flatback. And, most studies on flatback include degenerative flatback, which inflates the amount of flatback by a considerable amount. Iatrogenic (caused by medical treatment) flatback still occurs today, especially when the surgeons do a lot less deformity surgery and those who aren't adequately trained. However, even the best surgeons probably cause at least a couple of cases every year.

    Anyway, to answer your question, I'm certain that PJK is far more common than flatback.

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  8. #8
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    I can't remember where I heard or read it but some surgeons singled out PJK as one of the major complications in fusion surgery.

    But that said, I think many if not most cases are in older patients, especially those fused thru the lumbar and into the thorax. I have never heard a case on the group or anywhere of a young person with a "common" thoracic fusion getting PJK. Thoracic curves are the most prevalent and also the most likely to progress so they make up a large fraction of fusions in younger people.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  9. #9
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    Quote Originally Posted by Pooka1 View Post
    I can't remember where I heard or read it but some surgeons singled out PJK as one of the major complications in fusion surgery.

    But that said, I think many if not most cases are in older patients, especially those fused thru the lumbar and into the thorax. I have never heard a case on the group or anywhere of a young person with a "common" thoracic fusion getting PJK. Thoracic curves are the most prevalent and also the most likely to progress so they make up a large fraction of fusions in younger people.
    It happens...

    http://www.ncbi.nlm.nih.gov/pubmed/20081513
    http://www.ncbi.nlm.nih.gov/pubmed/18007253
    http://www.ncbi.nlm.nih.gov/pubmed/16166893
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

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