Sungkyunkwan University · Medicine
Professor Se-Jun Park's research lab specializes in spinal deformity surgery and spinal alignment, with a strong focus on understanding and preventing postoperative complications such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). The lab investigates patient-specific risk factors, including body mass index, age, osteoporosis, pelvic incidence, and preoperative sagittal vertical axis, to optimize surgical outcomes. They also explore biomechanical principles in instrumented spinal fusion, particularly the role of cage positioning in maintaining sagittal alignment and indirect neural decompression. Their work emphasizes individualized surgical planning based on age-adjusted spinal alignment targets to reduce overcorrection and improve long-term clinical results.
Figures are computed from collected data and may differ slightly.
PJK developed at a median of 17 months and PJF at a median of 3 months. A high body mass index was an independent risk factor for PJK, whereas older age, osteoporosis, uppermost instrumented vertebra level at the thoracolumbar junction, and greater preoperative sagittal vertical axis were risk factors for PJF.
The cage position within the anterior 1/3 of disk space is better for achieving the restoration of the SA without compromising the indirect neural decompression, if the height of cage is large enough.
3.
Overcorrection relative to age-adjusted sagittal alignment increases the risk of PJF development and is associated with poor clinical outcomes. Older patients and those with small PI are likely to be overcorrected in terms of the age-adjusted PI-LL target. Therefore, the age-adjusted alignment should be considered more strictly in these patients.
4.
SPFF develops in different patterns with different risk factors. Above-S1 SPFF was associated with nonunion at L5-S1, while below-S1 SPFF was associated with mechanical stress.
Bony failure with PJA of greater than 22° increased the likelihood for revision surgery. Therefore, early surgical intervention should be considered in these patients.Level of Evidence: 4.
Even if PJK was asymptomatic at initial development, it progressed radiographically with time and eventually gave a negative impact on the clinical outcomes in long-term follow-up.Level of Evidence: 3.
The current study reported successful outcomes with very low complication rates after nonfusion surgery for patients with spinal metastases, even among those who survived for more than 6 months. More than half of the instrumentation-related complications were asymptomatic and did not require revision. The results suggest that nonfusion surgery might be sufficient for a majority of patients with spinal metastases.
In patients younger than 70 years, a greater change in LL was associated with PJF development regardless of PI-related values. However, in older patients, overcorrection of PI-LL relative to the age-adjusted PI-LL target was a significant risk factor of PJF.
The present study indicates that osteoporosis should be well corrected preoperatively and extending the fusion above T10 should be considered for severe imbalance in old patients. However, the amount of correction was not associated with PJF development.
De novo scoliosis developed in 3.7% and scoliosis progressed in 16.4% of the patients during rhGH treatment. However, scoliosis development or progression was not affected by the types or duration of rhGH treatment in patients with ISS.
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