Economic Impact of Proximal Junctional Kyphosis

Proximal junctional kyphosis (PJK) is a common occurrence after posterior thoracolumbar instrumented spinal fusions for adult spinal deformity (ASD). Despite its relative frequency, PJK's economic impact has only recently gained appreciation and attention. On the basis of the available literature, direct costs associated with revision surgery for PJK range from similar to$20,000 to $120,000. The average direct costs for revision operations for PJK in the lower thoracic spine are similar to the costs for revision operations for PJK in the upper thoracic spine. Variability in costs may be attributable to variations in surgical strategies and individual hospital's postoperative care protocols and pricing. In the discussion to follow, the economic impact of PJK after operative intervention for ASD will be showcased by presenting it in the larger context of our health care system's focus on value-based care, the health burden of ASD, and quality and costs associated with ASD operations.