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Nontraumatic Proximal Junctional Kyphosis with Catastrophic Neurologic Deficits After Instrumented Arthrodesis in an Adolescent with Cerebral PalsyCase Report and Review of the Literature
Daniel Cruz, MD1; Sergio Mendoza-Lattes, MD2; Stuart L. Weinstein, MD2
1 Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario La Fe Valencia, Avenida Bulevar Sur s/n, Valencia, 46026, Spain. E-mail address: dr.jdcruz@gmail.com
2 Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, 01026 JPP, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for S. Mendoza-Lattes: sergio-mendoza@uiowa.edu. E-mail address for S.L. Weinstein: stuart-weinstein@uiowa.edu
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Investigation performed at the Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jun 12;3(2):e58 1-5. doi: 10.2106/JBJS.CC.L.00326
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Extract

Children with cerebral palsy frequently present with complex and progressive spinal deformities that often require surgical treatment1,2. The Luque-Galveston technique, along with arthrodesis, has been the most common technique used3-5. The incidence of proximal junctional kyphosis (PJK) in adults and adolescents with spinal deformity is high, ranging from 26% to 46% in recent studies1,6-10. Published series of scoliotic patients with cerebral palsy show smaller percentages of PJK (<2% to 25%), and none reported any neurologic complications1-3,8-12. We present a case of a catastrophic neurologic deficit associated with PJK in a patient with cerebral palsy and neuromuscular scoliosis.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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