Proximal Junctional Kyphosis ICD-10, Definition, Symptoms, Causes, Treatment

Proximal Junctional Kyphosis (PJK) is a disease that can develop after spinal surgery, particularly after spinal fusion. It refers to the abnormal curvature of the spine at the point where the fused vertebrae meet the non-fused vertebrae. For those who experience PJK, it can lower overall quality of life by causing discomfort, pain, and functional limits. 

Proximal Junctional Kyphosis is caused by the stress imposed on the vertebrae adjacent to a spinal fusion. The fusion limits motion at the fused segment, increasing the load on the nearby vertebrae. The vertebrae may start to shift out of place with time as a result of this increased stress, giving the spine an unnatural curve.

Symptoms

Proximal Junctional Kyphosis symptoms can differ from person to person. Typical clinical manifestations include:

• Progressive upper back pain
• Stiffness and restricted mobility
• Increased thoracic kyphosis (hunchback look)
• neurological signs (in serious circumstances)
• Difficulty keeping a balanced position

Patients who have undergone spinal fusion surgery should be vigilant for these symptoms and seek medical attention if they experience any concerning signs related to Proximal Junctional Kyphosis.

Causes

The onset of Proximal Junctional Kyphosis is influenced by a number of variables. A few of these include

• Surgical technique and instrumentation used in spinal fusion surgery
• Low bone density and low bone integrity
• Misalignment of the spine and biomechanics
• Pre-existing sagittal imbalance
• Degenerative spinal alterations brought on by aging

It is crucial to highlight that not all people who have spinal fusion surgery acquire Proximal Junctional Kyphosis. Understanding the risk factors, on the other hand, can aid in identifying those who are predisposed to this condition.

Diagnsosis

Healthcare practitioners use a variety of diagnostic techniques to identify proximal junctional kyphosis, such as:

• Comprehensive medical history and physical examination
• CT scans, MRIs, and other imaging procedures
• Kyphotic angle and sagittal balancing parameters measurement
• Neurological evaluation to determine any related nerve impingement or dysfunction

These tests assist in verifying the diagnosis, assessing the condition's severity, and identifying the best course of treatment.

Treatment Options

Proximal Junctional Kyphosis can be treated non-surgically or surgically, depending on the severity and specific patient variables.

Non-surgical approaches

1. Options for non-surgical treatment might include:
2. Activity modification and rest
3. Strengthening and flexibility exercises using physical therapy
4. Strategies for reducing pain, such as drugs or injections
5. Using a spinal brace or other orthotic devices to support your spine

Surgical interventions

When non-surgical treatments are ineffective at symptom relief or when the condition is severe, surgical intervention may be required. Surgical options for Proximal Junctional Kyphosis include:

1. Revision surgery to improve spinal alignment and stabilize the damaged segment
2. Extending the instrumented fusion to cover additional vertebrae
3. Osteotomy, a surgery in which bone is cut out or reshaped to enhance alignment
4. Employing cutting-edge techniques like pedicle subtraction osteotomy or resecting the spinal column

ICD-10

M40.294 is the ICD-10 code for thoracic kyphosis. However, this code may not be specific to PJK and may not be enough for reimbursement.

Other ICD-10 codes for kyphosis include:

M40.00 – Postural kyphosis, site unspecified

M40.03 – Postural kyphosis, cervicothoracic region

M40.04 – Postural kyphosis, thoracic region