Posterior Ligamentous Reinforcement of the Upper Instrumented Vertebrae +1 Does Not Decrease Proximal Junctional Kyphosis in Adult Spinal Deformity

Abstract

Study Design: Retrospective cohort study.Objectives: Violation of the posterior soft tissues is believed to contribute to the development of proximal junctional kyphosis (PJK). Biomechanical and clinical studies suggest that augmentation of the posterior ligamentous structures (PLS) may help prevent PJK. The purpose of this study was to evaluate the effect of PLS augmentation on the rate of PJK at 1 year. Methods: A retrospective single-surgeon cohort study was performed of 108 adult spinal deformity patients who underwent 5 level fusions to the pelvis. Patients were divided into 2 groups: PLS+ patients had reconstruction of the PLS between upper instrumented vertebrae +1 (UIV+1) and UIVÀ1 with a surgical nylon tape while PLSÀ patients did not. Demographics, surgical data, and sagittal alignment parameters were compared between the cohorts. The primary outcome of interest was the development of PJK at final follow-up. A subgroup propensity match and logistic regression model were utilized to control for differences in the cohorts. Results: A total of 108 patients met final criteria, 31 patients (28.7%) were PLS+. There were no differences with regard to preoperative or final sagittal alignment parameters, number of levels fused, rates of 3-column osteotomies, and body mass index (P > .05), though the PLS+ cohort was older and had larger initial sagittal corrections (P < .05). The rates of PJK for PLS+ (27.3%) and PLSÀ (28.6%) were similar (P ¼ .827). After controlling for sagittal correction via propensity matching, PLS+ had no impact on PJK (29% vs 38.7%, P ¼ .367). In our multivariate analysis, only increased sagittal malalignment and failure to restore sagittal balance were retained as significant predictors of PJK. Conclusion: Even after controlling for extent of correction and preoperative sagittal alignment, PLS reinforcement at UIV+1 using a hand-tensioned nylon tape does not reduce the incidence of PJK at 1 year.

Ligament Augmentation With Mersilene Tape Reduces the Rates of Proximal Junctional Kyphosis and Failure in Adult Spinal Deformity

“…Surgical nylon tape and semitendinosus allograft have also been used to reinforce the posterior ligamentous structures. 21,22 Similar to our results, Rodriguez-Fontan et al 20 reported an increased latent period to development of PJD of 20 months in an augmented cohort, compared to 7.5 months in the control group (p = 0.018). This study is not without limitations.…”

Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies

“…For each study, PJK incidence, Revision Rate for PJK (RR), PJF incidence, reported clinical outcomes and complications were reported in Table 3. Twelve of the included studies reported on PJK incidence, 28-31,33-36,38,39,41,43 10 on revision rate for PJK, 28-31,33,35,36,38,39,41 13 on PJF incidence, 29,32,34-40,42-45 5 on any clinical outcome measure 28,38,40,41,45 and 10 on complications. 28-30,35-39,41,45 Four studies 28-30,37,45 did not elaborate on the type of complications, and could thus not be converted to the classification of Glassman et al 27 If reported, the clinical outcome measures were further elucidated in Table 4.…”

“…Thirteen of the studies compared the intervention to a control group, consisting of patients treated with pedicle screws at the UIV (PS). 28,29,[31][32][33][34][35][36][37][40][41][42][43] The minimal follow-up duration was 12 months. All study characteristics are presented in Table 1.…”

Revision Surgery Due to Proximal Junctional Failure and Rod Fracture in Adult Deformity Surgery at a Single Institution in Japan

“…Previous studies have described various risk factors for PJF after corrective fusion for ASD [10][11][12][13][14][15] . Damage to the Spine Surgery and Related Research J-STAGE Advance Publication (February 10, 2022) Ⓒ The Japanese Society for Spine Surgery and Related Research.…”