Semitendinosus Tendon Augmentation for Prevention of Proximal Junctional Failure

Abstract

Study Design. Retrospective cohort study. Objective. The aim of this study was to compare the incidence of proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and clinical outcomes of patients who did and did not receive posterior ligament complex (PLC) augmentation using a semitendinosus allograft when undergoing long-segment posterior spinal fusion for adult spinal deformity. Summary of Background Data. Clinical research on the augmentation of the PLC to prevent PJK and PJF has been limited to small case series without a comparable control group. Methods. From 2014 to 2019, a consecutive series of patients with adult spinal deformity who underwent posterior long-segment spinal fusion with semitendinosus allograft to augment the PLC (allograft) or without PLC augmentation (control) were identified. Preoperative and postoperative spinopelvic parameters were measured. PJK, PJF, and Oswestry Disability Index (ODI) scores were recorded and compared between the two groups. Univariate and multivariate analysis was performed. P ≤ 0.05 was considered significant. Results. Forty-nine patients in the allograft group and 34 patients in the control group were identified. There were no significant differences in demographic variables or operative characteristics between the allograft and control group. Preoperative and postoperative spinopelvic parameters were also similar between the two groups. PJK was present in 33% of patients in the allograft group and 32% of patients in the control group (P = 0.31). PJF did not occur in the allograft group, whereas six patients (18%) in the control group developed PJF (P = 0.01). Postoperative absolute ODI was significantly better in the allograft group (P = 0.007). Conclusion. The utilization of semitendinosus allograft tendon to augment the PLC at the upper instrumented vertebrae in patients undergoing long-segment posterior spinal fusion for adult deformity resulted in a significant decrease in PJF incidence and improved functional outcomes when compared to a cohort with similar risk of developing PJK and PJF Level of Evidence: 3

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.…”

“…Of the included studies, 4 were prospective- and 14 were retrospective cohort studies. The studies that were included reported on tether fixation, 28 - 34 prophylactic 2-level vertebroplasty (2-PVP), 32 , 35 - 40 transverse process hooks (TPH), 32 , 41 , 42 flexible rods (FR), 43 multilevel stabilization screw (MLSS), 44 and sublaminar tapes (ST). 45 These surgical techniques are schematically illustrated in Figure 1 .…”

“… 32 , 37 , 39 , 41 , 44 In the remaining 13 studies, additional interventions were performed (osteotomies, hooks, vertebroplasty, sublaminar taping, additional fusion or decompression). 28 - 31 , 33 - 36 , 38 , 40 , 42 , 43 , 45 The mean number of fused segments in the included studies ranged between 6.7 and 16.0 levels, and the constructs ended distally in the sacrum for the majority of patients.…”

“…Twelve of the included studies reported on PJK incidence, [28][29][30][31][33][34][35][36]38,39,41,43 10 on revision rate for PJK, [28][29][30][31]33,35,36,38,39,41 13 on PJF incidence, 29,32,[34][35][36][37][38][39][40][42][43][44][45] 5 on any clinical outcome measure 28,38,40,41,45 and 10 on complications. [28][29][30][35][36][37][38][39]41,45 Four studies [28]…”

“…Alluri et al 2020 28 Buell et al 2018 29 Buell et al 2019 30 Ghobrial et al 2017 35 Han et al 2019 36 Hart et al 2008 37 Hassanzadeh et al 2013 41 Iyer et al 31 Lee et al 2019 43 Line et al 2020 32 Matsumura et al 2018 42 Martin et al 2013 38 Raman et al 2017 39 Rodriguez-Fontan et al 2019 34 Safaee et al 2018 33 * Indicates that the mentioned study has reported these values as significantly different between groups.…”