The effect of prophylactic vertebroplasty on the incidence of proximal junctional kyphosis and proximal junctional failure following posterior spinal fusion in adult spinal deformity: a 5-year follow-up study

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

“…More recent, longer-term data, however, suggests that while cement augmentation might reduce the risk of junctional failure in the early postoperative period, it does not reduce the incidence of PJK at 5 years. 10 It should also be noted that vertebral augmentation is not without risk; the cost of augmentation as well as load transfer to adjacent vertebrae are factors that must be considered. 32 Another surgical tactic to prevent PJK might be more judicious correction.…”

Prospective assessment of the safety and early outcomes of sublaminar band placement for the prevention of proximal junctional kyphosis

“…Enhanced PJ anterior column support with UIV/ UIV+1 vertebroplasty is another intriguing option but recently was shown not to convincingly reduce PJK or PJF rates at 5 years postoperatively; instead, the increased anterior column support appears to delay the occurrence of PJK beyond the usual early period. 38,46 Despite the low incidence of PJK in our sublaminar band cohort, we observed that mean PJ Cobb angles significantly increased at the immediate postoperative time point as compared with preoperative values; however, the angles subsequently stabilized with no significant difference between the final follow-up and the immediate postoperative values. In contrast, PJ Cobb angles have been shown to successively increase over time in patients who develop PJK with pedicle screw-only constructs.…”

“…Study limitations include an absence of randomization and comparisons that are limited to findings in the previously published literature, which can introduce confounding effects related to patient characteristics and surgical techniques (for example, the proportion of patients implanted with stiffer cobalt-chrome rods). As with the recent experience with prophylactic vertebroplasty, 46 it remains to be seen whether our early results at the 1-year median follow-up (3 patients with a 3-month follow-up, 11 patients with a 6-month follow-up, and 26 patients with a 1-year follow-up) will be maintained over the long term. Finally, our analysis does not exclude the possibility of added PJK prevention related to perioperative teriparatide treatment, which was administered in 6 patients.…”

“…3,7,8,21,24,25,37,40,42,52,60 Prophylactic UIV and UIV+1 vertebroplasty has recently been assessed in a cohort of patients undergoing surgery for ASD. 36,46 Despite the anterior column supplementation and likely transition zone widening, this technique did not directly mitigate the persistently elevated stresses across the PJ posterior elements. Thus, while the incidence of PJF remained stable at 5.1% in that series, the development of PJK was primarily delayed beyond the usual early (< 3 months) time period as the reported 2-year and 5-year rates were 8% and 28.2%, respectively.…”

“…Thus, while the incidence of PJF remained stable at 5.1% in that series, the development of PJK was primarily delayed beyond the usual early (< 3 months) time period as the reported 2-year and 5-year rates were 8% and 28.2%, respectively. 38,46 The posterior ligamentous complex acts as a primary constraint against pathological flexion stresses. Biomechanical studies have demonstrated that forward angulation is significantly increased when this restraint is lost.…”