Ligament augmentation for prevention of proximal junctional kyphosis and proximal junctional failure in grownup spinal deformity.
J Neurosurg Backbone. 2018 Feb 23;:1-Eight
Authors: Safaee MM, Deviren V, Dalle Ore C, Scheer JK, Lau D, Osorio JA, Nicholls F, Ames CP
OBJECTIVE Proximal junctional kyphosis (PJK) is a well-recognized, but incompletely outlined, complication of grownup spinal deformity surgical procedure. There is no such thing as a standardized definition for PJK, however most research describe PJK as a rise within the proximal junctional angle (PJA) of higher than 10°-20°. Ligament augmentation is a novel technique for PJK discount that gives energy to the higher instrumented vertebra (UIV) and adjoining segments whereas additionally lowering junctional stress at these ranges. METHODS On this research, ligament augmentation was utilized in a consecutive sequence of grownup spinal deformity sufferers at a single establishment. Affected person demographics, together with age; intercourse; indication for surgical procedure; revision surgical procedure; surgical strategy; and use of Three-column osteotomies, vertebroplasty, or hook fixation on the UIV, had been collected. The PJA was measured preoperatively and eventually follow-up utilizing 36-inch radiographs. Information on change in PJA and want for revision surgical procedure had been collected. Univariate and multivariate analyses had been carried out to determine elements related to change in PJA and proximal junctional failure (PJF), outlined as PJK requiring surgical correction. RESULTS A complete of 200 consecutive sufferers had been included: 100 sufferers earlier than implementation of ligament augmentation and 100 sufferers after implementation of this system. The imply age of the ligament augmentation cohort was 66 years, and 67% of sufferers had been ladies. Over half of those instances (51%) had been revision surgical procedures, with 38% involving a mixed anterior or lateral and posterior strategy. The imply change in PJA was 6° within the ligament augmentation group in contrast with 14° within the management group (p < zero.001). Eighty-four sufferers had a change in PJA of lower than 10°. In a multivariate linear regression mannequin, age (p = zero.016), use of hook fixation on the UIV (p = zero.045), and use of ligament augmentation (p < zero.001) had been related to a change in PJA. In a separate mannequin, solely ligament augmentation (OR zero.193, p = zero.012) confirmed a major affiliation with PJF. CONCLUSIONS Ligament augmentation represents a novel approach for the prevention of PJK and PJF. In contrast with a well-matched historic cohort, ligament augmentation is related to a major lower in PJK and PJF. These information assist the implementation of ligament augmentation in surgical procedure for grownup spinal deformity, notably in sufferers with a excessive threat of creating PJK and PJF.
PMID: 29473789 [PubMed – as supplied by publisher]