Potential evaluation of the protection and early outcomes of sublaminar band placement for the prevention of proximal junctional kyphosis.
J Neurosurg Backbone. 2018 Feb 09;:1-12
Authors: Viswanathan VK, Kukreja S, Minnema AJ, Farhadi HF
OBJECTIVE Proximal junctional kyphosis (PJK) can progress to proximal junctional failure (PJF), a widely known early and critical complication of multisegment spinal instrumentation for the therapy of grownup spinal deformity (ASD). Sublaminar band placement has been recommended as a potential method to forestall PJK and PJF however carries the theoretical risk of a paradoxical improve in these issues because of the required muscle dissection and posterior ligamentous disruption. On this examine, the authors prospectively assess the protection in addition to the early medical and radiological outcomes of sublaminar band insertion on the higher instrumented vertebra (UIV) plus 1 degree (UIV+1). METHODS Between August 2015 and February 2017, 40 consecutive sufferers underwent both higher (T2-Four) or decrease (T8-10) thoracic sublaminar band placement on the UIV+1 throughout long-segment thoracolumbar arthrodesis surgical procedure. End result measures had been prospectively collected and uploaded to a web-based REDCap database particularly designed to incorporate demographic, medical, and radiological information. All sufferers underwent medical evaluation, in addition to radiological evaluation with anteroposterior and lateral 36-inch whole-spine standing radiographs each pre- and postoperatively. RESULTS Forty sufferers (24 girls and 16 males) had been included on this examine. Median age at surgical procedure was 64.Zero years with an IQR of 57.7-70.Zero years. Median follow-up was 12 months (IQR 6-15 months). Three procedure-related issues had been famous, together with 2 intraoperative cerebrospinal spinal fluid leaks and 1 transient neurological deficit. Median visible analog scale (VAS) scores for again ache considerably improved after surgical procedure (preoperatively: eight.Zero, IQR 6.Zero-10.Zero; 1-year follow-up: 2.Zero, IQR Zero.Zero-6.Zero; p = Zero.001). Median Oswestry Incapacity Index (model 2.1a) scores additionally considerably improved after surgical procedure (preoperatively: 56.Zero, IQR 45.Zero-64.Zero; 1-year follow-up: 46.Zero, IQR 22.2-54.Zero; p < Zero.001). Sagittal vertical axis (preoperatively: 9.Zero cm, IQR 5.Three-11.6 cm; ultimate follow-up: Four.7 cm, IQR 2.Zero-6.6 cm; p < Zero.001), pelvic incidence-lumbar lordosis mismatch (24.7°, IQR 11.2°-31.2°; 7.7°, IQR -1.2° to 19.5°; p < Zero.001), and pelvic tilt (28.7°, IQR 20.Four°-32.6°; 17.1°, IQR 10.eight°-25.2°; p < Zero.001) had been all improved on the ultimate follow-up. Whereas proximal junctional (PJ) Cobb angles elevated total on the ultimate follow-up (preoperatively: Four.2°, IQR 1.9°-7.Four°; ultimate follow-up: eight.Zero°, IQR 5.eight°-10.Three°; p = Zero.002), the numerous improve was primarily famous beginning on the rapid postoperative time level (7.2°, IQR Four.Four°-11.eight°; p = Zero.001) and never past. Three sufferers (7.5%) developed radiological PJK (imply ?PJ Cobb 15.5°), whereas there have been no cases of PJF on this cohort. CONCLUSIONS Sublaminar band placement on the UIV+1 throughout long-segment thoracolumbar instrumented arthrodesis is comparatively protected and isn’t related to an elevated fee of PJK. Furthermore, no topics developed PJF. Potential large-scale and long-term evaluation is required to outline the potential advantage of sublaminar bands in decreasing the incidence of PJK and PJF following surgical procedure for ASD. Medical trial registration no.: NCT02411799 (clinicaltrials.gov).
PMID: 29424677 [PubMed – as supplied by publisher]