Proximal junctional failure prevention in adult spinal deformity surgery utilizing interlaminar fixation constructs

Proximal junctional kyphosis (PJK) is a common complication following fusion for Adult Spinal Deformity. PJK and proximal junctional failure (PJF) may lead to pain, neurological injury, reoperation, and increased healthcare costs. Efforts to prevent PJK and PJF have aimed to preserve or reconstruct the posterior spinal tension band and/or modifying instrumentation to allow for more gradual transitions in stiffness at the cranial end of long spinal constructs. We describe placement of an interlaminar fixation construct at the upper instrumented vertebra which may decrease PJK/PJF severity, and is placed with little additional operative time and minimal posterior soft tissue trauma.

[1]  Justin K Scheer,et al.  Ligament augmentation for prevention of proximal junctional kyphosis and proximal junctional failure in adult spinal deformity. , 2018, Journal of neurosurgery. Spine.

[2]  G. Gosheger,et al.  Is a gradual reduction of stiffness on top of posterior instrumentation possible with a suitable proximal implant? A biomechanical study. , 2017, The spine journal : official journal of the North American Spine Society.

[3]  A. Jakoi,et al.  Semitendinosus Graft for Interspinous Ligament Reinforcement in Adult Spinal Deformity. , 2017, Orthopedics.

[4]  Alexander W. L. Turner,et al.  The effect of posterior polyester tethers on the biomechanics of proximal junctional kyphosis: a finite element analysis. , 2017, Journal of neurosurgery. Spine.

[5]  V. Patel,et al.  Preventing Proximal Adjacent Level Kyphosis With Strap Stabilization. , 2016, Orthopedics.

[6]  John C. Liu,et al.  Biomechanical Analysis of the Proximal Adjacent Segment after Multilevel Instrumentation of the Thoracic Spine: Do Hooks Ease the Transition? , 2015, Global spine journal.

[7]  C. Aubin,et al.  Biomechanical Risk Factors for Proximal Junctional Kyphosis: A Detailed Numerical Analysis of Surgical Instrumentation Variables , 2014, Spine.

[8]  S. Burch,et al.  Hospital Readmission After Spine Fusion for AdultSpinal Deformity , 2013, Spine.

[9]  Samuel K. Cho,et al.  Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle. , 2013, Neurosurgery.

[10]  Munish C. Gupta,et al.  Incidence, Mode, and Location of Acute Proximal Junctional Failures After Surgical Treatment of Adult Spinal Deformity , 2013, Spine.

[11]  L. Lenke,et al.  Does a Long-Fusion “T3-Sacrum” Portend a Worse Outcome Than a Short-Fusion “T10-Sacrum” in Primary Surgery for Adult Scoliosis? , 2012, Spine.

[12]  R. Betz,et al.  Evaluation of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Following Pedicle Screw, Hook, or Hybrid Instrumentation , 2010, Spine.

[13]  L. Lenke,et al.  Proximal Junctional Kyphosis in Adult Spinal Deformity Following Long Instrumented Posterior Spinal Fusion: Incidence, Outcomes, and Risk Factor Analysis , 2005, Spine.