Prophylactic vertebral cement augmentation at the uppermost instrumented vertebra and rostral adjacent vertebra for the prevention of proximal junctional kyphosis and failure following long-segment fusion for adult spinal deformity

The Spine Journal : Official Journal of the North American Spine Society
George M GhobrialJoseph P Gjolaj

Abstract

Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common problems after long-segment (>5 levels) thoracolumbar instrumented fusions in the treatment of adult spinal deformity (ASD). No specific surgical strategy has definitively been shown to lower the risk of PJK as the result of a multifactorial etiology. The study aimed to assess the incidence of PJK and PJF in patients treated with prophylactic polymethylmethacrylate (PMMA) cement augmentation at the uppermost instrumented vertebrae (UIV) and rostral adjacent vertebrae (UIV+1). This is a retrospective cohort-matched surgical case series at an academic institutional setting. Eighty-five adult patients over a 16-year enrollment period were identified with long-segment (>5 levels) posterior thoracolumbar instrumented fusions for ASD. Primary outcomes measures were PJK magnitude and PJF formation. Secondary outcomes measures were spinopelvic parameters, as well as global and regional sagittal alignment. The impact of adjunctive PMMA use in long-segment (≥5 levels) fusion for ASD was assessed in adult patients aged 18 and older. Patients were included with at least one of the following: lumbar scoliosis >20°, pelvic tilt >25°, sagittal vertical axis >5...Continue Reading

Citations

Aug 4, 2018·Journal of Neurosurgery. Spine·Thomas J BuellShay Bess
Apr 11, 2019·JBJS Reviews·Aleksander P MikaEmmanuel N Menga
Apr 17, 2018·Annals of the Royal College of Surgeons of England·K DivaniS Molloy
Jan 23, 2021·The Spine Journal : Official Journal of the North American Spine Society·Remco J P DoodkortePaul C Willems
Jun 2, 2018·World Neurosurgery·Corinna C ZygourakisChristopher P Ames

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