Posterior Ligamentous Reinforcement of the Upper Instrumented Vertebrae +1 Does Not Decrease Proximal Junctional...

Area of Science:

• Spine surgery
• Orthopedics
• Biomechanical engineering

Background:

• Proximal junctional kyphosis (PJK) is a complication of spinal fusion.
• Posterior soft tissue disruption is a suspected cause of PJK.
• Augmenting posterior ligamentous structures (PLS) may prevent PJK.

Purpose of the Study:

• To evaluate the efficacy of PLS augmentation in preventing PJK at one year.
• To assess the impact of PLS reconstruction on PJK rates in adult spinal deformity surgery.

Main Methods:

• Retrospective cohort study of 108 adult spinal deformity patients undergoing 5-level fusions.
• Patients were divided into PLS augmentation (PLS+) and no augmentation (PLS-) groups.
• Propensity matching and logistic regression controlled for confounding variables.

Main Results:

• No significant difference in PJK rates between PLS+ (27.3%) and PLS- (28.6%) groups.
• PLS augmentation did not impact PJK incidence after controlling for sagittal correction (29% vs 38.7%).
• Increased sagittal malalignment and failure to restore sagittal balance were predictors of PJK.

Conclusions:

• PLS reinforcement using nylon tape at UIV+1 does not reduce PJK incidence at one year.
• Surgical technique for PLS augmentation may influence outcomes.
• Focusing on sagittal balance restoration is crucial for PJK prevention.