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Revision surgery for proximal junctional failure: A single-center analysis.
Samuel Adida1, Joseph S Hudson2, Andrew D Legarreta2
1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213, USA.
Proximal junctional failure (PJF) after adult spinal deformity surgery often requires revision, with recurrent PJF being the most common complication. Understanding failure mechanisms and optimizing revision strategies are crucial for better patient outcomes.
Area of Science:
- Spine surgery
- Orthopedics
- Deformity correction
Background:
- Proximal junctional kyphosis (PJK) is a complication of adult spinal deformity (ASD) surgery.
- Proximal junctional failure (PJF) involves structural failure, neurological deficit, or instability at the upper instrumented vertebra (UIV).
- This study examines PJF in ASD patients fused to the pelvis.
Purpose of the Study:
- To investigate the clinical presentation of PJF.
- To analyze mechanisms of PJF and identify revision strategies.
- To evaluate outcomes for ASD patients experiencing PJF.
Main Methods:
- Retrospective analysis of 54 ASD patients with PJF after posterior instrumented fusion to the pelvis.
- PJF defined by radiographic PJK with UIV/UIV+1 fracture, screw pullout, or ligamentous disruption, plus neurological deficit.
- Cohort stratified by UIV location: upper thoracic (UT), lower thoracic (LT), and lumbar (L).
Main Results:
- PJF occurred at a median of 14 months post-surgery, with neurological deficits common.
- Mechanisms varied by UIV location: vertebral fracture/screw pullout in LT/L, soft-tissue disruption in UT.
- 48% required second revision, 28% for recurrent PJF; risk factors for recurrence were not identified.
Conclusions:
- Recurrent PJF is the most frequent complication after revision surgery for PJF in ASD patients.
- Failure mechanisms differ based on UIV location, influencing revision strategies.
- Further research is needed to identify risk factors and preventative measures for recurrent PJF.
