An Innovative Technique of Revision Surgery for Distal Junctional Failure

Distal junctional kyphosis (DJK) or the adding-on phenomenon is one of the most challenging complications following long fusion for adolescent idiopathic scoliosis (AIS) or adult spinal deformity (ASD). Among these complications, distal junctional failure (DJF) is defined as a condition requiring revision surgery due to severe symptoms such as intense low back pain, myelopathy, and difficulty in standing and walking. Three patients developed severe lower back pain due to DJF, and two patients underwent revision surgery with a new technique. Surgical outcomes, surgical time, intraoperative blood loss, and operative complications were evaluated. Two patients underwent revision surgery with a novel method for revising distal screw loosening without excessive distal extension. There was no complication, and two patients had solid bony fusion at a two-year follow-up. The revision surgery for type 1 DJK can be challenging because the conventional pedicle screw technique is not feasible for the lower instrumented vertebra, and a more extended distal fusion is required. The adoption of O-arm-guided transdiscal screw fixation has significant clinical implications. This technique also increases accuracy in screw placement, mitigating the risks associated with traditional revision methods and preserving motion segments.