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Vertebral Cement Augmentation is Associated With Reduced Rates of Proximal Junctional Failure in Adult Spinal
Stavros Matsoukas1,2, Shaan Patel3, Pavlos Texakalidis4
1Department of Neurosurgery, Thomas Jefferson University, Jefferson Hospital for Neuroscience, Philadelphia , Pennsylvania , USA.
Background And Objectives:
Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common complications after adult spinal deformity (ASD) surgery, with reported rates ranging from 17% to 61.7%. Vertebral cement augmentation (VCA) at upper instrumented vertebra (UIV) or UIV + 1 has been proposed as a preventive strategy to mitigate these complications.
Methods:
In this Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis we searched Medline and Embase to identify studies comparing VCA vs no VCA on rates of PJK and PJF in patients undergoing ASD surgery. Secondary outcomes on spinal alignment data were extracted. Most studies defined PJK as increase of ≥10° in sagittal Cobb angle from UIV to UIV + 2 compared with preoperative measurement. Need for revision surgery for PJK was defined as PJF.
Results:
Eight studies comprising 1211 patients (VCA = 355, no VCA = 856) were included. The mean age of the VCA group was slightly higher (mean differences [MD] = 5.2, 95% CI: 1.8-8.6, P = .003), while body mass index and smoking rates were comparable. The VCA group had a higher prevalence of osteoporosis (56.3% vs 46.8%, odds ratio [OR]: 3.8, P < .001). Preoperative sagittal vertical axis (MD = 0.1, 95% CI: -0.8 to 2.1, I 2 : 0%, P = .9), postoperative sagittal vertical axis (MD = 0.9, 95% CI: -0.7 to 2.4, I 2 : 0%, P = .3) and overcorrection rates (VCA = 60%, no VCA = 63%, OR: 1, 95% CI: 0.6-1.3, I 2 : 0%, P = .9) were comparable between groups. Mean follow-up ranged between 14.8 and 45 months. Although there was a trend toward lower PJK rates in the VCA group (22.8% vs 29.4%, OR: 0.6, P = .1), statistical significance was not reached. However, VCA was associated with a significantly lower risk of PJF requiring surgical revision (6.8% vs 13.3%, OR: 0.4, P = .02).
Conclusion:
The use of VCA was associated with lower risk of PJF in ASD surgery patients, but its impact on PJK was inconclusive, with mean follow-up 14.8 to 45 months. Further high-quality prospective studies are warranted to validate these findings and optimize patient selection for VCA in ASD surgery.
