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Proximal junctional failure combined with symptomatic thoracic disc herniation: a rare case report
Xuejun Zhang1,2, Lukas Klein1,2, Nils Mühlenfeld2
1Department of Spine Surgery, Loretto Study Group, Loretto-krankenhaus Freiburg, Freiburg, Germany.
Spine Deformity
|June 15, 2026
Summary
Proximal junctional failure (PJF) after spinal fusion can lead to acute thoracic disc herniation (TDH). Prompt surgical intervention and spinal stabilization are key for recovery and preventing neurological damage.
Area of Science:
- Spine surgery
- Neurosurgery
- Orthopedic surgery
Background:
- Proximal junctional failure (PJF) is a known complication following spinal fusion.
- Acute thoracic disc herniation (TDH) is a rare but serious neurological emergency.
- The relationship between PJF and subsequent TDH requires further investigation.
Purpose of the Study:
- To present a complex case of PJF.
- To highlight the association between PJF and acute TDH.
- To discuss the management and outcomes of such a case.
Main Methods:
- A case report detailing a 74-year-old female patient.
- The patient had a history of osteoporosis and rheumatoid arthritis.
- The case involved multiple spinal fusion and revision surgeries.
Main Results:
- The patient developed PJF two months after a T9-S1 fusion.
- She later presented with severe pain and neurological deficits (incomplete paraparesis, AIS grade C).
- Thoracic imaging revealed a T8 vertebral fracture and a T8/9 disc herniation causing spinal stenosis.
- Following revision surgery (T5-S1), her neurological function improved to AIS grade E with pain relief.
Conclusions:
- PJF can precipitate acute intervertebral disc herniation due to biomechanical stress.
- Restoring sagittal alignment and proactive spinal stabilization are critical.
- Early intervention is essential for protecting spinal cord function.
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