A Novel Weave Tether Technique for Proximal Junctional Kyphosis Prevention in 71 Adult Spinal Deformity Patients: A Preliminary Case Series Assessing Early Complications and Efficacy

Abstract

BACKGROUND Proximal junctional kyphosis (PJK) rates may be as high as 69.4% after adult spinal deformity (ASD) surgery. PJK is one of the greatest unsolved challenges in long-segment fusions for ASD and remains a common indication for costly and impactful revision surgery. Junctional tethers may help to reduce the occurrence of PJK by attenuating adjacent-segment stress. OBJECTIVE To report our experience and assess early safety associated with a novel “weave-tether technique” (WTT) for PJK prophylaxis in a large series of patients. METHODS This single-center retrospective study evaluated consecutive patients who underwent ASD surgery including WTT between 2017 and 2018. Patient demographics, operative details, standard radiographic measurements, and complications were analyzed. RESULTS A total of 71 patients (mean age 66 ± 12 yr, 65% women) were identified. WTT included application to the upper-most instrumented vertebrae (UIV) + 1 and UIV + 2 in 38(53.5%) and 33(46.5%) patients, respectively. No complications directly attributed to WTT usage were identified. For patients with radiographic follow-up (96%; mean duration 14 ± 12 mo), PJK occurred in 15% (mean 1.8 ± 1.0 mo postoperatively). Proximal junctional angle increased an average 4° (10° to 14°, P = .004). Rates of symptomatic PJK and revision for PJK were 8.8% and 2.9%, respectively. CONCLUSION Preliminary results support the safety of the WTT for PJK prophylaxis. Approximately 15% of patients developed radiographic PJK, no complications were directly attributed to WTT usage, and the revision rate for PJK was low. These early results warrant future research to assess longer-term efficacy of the WTT for PJK prophylaxis in ASD surgery.

Commentary: A Novel Weave Tether Technique for Proximal Junctional Kyphosis Prevention in 71 Adult Spinal Deformity Patients: A Preliminary Case Series Assessing Early Complications and Efficacy

“…7 The authors report no complications directly related to the WTT and report a PJK rate of 15%. 7 Furthermore, the rates of symptomatic PJK and revision surgery due to PJK were reported to be 8.8% and 2.9%, respectively. 7 Other techniques have been described in the literature to address the development of PJK, including mitigating the proximal forces at the construct/native spine junction through the use of hooks, suture loops, sublaminar tapes, transition rods, and other tethers.…”

“…7 Furthermore, the rates of symptomatic PJK and revision surgery due to PJK were reported to be 8.8% and 2.9%, respectively. 7 Other techniques have been described in the literature to address the development of PJK, including mitigating the proximal forces at the construct/native spine junction through the use of hooks, suture loops, sublaminar tapes, transition rods, and other tethers. 2,[8][9][10] Additional approaches have been to harden the proximal vertebral level(s) above the construct with cement 11,12 or prophylactic rib fixation 13,14 to help withstand the increased forces generated by long constructs.…”

Failure in Adult Spinal Deformity Surgery

“…These systems thus provide semirigid fixation above the UIV, thereby distributing the force of fixation smoothly to the spinal levels cranial to the instrumentation. 141,142 Various configurations of the tether have been studied, 143,144 however there is no definitive data that any particular pattern is more effective at preventing PJK. In a series of studies, Safaee et al 133,[145][146][147] showed that ligament augmentation decreases the rate of PJK, independent of the use of hooks or other prevention strategies.…”

Comparison of staged LLIF combined with posterior instrumented fusion and posterior instrumented fusion alone for adult degenerative lumbar scoliosis with sagittal imbalance

“…Decompression ∘ alone or combined with limited instrumented fusion is usually performed in patients predominantly presented with radiculopathy or stenosis [5,6]. For ADLS with sagittal imbalance, long-segment posterior instrumented fusion (PIF) extending to the thoracic vertebra, even combined with three-column osteotomy, is traditionally performed, however, which is associated with major surgical trauma, high complication and even death [7].…”