Proximal junctional kyphosis

Fakhre, Edward; Kelly, Michael; Mo, Fred

doi:10.1016/j.semss.2022.100926

Cited by 2 publications

(2 citation statements)

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“…Two failure mechanisms constitute PJK/PJF: ligamentous failure and osseous failure [ 4 ]. Ligamentous failure often is due to iatrogenic alteration of the posterior supraspinous and interspinous ligaments, spinous process, and paraspinal musculature and can result in catastrophic subluxation at the proximal junction [ 4 – 9 ]. Osseous failure resulting in PJK/PJF presents with a fracture of the upper instrumented vertebrae (UIV) and/or fracture of the supra-adjacent vertebrae (UIV + 1) [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical analysis of a trans-discal, multi-level stabilization screw (MLSS) at the upper instrumented vertebra (UIV) of long posterior thoracolumbar instrumentations

Collins,

Shah,

Shekouhi

et al. 2024

Spine Deform

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Purpose To evaluate proximal junctional biomechanics of a MLSS relative to traditional pedicle screw fixation at the proximal extent of T10-pelvis posterior instrumentation constructs (T10-p PSF). Methods A previously validated three-dimensional osseoligamentous spinopelvic finite element (FE) model was used to compare proximal junctional range-of-motion (ROM), vertebral body stresses, and discal biomechanics between two groups: (1) T10-p with a T10-11 MLSS (“T10-11 MLSS”) and (2) T10-p with a traditional T10 pedicle screw (“Traditional T10-PS”). Results The T10-11 MLSS had a 5% decrease in T9 cortical bone stress compared to Traditional T10-PS. Conversely, the T10 and T11 bone stresses increased by 46% and 98%, respectively, with T10-11 MLSS compared to Traditional T10-PS. Annular stresses and intradiscal pressures (IDP) were similar at T9-T10 between constructs. At the T10-11 disc, T10-11 MLSS decreased annular stresses by 29% and IDP by 48% compared to Traditional T10-PS. Adjacent ROM (T8-9 & T9-10) were similar between T10-11 MLSS and Traditional T10-PS. T10-11 MLSS had 39% greater ROM at T10-11 and 23% less ROM at T11-12 compared to Traditional T10-PS. Conclusions In this FE analysis, a T10-11 MLSS at the proximal extent of T10-pelvis posterior instrumentation resulted in increased T10 and T11 cortical bone stresses, decreased discal annular stress and IDP and increased ROM at T10-11, and no change in ROM at the adjacent level. Given the complex and multifactorial nature of proximal junctional kyphosis, these results require additional biomechanical and clinical evaluations to determine the clinical utility of MLSS on the proximal junctions of thoracolumbar posterior instrumented fusions.

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Section: Introductionmentioning

confidence: 99%

“…Fracture patterns are heterogeneous, ranging from a compression fracture with mild kyphosis, severe UIV collapse, or fracture-dislocation of the UIV + 1 [ 4 ]. Translation instability is often clinically significant and commonly results in myelopathy necessitating revision surgery [ 9 ].…”

Section: Introductionmentioning

confidence: 99%