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

• Published in: Operative neurosurgery (Hagerstown, Md.) Vol. 21; no. 6; pp. 393 - 399
• Main Authors: Rabinovich, Emily P, Buell, Thomas J, Sardi, Juan P, Lazaro, Bruno C R, Shaffrey, Christopher I, Smith, Justin S
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-12-2021; Wolters Kluwer Health, Inc
• Subjects: Adult; Aged; Back surgery; Bone surgery; Disease prevention; Female; Humans; Kyphosis - diagnostic imaging; Kyphosis - etiology; Kyphosis - surgery; Ligaments; Male; Medical records; Middle Aged; Neurosurgery; Patients; Postoperative Complications - etiology; Range of motion; Retrospective Studies; Scoliosis; Spinal Fusion - methods; Spine - surgery; Vertebrae; Early complications; Adult spinal deformity surgery; Junctional tethers; Proximal junctional kyphosis
• ISSN: 2332-4252; 2332-4260
• DOI: 10.1093/ons/opab305

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.