Abstract：
METHODS: Retrospective cohort.
OBJECTIVE: Determine effects of bracing on proximal junctional kyphosis (PJK) after adult deformity correction.
METHODS: Patients were identified from a single-surgeon dataset of posterior-only fusions for ASD (pelvis to UIV of T9-12) with a minimum of 1-year follow up. Starting in 2021, all lower thoracic fusions were braced using a hyperextension brace. Patients wore the brace at all times (unless in bed) for the first 6 weeks after surgery. A 1:1 propensity-match was performed based on age, number of levels, 3 column osteotomies, and magnitude of correction to identify a comparative non-braced cohort.
RESULTS: 141 patients (113 non-brace, 28 brace) were evaluated. After matching, 56 patients were identified to form similar cohorts. Non-matched and matched groups had no statistically significant differences in demographics, comorbid conditions, surgical characteristics (except shorter operative time and lower EBL in the braced group), and preoperative radiographic parameters. For the overall cohort, the change in proximal junctional angle at 1-year was higher in the non-braced group (7.6° vs 8.1°, P = .047), and non-braced patients had a higher incidence of PJK at 1-year in both the overall cohort (36% vs 14%, P = .045) and matched cohort (43% vs 14%, P = .038). There was no difference in proximal junctional failure between groups.
CONCLUSIONS: This pilot study shows that our protocol for extension bracing may reduce rates of PJK. These findings can form the basis for future multi-center trials examining the effect of extension bracing on junctional complications.
OBJECTIVE: Determine effects of bracing on proximal junctional kyphosis (PJK) after adult deformity correction.
METHODS: Patients were identified from a single-surgeon dataset of posterior-only fusions for ASD (pelvis to UIV of T9-12) with a minimum of 1-year follow up. Starting in 2021, all lower thoracic fusions were braced using a hyperextension brace. Patients wore the brace at all times (unless in bed) for the first 6 weeks after surgery. A 1:1 propensity-match was performed based on age, number of levels, 3 column osteotomies, and magnitude of correction to identify a comparative non-braced cohort.
RESULTS: 141 patients (113 non-brace, 28 brace) were evaluated. After matching, 56 patients were identified to form similar cohorts. Non-matched and matched groups had no statistically significant differences in demographics, comorbid conditions, surgical characteristics (except shorter operative time and lower EBL in the braced group), and preoperative radiographic parameters. For the overall cohort, the change in proximal junctional angle at 1-year was higher in the non-braced group (7.6° vs 8.1°, P = .047), and non-braced patients had a higher incidence of PJK at 1-year in both the overall cohort (36% vs 14%, P = .045) and matched cohort (43% vs 14%, P = .038). There was no difference in proximal junctional failure between groups.
CONCLUSIONS: This pilot study shows that our protocol for extension bracing may reduce rates of PJK. These findings can form the basis for future multi-center trials examining the effect of extension bracing on junctional complications.
摘要：
方法：回顾性队列。
目的：确定支撑对成人畸形矫正后近端交界性脊柱后凸(PJK)的影响。
方法：从ASD（T9-12的骨盆至UIV）的单外科医生数据集中确定患者，并至少随访1年。从2021年开始，所有下胸融合都使用过张支架进行支撑。患者在手术后的前6周内始终佩戴支具(除非在床上)。根据年龄进行1：1的倾向匹配，等级数,3柱截骨术，和校正幅度，以确定一个比较的非支撑队列。
结果：141例患者（113例非支撑，28支具）进行了评估。匹配后,56名患者被确定为类似的队列。非匹配组和匹配组的人口统计学差异无统计学意义，合并症条件，手术特点（除了较短的手术时间和较低的EBL在支架组），和术前影像学参数。对于整个队列，非支撑组1年时近端交界角的变化较高（7.6°vs8.1°，P=.047），在这两个整体队列中，未支撑的患者在1年时PJK的发生率更高(36%vs14%,P=0.045）和匹配队列（43%vs14%，P=.038）。组间近端交界失败没有差异。
结论：这项初步研究表明，我们的扩展支撑方案可能会降低PJK的发生率。这些发现可以为将来的多中心试验奠定基础，以检查伸展支撑对交界并发症的影响。
目的：确定支撑对成人畸形矫正后近端交界性脊柱后凸(PJK)的影响。
方法：从ASD（T9-12的骨盆至UIV）的单外科医生数据集中确定患者，并至少随访1年。从2021年开始，所有下胸融合都使用过张支架进行支撑。患者在手术后的前6周内始终佩戴支具(除非在床上)。根据年龄进行1：1的倾向匹配，等级数,3柱截骨术，和校正幅度，以确定一个比较的非支撑队列。
结果：141例患者（113例非支撑，28支具）进行了评估。匹配后,56名患者被确定为类似的队列。非匹配组和匹配组的人口统计学差异无统计学意义，合并症条件，手术特点（除了较短的手术时间和较低的EBL在支架组），和术前影像学参数。对于整个队列，非支撑组1年时近端交界角的变化较高（7.6°vs8.1°，P=.047），在这两个整体队列中，未支撑的患者在1年时PJK的发生率更高(36%vs14%,P=0.045）和匹配队列（43%vs14%，P=.038）。组间近端交界失败没有差异。
结论：这项初步研究表明，我们的扩展支撑方案可能会降低PJK的发生率。这些发现可以为将来的多中心试验奠定基础，以检查伸展支撑对交界并发症的影响。
