PDF(Pubmed)
Abstract：
Background and Objectives: Proximal junctional kyphosis (PJK) and failure (PJF), the most prevalent complications following long-segment thoracolumbar fusions for adult spinal deformity (ASD), remain lacking in defined preventive measures. We studied whether one of the previously reported strategies with successful results-a prophylactic augmentation of the uppermost instrumented vertebra (UIV) and supra-adjacent vertebra to the UIV (UIV + 1) with polymethylmethacrylate (PMMA)-could also serve as a preventive measure of PJK/PJF in minimally invasive surgery (MIS). Materials and Methods: The study included 29 ASD patients who underwent a combination of minimally invasive lateral lumbar interbody fusion (MIS-LLIF) at L1-2 through L4-5, all-pedicle-screw instrumentation from the lower thoracic spine to the sacrum, S2-alar-iliac fixation, and two-level balloon-assisted PMMA vertebroplasty at the UIV and UIV + 1. Results: With a minimum 3-year follow-up, non-PJK/PJF group accounted for fifteen patients (52%), PJK for eight patients (28%), and PJF requiring surgical revision for six patients (21%). We had a total of seven patients with proximal junctional fracture, even though no patients showed implant/bone interface failure with screw pullout, probably through the effect of PMMA. In contrast to the PJK cohort, six PJF patients all had varying degrees of neurologic deficits from modified Frankel grade C to D3, which recovered to grades D3 and to grade D2 in three patients each, after a revision operation of proximal extension of instrumented fusion with or without neural decompression. None of the possible demographic and radiologic risk factors showed statistical differences between the non-PJK/PJF, PJK, and PJF groups. Conclusions: Compared with the traditional open surgical approach used in the previous studies with a positive result for the prophylactic two-level cement augmentation, the MIS procedures with substantial benefits to patients in terms of less access-related morbidity and less blood loss also provide a greater segmental stability, which, however, may have a negative effect on the development of PJK/PJF.
摘要：
背景和目的：近端交界性脊柱后凸（PJK）和失败（PJF），成人脊柱畸形（ASD）的长段胸腰椎融合术后最常见的并发症，仍然缺乏明确的预防措施。我们研究了先前报道的具有成功结果的策略之一-使用聚甲基丙烯酸甲酯（PMMA）将最上面的器械椎骨（UIV）和上相邻椎骨预防性增强到UIV（UIV1）-是否也可以作为微创手术（MIS）中PJK/PJF的预防措施。材料和方法：该研究包括29例ASD患者，他们接受了L1-2至L4-5的微创腰椎外侧椎间融合术（MIS-LLIF），从下胸椎到骶骨的全椎弓根螺钉器械，S2-ilar-liac固定，在UIV和UIV+1处进行两级球囊辅助PMMA椎体成形术。结果：经过至少3年的随访，非PJK/PJF组15例（52%），PJK为8名患者（28%），和PJF需要手术翻修6例(21%)。我们共有7例近端交界性骨折患者，即使没有患者显示植入物/骨界面失败与螺钉拔出，可能是通过PMMA的作用。与PJK队列相比，6名PJF患者均有不同程度的神经功能缺损，从改良的FrankelC级到D3级，分别恢复到D3级和D2级，在进行或不进行神经减压的器械融合近端延伸的翻修手术后。没有可能的人口统计学和放射学危险因素显示非PJK/PJF之间的统计学差异，PJK,和PJF组。结论：与以往研究中使用的传统开放手术方法相比，预防性两级骨水泥增强具有积极的结果，MIS程序对患者有实质性的好处，减少与接触相关的发病率和减少失血也提供了更大的节段稳定性。which,然而,可能对PJK/PJF的发展产生负面影响。
