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Strap stabilization for proximal junctional kyphosis prevention in instrumented posterior spinal fusion

Abstract

Study design

This is a retrospective, single-institution, cohort study.

Objectives

To evaluate the association of Mersilene tape use and risk of proximal junctional kyphosis (PJK), after surgical correction of adult spinal deformity (ASD) by posterior instrumented fusion (PIF).

Summary of background data

PJK, following long spinal PIF, is a complication which often requires reoperation. Mersilene tape, strap stabilization of the supra-adjacent level to upper instrumented vertebra (UIV) seems a preventive measure.

Methods

Patients who underwent PIF for ASD with Mersilene tape stabilization (case group) or without (control group) between 2006 and 2016 were analyzed preoperatively to 2-year follow-up. Matching of potential controls to each case was performed. Radiographic sagittal Cobb angle (SCA), lumbar lordosis, pelvic tilt, sacral slope, and pelvic incidence were measured pre- and postoperatively, using a deformity measuring software program. PJK was defined as progression of postoperative junctional SCA at UIV ≥ 10°.

Results

Eighty patients were included: 20 cases and 60 controls. The cumulative rate of PJK ≥ 10° at 2-year follow-up was 15% in cases versus 38% of controls (OR = 0.28; P = 0.04) with higher latent period in cases, (20 vs. 7.5 months), P = 0.018. Mersilene tape decreased risk of PJK linked with the impact of the following confounders: age, ≥ 55 years old (OR = 0.19; 0.02 ≥ P ≤ 0.03); number of spinal levels fused 7–15 (OR = 0.13; 0.02 ≥ P ≤ 0.06); thoracic UIV (T12–T1) (OR = 0.13; 0.02 ≥ P ≤ 0.06); BMI ≥ 27 kg/m2 (OR = 0.22; 0.03 ≥ P ≤ 0.08); and osteoporosis (OR = 0.13; 0.02 ≥ P ≤ 0.08).

Conclusions

Mersilene tape at UIV + 1 level decreases the risk of PJK following PIF for ASD.

Graphic abstract

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Author information

We, the undersigned, certify that each author has participated in and has contributed sufficiently to the work to take public responsibility for the appropriateness of the experimental design and method, and the collection, analysis and interpretation of the data and that this final version has been reviewed and approved for submission and/or publication. The sequence of authorship below is identical to that on the submitted manuscript. FRF, DOY, CK, CC, EB and VV were involved in conception/design of the work. FRF, BR, AN, DOY, CK, CC, EB and VV were involved in acquisition of data.

Correspondence to Francisco Rodriguez-Fontan.

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Rodriguez-Fontan, F., Reeves, B.J., Noshchenko, A. et al. Strap stabilization for proximal junctional kyphosis prevention in instrumented posterior spinal fusion. Eur Spine J (2020). https://doi.org/10.1007/s00586-020-06291-0

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Keywords

  • Proximal junctional kyphosis
  • Proximal junctional failure
  • Mersilene tape
  • Upper instrumented vertebrae
  • Sagittal Cobb angle