Advertisement

Spine Surgery pp 659-666 | Cite as

Management of Failure of Osteoporotic Fixation

  • Andreas PingelEmail author
  • Frank Kandziora
Chapter

Abstract

Reoperation rate because of failing fixation construct in osteoporotic bone is high (about 30%). Especially proximal junctional kyphosis (PJK) with balance problems of the spine is seen frequently after internal fixation of the aging spine. Multiple possible reasons were found regarding adjacent segment problems, but it is still unknown, if there are special rules in osteoporotic bone and in sagittal balance of elderly population. In this chapter a case of PJK as a typical complication will be described and possible pearls and pitfalls are highlighted.

References

  1. 1.
    Anderson AL, McIff TE, Asher MA, Burton TC, Smooth RC. The effect of posterior thoracic spine anatomical structures on motion segment flexion stiffness. Spine. 2009;34:441–6.CrossRefGoogle Scholar
  2. 2.
    Bridwell KH, Lenke LG, Cho SK, et al. Proximal junctional kyphosis in primary adult deformity surgery. Neurosurgery. 2013;72:899–906.CrossRefGoogle Scholar
  3. 3.
    Farcy JP, Schwab FJ. Management of flatback and related kyphotic decompensation syndromes. Spine. 1997;22(20):2452–7.CrossRefGoogle Scholar
  4. 4.
    Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C II. Proximal junctional kyphosis in adult spinal sdeformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine. 2005;30:1643–9.CrossRefGoogle Scholar
  5. 5.
    Hart R, Bess S, Burton DC, et al. Proximal junctional failure (PJF). AFS/CNS section: disorders of the spine and peripheral nerves; 2013a; Phoenix, AZ.Google Scholar
  6. 6.
    Hart RA, Prendergast MA, Roberts WG, Nesbit GM, Barnwell SL. Proximal junctional acute collapse cranial to multi-level lumbar fusion: a cost analysis of prophylactic vertebral augmentation. Spine J. 2008;8:875–81.CrossRefGoogle Scholar
  7. 7.
    Hart R, McCarthy I, O'Brien M, et al. Identification of decision criteria for revision surgery among patients with proximal junctional failure following surgical treatment for spinal deformity. Spine. 2013b;38:E1223–7.CrossRefGoogle Scholar
  8. 8.
    Hassanzadeh H, Gupta S, Jain A, El Dafrawy MH, Skolasky RL, Kebaish KM. The proximal fusion level has a significant effect on the incidence of proximal junctional kyphosis and outcome in adults after long posterior spinal fusion. Spine Deform. 2013;1:299–305.CrossRefGoogle Scholar
  9. 9.
    Helgeson MD, Shah SA, Newton PO, et al. Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation. Spine (Phila Pa 1976). 2010;35:177–81.CrossRefGoogle Scholar
  10. 10.
    Hostin R, McCarthy I, O'Brien M, et al. Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity spine. Phila Pa 1976. 2013;38:1008–15.CrossRefGoogle Scholar
  11. 11.
    Kim HJ, Yagi M, Nguyen J, Cunningham ME, Boachie-Adjei O. Combined anterior-posterior surgery is the most important risk factor for developing proximal junctional kyphosis in idiopathic scoliosis. Clin Orthop Relat Res. 2012;470:1633–9.CrossRefGoogle Scholar
  12. 12.
    Kim YJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis f12. ollowing segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up. Spine. 2005;30:2045–50.CrossRefGoogle Scholar
  13. 13.
    Kim YJ, Bridwell KH, Lenke LG, Smooth CR, Rhim S, Cheh G. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up. Spine (Phila Pa 1976). 2008;33:2179–84.CrossRefGoogle Scholar
  14. 14.
    Kim HJ, Bridwell KH, Lenke LG, et al. Patients with proximal junctional repair surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections. Spine (Phila Pa 1976). 2014;39:E576–80.CrossRefGoogle Scholar
  15. 15.
    Kim YJ, Lenke LG, Bridwell KH, et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusion: incidence and risk factor analysis of 410 cases. Spine (Phila Pa 1976). 2007;32:2731–8.CrossRefGoogle Scholar
  16. 16.
    Lau D, Funao H, Clark AJ, Nicholls F, Smith J, Bess S, Shaffrey C, Schwab FJ, Lafage V, Deviren V, Hart R, Kebaish KM, Ames CP, International Spine Study Group. The Clinical Correlation of the Hart-ISSG Proximal Junctional Kyphosis Severity Scale With Health-Related Quality-of-Life Outcomes and Need for Surgery Revision. Spine. 2016;41:213–23.CrossRefGoogle Scholar
  17. 17.
    Maruo K, Ha Y, Inoue S, et al. Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity. Spine. 2013;38:E1469–76.CrossRefGoogle Scholar
  18. 18.
    McClendon J Jr, O'Shaughnessy BA, Sugrue PA, et al. Techniques for surgical correction of proximal junctional kyphosis of the upper thoracic spine. Spine (Phila Pa 1976). 2012;37:292–303.CrossRefGoogle Scholar
  19. 19.
    O’Leary PT, Bridwell KH, Lenke LG, et al. Risk factors and outcomes for catastrophic failures at the top of long pedicle screw constructs: a matched cohort analysis performed at a single center. Spine. 2009;34:2134–9.CrossRefGoogle Scholar
  20. 20.
    O’Shaughnessy BA, Bridwell KH, Lenke LG, et al. Does a long-fusion “T3-sacrum” portend a worse outcome than a short-fusion “T10-sacrum” in primary surgery for adult scoliosis? Spine (Phila Pa 1976). 2012;37:884–90.CrossRefGoogle Scholar
  21. 21.
    Smooth RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C II. Proximal junctional kyphosis in adult spinal deformity following long-instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine. 2005;30:1643–9.CrossRefGoogle Scholar
  22. 22.
    Vedantam R, Lenke LG, Keeney JA, Bridwell KH. Comparison of standing sagittal alignment in asymptomatic adolescents and adults. Spine. 1998;23:211–5.CrossRefGoogle Scholar
  23. 23.
    Wang J, Zhao Y, Shen B, et al. Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis. Injury. 2010;41:415–20.CrossRefGoogle Scholar
  24. 24.
    Yagi M, King AB, Boachie-Adjei O. Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical Outcomes review of adult idiopathic scoliosis: minimum 5 years follow-up. Spine. 2012;37:1479–89.CrossRefGoogle Scholar
  25. 25.
    Yagi M, Akilah KB, Boachie-Adjei O. Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Spine. 2011;36:E60–8.CrossRefGoogle Scholar
  26. 26.
    Kim HJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis results in inferior SRS pain subscores in adult deformity patients. Spine. 2013;38:896–901.CrossRefGoogle Scholar
  27. 27.
    Thawrani DP, Glos DL, Coombs MT, Bylski-Austrow DI, Sturm PF. Transverse process hooks at upper instrumented vertebra provide more gradual motion transition than pedicle screws. Spine. 2014;39(14):E826–32.CrossRefGoogle Scholar
  28. 28.
    Cammarata M, Aubin C-É, Wang X, Mac-Thiong J-M. Biomechanical risk factors for proximal junctional kyphosis. Spine. 2014;39(8):E500–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurtGermany

Personalised recommendations