Cargando…
Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies
STUDY DESIGN: Systematic review. OBJECTIVES: To summarize the results of clinical studies investigating spinal instrumentation techniques aiming to reduce the postoperative incidence of proximal junctional kyphosis (PJK) and/or failure (PJF) in adult spinal deformity (ASD) patients. METHODS: EMBASE...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210240/ https://www.ncbi.nlm.nih.gov/pubmed/34325554 http://dx.doi.org/10.1177/21925682211034500 |
_version_ | 1784730123498422272 |
---|---|
author | Vercoulen, Timon F. G. Doodkorte, Remco J. P. Roth, Alex de Bie, Rob Willems, Paul C. |
author_facet | Vercoulen, Timon F. G. Doodkorte, Remco J. P. Roth, Alex de Bie, Rob Willems, Paul C. |
author_sort | Vercoulen, Timon F. G. |
collection | PubMed |
description | STUDY DESIGN: Systematic review. OBJECTIVES: To summarize the results of clinical studies investigating spinal instrumentation techniques aiming to reduce the postoperative incidence of proximal junctional kyphosis (PJK) and/or failure (PJF) in adult spinal deformity (ASD) patients. METHODS: EMBASE and Medline® were searched for articles dating from January 2000 onward. Data was extracted by 2 independent authors and methodological quality was assessed using ROBINS-I. RESULTS: 18 retrospective- and prospective cohort studies with a severe or critical risk of bias were included. Different techniques were applied at the upper instrumented vertebra (UIV): tethers in various configurations, 2-level prophylactic vertebroplasty (2-PVP), transverse process hooks (TPH), flexible rods (FR), sublaminar tapes (ST) and multilevel stabilization screws (MLSS). Compared to a pedicle screw (PS) group, significant differences in PJK incidence were found using tethers in various configurations (18% versus 45%, P = 0.001, 15% versus 38%, P = 0.045), 2-PVP (24% vs 36%, P = 0.020), TPH (0% vs. 30%, P = 0.023) and FR (15% versus 38%, P = 0.045). Differences in revision rates for PJK were found in studies concerning tethers (4% versus 18%, P = 0.002), 2-PVP (0% vs 13%, P = 0.031) and TPH (0% vs 7%, P = n.a.). CONCLUSION: Although the studies are of low quality, the most frequently studied techniques, namely 2-PVP as anterior reinforcement and (tensioned) tethers or TPH as posterior semi-rigid fixation, show promising results. To provide a reliable comparison, more controlled studies need to be performed, including the use of clinical outcome measures and a uniform definition of PJF. |
format | Online Article Text |
id | pubmed-9210240 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-92102402022-06-22 Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies Vercoulen, Timon F. G. Doodkorte, Remco J. P. Roth, Alex de Bie, Rob Willems, Paul C. Global Spine J Review Articles STUDY DESIGN: Systematic review. OBJECTIVES: To summarize the results of clinical studies investigating spinal instrumentation techniques aiming to reduce the postoperative incidence of proximal junctional kyphosis (PJK) and/or failure (PJF) in adult spinal deformity (ASD) patients. METHODS: EMBASE and Medline® were searched for articles dating from January 2000 onward. Data was extracted by 2 independent authors and methodological quality was assessed using ROBINS-I. RESULTS: 18 retrospective- and prospective cohort studies with a severe or critical risk of bias were included. Different techniques were applied at the upper instrumented vertebra (UIV): tethers in various configurations, 2-level prophylactic vertebroplasty (2-PVP), transverse process hooks (TPH), flexible rods (FR), sublaminar tapes (ST) and multilevel stabilization screws (MLSS). Compared to a pedicle screw (PS) group, significant differences in PJK incidence were found using tethers in various configurations (18% versus 45%, P = 0.001, 15% versus 38%, P = 0.045), 2-PVP (24% vs 36%, P = 0.020), TPH (0% vs. 30%, P = 0.023) and FR (15% versus 38%, P = 0.045). Differences in revision rates for PJK were found in studies concerning tethers (4% versus 18%, P = 0.002), 2-PVP (0% vs 13%, P = 0.031) and TPH (0% vs 7%, P = n.a.). CONCLUSION: Although the studies are of low quality, the most frequently studied techniques, namely 2-PVP as anterior reinforcement and (tensioned) tethers or TPH as posterior semi-rigid fixation, show promising results. To provide a reliable comparison, more controlled studies need to be performed, including the use of clinical outcome measures and a uniform definition of PJF. SAGE Publications 2021-07-30 2022-07 /pmc/articles/PMC9210240/ /pubmed/34325554 http://dx.doi.org/10.1177/21925682211034500 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Review Articles Vercoulen, Timon F. G. Doodkorte, Remco J. P. Roth, Alex de Bie, Rob Willems, Paul C. Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies |
title | Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies |
title_full | Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies |
title_fullStr | Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies |
title_full_unstemmed | Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies |
title_short | Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies |
title_sort | instrumentation techniques to prevent proximal junctional kyphosis and proximal junctional failure in adult spinal deformity correction: a systematic review of clinical studies |
topic | Review Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210240/ https://www.ncbi.nlm.nih.gov/pubmed/34325554 http://dx.doi.org/10.1177/21925682211034500 |
work_keys_str_mv | AT vercoulentimonfg instrumentationtechniquestopreventproximaljunctionalkyphosisandproximaljunctionalfailureinadultspinaldeformitycorrectionasystematicreviewofclinicalstudies AT doodkorteremcojp instrumentationtechniquestopreventproximaljunctionalkyphosisandproximaljunctionalfailureinadultspinaldeformitycorrectionasystematicreviewofclinicalstudies AT rothalex instrumentationtechniquestopreventproximaljunctionalkyphosisandproximaljunctionalfailureinadultspinaldeformitycorrectionasystematicreviewofclinicalstudies AT debierob instrumentationtechniquestopreventproximaljunctionalkyphosisandproximaljunctionalfailureinadultspinaldeformitycorrectionasystematicreviewofclinicalstudies AT willemspaulc instrumentationtechniquestopreventproximaljunctionalkyphosisandproximaljunctionalfailureinadultspinaldeformitycorrectionasystematicreviewofclinicalstudies |