A Pilot Study on Posterior Polyethylene Tethers to Prevent Proximal Junctional Kyphosis After Multilevel Spinal Instrumentation for Adult Spinal Deformity

Thomas J. Buell, Avery L. Buchholz, John C Quinn, Shay Bess, Breton G. Line, Christopher P. Ames, Frank J. Schwab, Virginie Lafage, Christopher I. Shaffrey, Justin S. Smith

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Proximal junctional kyphosis (PJK) is a common problem after multilevel spine instrumentation. OBJECTIVE: To determine if junctional tethers reduce PJK after multilevel instrumented surgery for adult spinal deformity (ASD). METHODS: ASD patients who underwent posterior instrumented fusion were divided into 3 groups: no tether (NT), polyethylene tether-only (TO; tied securely through the spinous processes of the uppermost instrumented vertebra [UIV] + 1 and UIV-1), and tether with crosslink (TC; passed through the spinous process of UIV+1 and tied to a crosslink between UIV-1 and UIV-2). PJK was defined as proximal junctional angle ≥ 10° and ≥ 10° greater than the corresponding preoperative measurement. RESULTS: One hundred eighty-four (96%) of 191 consecutive patients achieved minimum 3-mo follow-up (mean = 20 mo [range:3-56 mo]; mean age = 66 yr; 67.4% female). There were no significant differences between groups based on demographic, surgical, and sagittal radiographic parameters. PJK rates were 45.3% (29/64), 34.4% (22/64), and 17.9% (10/56) for NT, TO, and TC, respectively. PJK rate for all tethered patients (TO + TC; 26.7% [32/120]) was significantly lower than NT (P = .011). PJK rate for TC was significantly lower than NT (P = .001). Kaplan-Meier analysis showed significant time-dependent PJK reduction for TC vs NT (log rank test, P = .010). Older age and greater change in lumbar lordosis were independent predictors of PJK, while junctional tethers had a significant protective effect. CONCLUSION: Junctional tethers significantly reduced occurrence of PJK. This difference was progressive from NT to TO to TC, but only reached pairwise significance for NT vs TC. This suggests potential benefit of tethers to reduce PJK, and that future prospective studies are warranted.

LanguageEnglish
Pages256-266
Number of pages11
JournalOperative neurosurgery (Hagerstown, Md.)
Volume16
Issue number2
DOIs
StatePublished - Feb 1 2019

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Kyphosis
Polyethylene
Spine
Lordosis
Kaplan-Meier Estimate
Demography
Prospective Studies

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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A Pilot Study on Posterior Polyethylene Tethers to Prevent Proximal Junctional Kyphosis After Multilevel Spinal Instrumentation for Adult Spinal Deformity. / Buell, Thomas J.; Buchholz, Avery L.; Quinn, John C; Bess, Shay; Line, Breton G.; Ames, Christopher P.; Schwab, Frank J.; Lafage, Virginie; Shaffrey, Christopher I.; Smith, Justin S.

In: Operative neurosurgery (Hagerstown, Md.), Vol. 16, No. 2, 01.02.2019, p. 256-266.

Research output: Contribution to journalArticle

Buell, TJ, Buchholz, AL, Quinn, JC, Bess, S, Line, BG, Ames, CP, Schwab, FJ, Lafage, V, Shaffrey, CI & Smith, JS 2019, 'A Pilot Study on Posterior Polyethylene Tethers to Prevent Proximal Junctional Kyphosis After Multilevel Spinal Instrumentation for Adult Spinal Deformity', Operative neurosurgery (Hagerstown, Md.), vol. 16, no. 2, pp. 256-266. https://doi.org/10.1093/ons/opy065
Buell, Thomas J. ; Buchholz, Avery L. ; Quinn, John C ; Bess, Shay ; Line, Breton G. ; Ames, Christopher P. ; Schwab, Frank J. ; Lafage, Virginie ; Shaffrey, Christopher I. ; Smith, Justin S. / A Pilot Study on Posterior Polyethylene Tethers to Prevent Proximal Junctional Kyphosis After Multilevel Spinal Instrumentation for Adult Spinal Deformity. In: Operative neurosurgery (Hagerstown, Md.). 2019 ; Vol. 16, No. 2. pp. 256-266.
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abstract = "BACKGROUND: Proximal junctional kyphosis (PJK) is a common problem after multilevel spine instrumentation. OBJECTIVE: To determine if junctional tethers reduce PJK after multilevel instrumented surgery for adult spinal deformity (ASD). METHODS: ASD patients who underwent posterior instrumented fusion were divided into 3 groups: no tether (NT), polyethylene tether-only (TO; tied securely through the spinous processes of the uppermost instrumented vertebra [UIV] + 1 and UIV-1), and tether with crosslink (TC; passed through the spinous process of UIV+1 and tied to a crosslink between UIV-1 and UIV-2). PJK was defined as proximal junctional angle ≥ 10° and ≥ 10° greater than the corresponding preoperative measurement. RESULTS: One hundred eighty-four (96{\%}) of 191 consecutive patients achieved minimum 3-mo follow-up (mean = 20 mo [range:3-56 mo]; mean age = 66 yr; 67.4{\%} female). There were no significant differences between groups based on demographic, surgical, and sagittal radiographic parameters. PJK rates were 45.3{\%} (29/64), 34.4{\%} (22/64), and 17.9{\%} (10/56) for NT, TO, and TC, respectively. PJK rate for all tethered patients (TO + TC; 26.7{\%} [32/120]) was significantly lower than NT (P = .011). PJK rate for TC was significantly lower than NT (P = .001). Kaplan-Meier analysis showed significant time-dependent PJK reduction for TC vs NT (log rank test, P = .010). Older age and greater change in lumbar lordosis were independent predictors of PJK, while junctional tethers had a significant protective effect. CONCLUSION: Junctional tethers significantly reduced occurrence of PJK. This difference was progressive from NT to TO to TC, but only reached pairwise significance for NT vs TC. This suggests potential benefit of tethers to reduce PJK, and that future prospective studies are warranted.",
author = "Buell, {Thomas J.} and Buchholz, {Avery L.} and Quinn, {John C} and Shay Bess and Line, {Breton G.} and Ames, {Christopher P.} and Schwab, {Frank J.} and Virginie Lafage and Shaffrey, {Christopher I.} and Smith, {Justin S.}",
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AU - Buchholz, Avery L.

AU - Quinn, John C

AU - Bess, Shay

AU - Line, Breton G.

AU - Ames, Christopher P.

AU - Schwab, Frank J.

AU - Lafage, Virginie

AU - Shaffrey, Christopher I.

AU - Smith, Justin S.

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N2 - BACKGROUND: Proximal junctional kyphosis (PJK) is a common problem after multilevel spine instrumentation. OBJECTIVE: To determine if junctional tethers reduce PJK after multilevel instrumented surgery for adult spinal deformity (ASD). METHODS: ASD patients who underwent posterior instrumented fusion were divided into 3 groups: no tether (NT), polyethylene tether-only (TO; tied securely through the spinous processes of the uppermost instrumented vertebra [UIV] + 1 and UIV-1), and tether with crosslink (TC; passed through the spinous process of UIV+1 and tied to a crosslink between UIV-1 and UIV-2). PJK was defined as proximal junctional angle ≥ 10° and ≥ 10° greater than the corresponding preoperative measurement. RESULTS: One hundred eighty-four (96%) of 191 consecutive patients achieved minimum 3-mo follow-up (mean = 20 mo [range:3-56 mo]; mean age = 66 yr; 67.4% female). There were no significant differences between groups based on demographic, surgical, and sagittal radiographic parameters. PJK rates were 45.3% (29/64), 34.4% (22/64), and 17.9% (10/56) for NT, TO, and TC, respectively. PJK rate for all tethered patients (TO + TC; 26.7% [32/120]) was significantly lower than NT (P = .011). PJK rate for TC was significantly lower than NT (P = .001). Kaplan-Meier analysis showed significant time-dependent PJK reduction for TC vs NT (log rank test, P = .010). Older age and greater change in lumbar lordosis were independent predictors of PJK, while junctional tethers had a significant protective effect. CONCLUSION: Junctional tethers significantly reduced occurrence of PJK. This difference was progressive from NT to TO to TC, but only reached pairwise significance for NT vs TC. This suggests potential benefit of tethers to reduce PJK, and that future prospective studies are warranted.

AB - BACKGROUND: Proximal junctional kyphosis (PJK) is a common problem after multilevel spine instrumentation. OBJECTIVE: To determine if junctional tethers reduce PJK after multilevel instrumented surgery for adult spinal deformity (ASD). METHODS: ASD patients who underwent posterior instrumented fusion were divided into 3 groups: no tether (NT), polyethylene tether-only (TO; tied securely through the spinous processes of the uppermost instrumented vertebra [UIV] + 1 and UIV-1), and tether with crosslink (TC; passed through the spinous process of UIV+1 and tied to a crosslink between UIV-1 and UIV-2). PJK was defined as proximal junctional angle ≥ 10° and ≥ 10° greater than the corresponding preoperative measurement. RESULTS: One hundred eighty-four (96%) of 191 consecutive patients achieved minimum 3-mo follow-up (mean = 20 mo [range:3-56 mo]; mean age = 66 yr; 67.4% female). There were no significant differences between groups based on demographic, surgical, and sagittal radiographic parameters. PJK rates were 45.3% (29/64), 34.4% (22/64), and 17.9% (10/56) for NT, TO, and TC, respectively. PJK rate for all tethered patients (TO + TC; 26.7% [32/120]) was significantly lower than NT (P = .011). PJK rate for TC was significantly lower than NT (P = .001). Kaplan-Meier analysis showed significant time-dependent PJK reduction for TC vs NT (log rank test, P = .010). Older age and greater change in lumbar lordosis were independent predictors of PJK, while junctional tethers had a significant protective effect. CONCLUSION: Junctional tethers significantly reduced occurrence of PJK. This difference was progressive from NT to TO to TC, but only reached pairwise significance for NT vs TC. This suggests potential benefit of tethers to reduce PJK, and that future prospective studies are warranted.

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