Effect of vertebroplasty at the upper instrumented vertebra (UIV) and UIV +1 for prevention of proximal junctional failure in adult spinal deformity surgery: A comparative matched cohort study.

Effect of vertebroplasty at the upper instrumented vertebra (UIV) and UIV +1 for prevention of proximal junctional failure in adult spinal deformity surgery: A comparative matched cohort study.

World Neurosurg. 2019 Jan 02;:

Authors: Han S, Hyun SJ, Kim KJ, Jahng TA, Jeon SI, Wui SH, Lee JY, Lee S, Rhim SC, Chung S, Jang J, Lee BH

Abstract
BACKGROUND: This study aimed to compare radiographic outcomes of adult spinal deformity (ASD) surgery with or without two-level prophylactic vertebroplasty (PVP) at the uppermost instrumented vertebra (UIV) and the vertebra one level proximal to the UIV (UIV+1).
METHODS: This retrospective 1:2 matched-cohort comparative study enrolled two groups of patients undergoing ASD surgery, including 28 patients with PVP (PVP group) and 56 patients without PVP (non-PVP group), in three institutes between 2012 and 2015. The primary outcome measure was the incidence of proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and proximal junctional fracture (PJFX). The secondary outcome measure were radiologic outcomes between PVP segments and non-PVP segments.
RESULTS: Between the PVP group and non-PVP group, no significant differences were found in the incidence of PJK (13[46.4%] vs 26[46.4%], P=1.000), PJF (11[39.3%] vs 18[32.1%], P=0.516), and PJFX (11[39.3%] vs 18[32.1%], P=0.516). The numbers of the PJFX segments were 16 and 33 in PVP segments and non-PVP segments, respectively. Until revision surgery or final follow-up, the PJFX had progressed in 24 (82.7%) non-PVP segments, but not in PVP segments. The PJFX progression in all PVP segments stopped right near the PVP mass at the final follow-up. Reoperation due to PJFX was performed in one (3.6%) and eight (14.3%) patients in PVP and non-PVP groups, respectively.
CONCLUSIONS: PVP at UIV and UIV+1 cannot prevent PJK, PJF and PJFX; however, it plays a positive role by delaying their progression. Furthermore, PVP tend to lower the reoperation rate after PJFX in ASD surgery.

PMID: 30610979 [PubMed - as supplied by publisher]

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