• World Neurosurg · Nov 2021

    Novel Distributed Loading Technique Using Multi-Material, Long-Segment Spinal Constructs to Prevent Proximal Junctional Pathology in Adult Spinal Deformity Correction-Operative Technique and Radiographic Findings.

    • Zachary J Tempel, Randall J Hlubek, Michael C Kachmann, Alaina Body, David O Okonkwo, Adam S Kanter, Avery L Buchholz, and Bryan M Krueger.
    • Mayfield Clinic, Cincinnati, Ohio, USA. Electronic address: ztempel@mayfieldclinic.com.
    • World Neurosurg. 2021 Nov 1; 155: e264-e270.

    BackgroundProximal junctional kyphosis (PJK) and proximal junction failure are common and costly complications after long-segment adult spinal deformity (ASD) correction. Although much research has focused on the concept of "softening the landing" to prevent proximal junction pathologies, long-segment constructs largely deviate from the force-deformation curve of the physiologic spine. Our novel distributed loading technique for ASD correction is described using multimaterial, long-segment constructs to create a biomechanically sound, yet physiologic, decremental stiffness toward the rostral end.MethodsOperative steps detail the custom-designed constructs of dual-headed pedicle screws and varied rod diameters and materials (cobalt chromium or titanium) for an initial 20 patients (mean 66.6 ± 4.8 years). Standing scoliosis films were obtained preoperatively and at regular intervals postoperatively to assess for PJK.ResultsNo patient had evidence of PJK or proximal junction failure at latest radiographic follow-up (mean 17.9 months, range 13-25 months). Radiographic findings for sagittal vertical axis averaged 11.2 ± 5.6 cm preoperatively and 3.6 ± 2.3 cm postoperatively. Compared with preoperative parameters, postoperative reductions in pelvic incidence-lumbar lordosis mismatch averaged 28.7 ± 12.9 degrees, and sagittal vertical axis averaged 7.6 ± 5.2 cm while PJA was essentially unchanged.ConclusionsPreliminary results suggest that the distributed loading technique is promising for prevention of PJK with stiffness gradients that mimic the force-deformation curve of the physiologic posterior tension band. Our technique may optimize the degree of stress at the proximal junction without overwhelming the anterior column bony while remodeling and mature arthrodesis takes place.Copyright © 2021 Elsevier Inc. All rights reserved.

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