• World Neurosurg · Feb 2024

    Tension Parameters of Junctional Tethers in Proximal Junction Kyphosis: A Cadaveric Biomechanical Study.

    • Mary Margaret O'Hehir, Timothy E O'Connor, Brandon L Mariotti, Mohamed A R Soliman, Esteban Quiceno, Munish C Gupta, Sigurd Berven, John Pollina, David W Polly, and Jeffrey P Mullin.
    • Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
    • World Neurosurg. 2024 Feb 1; 182: e798e806e798-e806.

    ObjectiveProximal junctional failure following surgical correction for adult spinal deformity significantly impacts quality of life and increases the economic burden of treating underlying spinal deformity. The objective of this cadaver study was to determine optimal tension parameters in junctional tethers for proximal junctional kyphosis prevention.MethodsCadaveric specimens were used to establish the optimal tension range in polyethylene tethering devices, such as the VersaTie (NuVasive) used in this study. Three specimens were instrumented to test tether tensions of 0, 75, and 150 Newtons (N) at L1-L2, T9-T10, and T3-T4. An optical tracking system was used to measure when specimens reached proximal junctional kyphosis, experienced instrumentation or tissue failure, or reached a cap of 2500 cycles. Radiographs were obtained before and after testing.ResultsAt all levels, use of a tether at tension forces of 75 N and 150 N elicited a protective effect. The only level in which a higher tension on the tether resulted in more protection was at T3-T4. When averaged, the use of a tether at tension forces of 75 N and 150 N showed 1000 cycles of protection at L1-L2, 2000 cycles at T9-T10, and 1426 cycles at T3-T4. Radiographic analysis corroborated these findings.ConclusionsThe use of a tether in a cadaveric model prevents the development of proximal junctional kyphosis across all tested levels and an increased tension force of 150 N is protective at the proximal thoracic spine. These data can be used to develop further models for a tether system that reproducibly applies a fixed tension force above the thoracolumbar rod construct.Copyright © 2023. Published by Elsevier Inc.

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