Strap stabilization for proximal junctional kyphosis prevention in instrumented posterior spinal fusion

Francisco Rodriguez-Fontan, Bradley J. Reeves, Andriy Noshchenko, David Ou-Yang, Christopher J. Kleck, Christopher Cain, Evalina Burger-Van der Walt, Vikas V. Patel

June 2020, Volume 29, Issue 6, pp 1287 - 1296 Original Article Read Full Article 10.1007/s00586-020-06291-0

First Online: 14 January 2020

Strap stabilization for proximal junctional kyphosis prevention in instrumented posterior spinal fusion

Study design

This is a retrospective, single-institution, cohort study.

Objectives

To evaluate the association of Mersilene tape use and risk of proximal junctional kyphosis (PJK), after surgical correction of adult spinal deformity (ASD) by posterior instrumented fusion (PIF).

Summary of background data

PJK, following long spinal PIF, is a complication which often requires reoperation. Mersilene tape, strap stabilization of the supra-adjacent level to upper instrumented vertebra (UIV) seems a preventive measure.

Methods

Patients who underwent PIF for ASD with Mersilene tape stabilization (case group) or without (control group) between 2006 and 2016 were analyzed preoperatively to 2-year follow-up. Matching of potential controls to each case was performed. Radiographic sagittal Cobb angle (SCA), lumbar lordosis, pelvic tilt, sacral slope, and pelvic incidence were measured pre- and postoperatively, using a deformity measuring software program. PJK was defined as progression of postoperative junctional SCA at UIV ≥ 10°.

Results

Eighty patients were included: 20 cases and 60 controls. The cumulative rate of PJK ≥ 10° at 2-year follow-up was 15% in cases versus 38% of controls (OR = 0.28; P = 0.04) with higher latent period in cases, (20 vs. 7.5 months), P = 0.018. Mersilene tape decreased risk of PJK linked with the impact of the following confounders: age, ≥ 55 years old (OR = 0.19; 0.02 ≥ P ≤ 0.03); number of spinal levels fused 7–15 (OR = 0.13; 0.02 ≥ P ≤ 0.06); thoracic UIV (T12–T1) (OR = 0.13; 0.02 ≥ P ≤ 0.06); BMI ≥ 27 kg/m2 (OR = 0.22; 0.03 ≥ P ≤ 0.08); and osteoporosis (OR = 0.13; 0.02 ≥ P ≤ 0.08).

Conclusions

Mersilene tape at UIV + 1 level decreases the risk of PJK following PIF for ASD.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.[graphic not available: see fulltext]

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