Posterior Ligamentous Augmentation is Associated With Reduced Rates of Proximal Junctional Kyphosis and Failure in Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis of 1333 Patients.

IF 3.5 2区医学 Q2 CLINICAL NEUROLOGY Spine Pub Date : 2025-07-01 Epub Date: 2025-02-14 DOI:10.1097/BRS.0000000000005299

Pavlos Texakalidis, Stavros Matsoukas, Mykhaylo Krushelnytskyy, Kevin Swong, Najib El Tecle, Tyler R Koski, Nader S Dahdaleh

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Abstract

Study design: Systematic review and meta-analysis.

Objective: To evaluate the impact of posterior ligamentous augmentation (PLA) on proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in adult spinal deformity (ASD) surgery.

Summary of background data: Adult spinal deformity (ASD) surgery is frequently complicated by PJK and PJF, with reported rates ranging from 17% to 61.7%. Techniques such as PLA, which involves spinous process or sublaminar tethering at the upper instrumented vertebra (UIV) +1 or +2, have been investigated as potential methods to mitigate these complications.

Materials and methods: A systematic literature review and meta-analysis was performed according to the PRISMA guidelines. Most studies defined PJK as an increase of ≥10° or ≥20° in the sagittal Cobb angle from UIV to UIV+2 compared with preoperative measurements. PJF was defined as PJK necessitating revision surgery.

Results: Eight comparative studies comprising 1333 patients (PLA: 579; no PLA: 754) were included. The mean age ranged from 55 to 68.6 years across studies, with a mean follow-up period of 17.6 to 31.2 months. There were no significant differences between the PLA and no PLA groups in terms of age (MD: 2.53; 95% CI: -0.28 to 5.34, I2 : 64.8%), BMI (MD: 1.03; 95% CI: -0.87 to 2.93, I2 : 69%), or sagittal vertical axis (SVA) preoperatively (MD: 3.92; 95% CI: -1.90 to 9.75, I2 : 73.1%) and postoperatively (MD: -1.54; 95% CI: -4.10 to 1.01, I2 : 56.2%). However, the PLA group demonstrated significantly lower odds of developing PJK compared with the no PLA group (PLA: 25.8%; no PLA: 28.8%; OR: 0.54; 95% CI: 0.34-0.85, I2 : 37.4%). Furthermore, PLA was associated with significantly lower odds of PJF (PLA: 3.3%; no PLA: 12.3%; OR: 0.23; 95% CI: 0.12-0.47, I2 : 17.9%).

Conclusions: PLA in ASD surgery is associated with reduced odds of developing PJK and PJF over a follow-up period of 17.6 to 31.2 months.

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在成人脊柱畸形手术中，后韧带增强与近端关节后凸和失败的发生率降低相关：一项1333例患者的系统回顾和荟萃分析。

研究设计：系统评价和荟萃分析。目的：探讨后韧带增强术（PLA）对成人脊柱畸形（ASD）手术中近端关节后凸（PJK）和近端关节功能衰竭（PJF）的影响。背景资料总结：成人脊柱畸形（ASD）手术经常并发PJK和PJF，报道的发生率从17%到61.7%不等。诸如PLA之类的技术，涉及棘突或上固定椎体(UIV) +1或+2的椎板下系带，已被研究作为减轻这些并发症的潜在方法。方法：根据PRISMA指南进行系统的文献综述和meta分析。大多数研究将PJK定义为与术前测量值相比，矢状Cobb角从UIV增加≥10°或≥20°。PJF被定义为需要翻修手术的PJK。结果：8项比较研究包括1333例患者(PLA: 579；未包括PLA: 754)。所有研究的平均年龄为55至68.6岁，平均随访时间为17.6至31.2个月。在年龄方面，PLA组与未PLA组之间无显著差异(MD 2.53；95% CI -0.28 ~ 5.34, I²：64.8%),BMI (MD 1.03；95%CI -0.87 ~ 2.93, I²：69%)，或矢状垂直轴（SVA） (MD 3.92；95% CI -1.90 ~ 9.75, I²：73.1%)和术后(MD -1.54；95%CI -4.10 ~ 1.01, I²：56.2%)。然而，与无PLA组相比，PLA组表现出明显较低的发生PJK的几率(PLA: 25.8%；无PLA: 28.8%；OR: 0.54;95%CI 0.34 ~ 0.85, I²：37.4%)。此外，PLA与PJF的发生率显著降低相关(PLA: 3.3%；无PLA: 12.3%；OR: 0.23;95%CI 0.12 ~ 0.47, I²：17.9%)。结论：在17.6至31.2个月的随访期间，ASD手术中的PLA与PJK和PJF的发生率降低相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.