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Adult kyphosis prevention

George M Ghobrial, Daniel G Eichberg, John Paul G Kolcun, Karthik Madhavan, Nathan H Lebwohl, Barth A Green, Joseph P Gjolaj
BACKGROUND CONTEXT: Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are common problems after long segment (>5 levels) thoracolumbar instrumented fusions in the treatment of adult spinal deformity (ASD). No specific surgical strategy has definitively been shown to lower the risk of PJK as the result of a multifactorial etiology. PURPOSE: To assess the incidence of PJK and PJF in patients treated with prophylactic polymethylmethacrylate(PMMA) cement augmentation at the uppermost instrumented vertebrae(UIV) and rostral adjacent vertebrae(UIV+1)...
May 15, 2017: Spine Journal: Official Journal of the North American Spine Society
Fred H Nicholls, Junseok Bae, Alexander A Theologis, Murat S Eksi, Christopher P Ames, Sigurd H Berven, Shane Burch, Bobby K Tay, Vedat Deviren
STUDY DESIGN: Retrospective review of prospectively collected data OBJECTIVE.: The aim of this study was to examine which radiographic parameters and surgical strategies are most closely associated with proximal junctional kyphosis (PJK) after adult spinal deformity (ASD) surgery, the need for revision surgery for PJK, and whether these differ based on the upper instrumented vertebra (UIV). SUMMARY OF BACKGROUND DATA: Multiple parameters are considered when planning correction of ASD...
April 24, 2017: Spine
Renaud Lafage, Frank Schwab, Steve Glassman, Shay Bess, Bradley Harris, Justin Sheer, Robert Hart, Breton Line, Jensen Henry, Doug Burton, HanJo Kim, Eric Klineberg, Christopher Ames, Virginie Lafage
STUDY DESIGN: Retrospective cohort OBJECTIVE.: To explore proximal junctional kyphosis(PJK) as a function of age-adjusted surgical correction goals. SUMMARY OF BACKGROUND DATA: Recent adult spinal deformity(ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK. METHODS: ASD patients with fusions to the pelvis were included and stratified into three groups: young adults(YA<40yo), middle aged(MA: 40-65yo), the elderly(ED>65yo)...
March 3, 2017: Spine
Sanghyun Han, Seung-Jae Hyun, Ki-Jeong Kim, Tae-Ahn Jahng, Subum Lee, Seung-Chul Rhim
BACKGROUND CONTEXT: Little is known about the effect of rod stiffness as a risk factor of proximal junctional kyphosis (PJK) after adult spinal deformity (ASD) surgery. PURPOSE: The aim of this study was to compare radiographic outcomes after the use of cobalt chrome multiple-rod constructs (CoCr MRCs) and titanium alloy two-rod constructs (Ti TRCs) for ASD surgery with a minimum 1-year follow-up. STUDY DESIGN: Retrospective case-control study in two institutes...
February 24, 2017: Spine Journal: Official Journal of the North American Spine Society
Anand Pandey, Vipin Gupta, Shailendra P Singh, Vijendra Kumar, Rajesh Verma
A trophic ulcer is a pressure ulcer caused by external trauma to a part of the body that is compromised due to disease, vascular insufficiency, or loss of afferent nerve fibers. Spinal dysraphism (ie, neural tube defects [NTD]) such as meningomyelocele is a risk factor for developing these ulcers in adults and pediatric patients. Information regarding the occurrence of trophic ulcers in pediatric patients with NTD is lacking. A review of the English-language literature on skin/neuropathic ulcers in patients with NTDs, irrespective of study design, published between 1975 and 2014, was undertaken using the PubMed database...
December 2015: Ostomy/wound Management
Martin H Pham, Alexander Tuchman, Lance Smith, Andre M Jakoi, Neil N Patel, Vivek A Mehta, Frank L Acosta
Proximal junctional kyphosis is an increasingly recognized complication following long-segment posterior spinal fusion for adult spinal deformity. The authors describe a novel technique for interspinous ligament reinforcement at the proximal adjacent levels using a cadaveric semitendinosus tendon graft secured with an Ethibond No. 2 double filament (Ethicon, Somerville, New Jersey) via the Krackow suture weave. A retrospective review identified 4 patients who had received this graft. No proximal junctional kyphosis was seen at a mean short-term follow-up of 5...
January 1, 2017: Orthopedics
Xu Sun, Ze-Zhang Zhu, Xi Chen, Zhen Liu, Bin Wang, Yong Qiu
This paper presents a highly challenging technique involving posterior double vertebral column resections (VCRs) and satellite rods placement. This was a young adult case with severe angular thoracolumbar kyphosis of 101 degrees, secondary to anterior segmentation failure from T11 to L1 . There were hemivertebrae at T11 and T12 , and a wedged vertebra at L1 . He received double VCRs at T12 and T11 and instrumented fusion from T6 to L4 via a posterior only approach. Autologous grafts and a cage were placed between the bony surfaces of the osteotomy gap...
August 2016: Orthopaedic Surgery
Chun-Po Yen, Yusef I Mosley, Juan S Uribe
With the aging population, there is a rising prevalence of degenerative spinal deformity and need of surgical care for these patients. Surgical treatment for adult spinal deformity (ASD) is often fraught with a high rate of complications. Minimally invasive surgery (MIS) has for the past decade been adopted by spine surgeons to treat ASD in the hopes of reducing access-related morbidity and perioperative complications. The benefits of MIS approach in general and recent development of MIS techniques to avoid long-term complications such as pseudoarthrosis or proximal junctional kyphosis are reviewed...
September 2016: Current Reviews in Musculoskeletal Medicine
Amanda L Lorbergs, George T O'Connor, Yanhua Zhou, Thomas G Travison, Douglas P Kiel, L Adrienne Cupples, Hillel Rosen, Elizabeth J Samelson
Background: Hyperkyphosis reduces the amount of space in the chest, mobility of the rib cage, and expansion of the lungs. Decline in pulmonary function may be greater in persons with more severe kyphosis; however, no prospective studies have assessed this association. We conducted a longitudinal study to quantify the impact of kyphosis severity on decline in pulmonary function over 16 years in women and men. Methods: Participants included a convenience sample of 193 women and 82 men in the Framingham Study original cohort (mean age: 63 years; range: 50-79 years), who had measurements of kyphosis angle from lateral spine radiographs obtained in 1972-1976 and forced expiratory volume in 1 second (FEV1) from spirometry taken four times over 16 (±1...
May 1, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
M Yagi, H Ohne, T Konomi, K Fujiyoshi, S Kaneko, T Komiyama, M Takemitsu, Y Yato, M Machida, T Asazuma
We conducted a prospective comparative study of the effect of teriparatide therapy for preventing vertebral-failure-type PJK after reconstructive surgery for adult spinal deformity. Prophylactic teriparatide improved the volumetric bone mineral density and fine bone structure of the vertebra above the upper-instrumented vertebra and reduced the incidence of vertebral-failure-type PJK. INTRODUCTION: Proximal junctional kyphosis (PJK) is a complication after corrective surgery for spinal deformity...
June 24, 2016: Osteoporosis International
Rachel E Ward, Marla K Beauchamp, Nancy K Latham, Suzanne G Leveille, Sanja Percac-Lima, Laura Kurlinski, Pengsheng Ni, Richard Goldstein, Alan M Jette, Jonathan F Bean
OBJECTIVE: To identify neuromuscular impairments most predictive of unfavorable mobility outcomes in late life. DESIGN: Longitudinal cohort study. SETTING: Research clinic. PARTICIPANTS: Community-dwelling primary care patients aged ≥65 years (N=391) with self-reported mobility modifications, randomly selected from a research registry. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Categories of decline in and persistently poor mobility across baseline, 1 and 2 years of follow-up in the Lower-Extremity Function scales of the Late-Life Function and Disability Instrument...
August 2016: Archives of Physical Medicine and Rehabilitation
Dennis E Carey, Neville H Golden
Osteoporosis occurs during childhood and adolescence as a heritable condition such as OI, with acquired disease (eg, IBD), or iatrogenically as a result of high-dose glucocorticoid therapy. However, the number of children affected by osteoporosis during youth is small compared to the numbers who will develop osteoporosis in adulthood. Prevention of adult osteoporosis requires that an optimal environment for the achievement of peak bone mass be established during the growing years. Detection of low BMD can be achieved using modalities such as DXA and pQCT...
August 2015: Adolescent Medicine: State of the Art Reviews
Roop Singh, Narender Kumar Magu
STUDY DESIGN: A prospective clinical study. PURPOSE: The objective of the present study was to evaluate the behavior of spinal deformities in tuberculosis (TB) of the spine during the initial 2 years and to suggest remedial measures. OVERVIEW OF LITERATURE: Spinal TB is the most common cause of a kyphotic deformity in many parts of the world. Treatment of the established deformity is difficult, hazardous and has a high complication rate. METHODS: We followed 50 adult patients treated for spinal TB for a minimum of 2 years...
October 2015: Asian Spine Journal
Lee Sandquist, Daniel Carr, Doris Tong, Roger Gonda, Teck M Soo
BACKGROUND: The authors sought to demonstrate the safety and effectiveness of the multilevel stabilization screw (MLSS) technique in decreasing the incidence of proximal junctional failure in long segmental instrumented fusions for adult degenerative scoliosis. METHODS: Institutional review board approval was obtained and all patients with adult spinal deformity who underwent the MLSS technique were analyzed. A neuro-radiologist and spine-focused neurosurgeon not involved with the surgical treatment performed radiographic analysis...
2015: Surgical Neurology International
Alexander A Theologis, Shane Burch
STUDY DESIGN: Retrospective cohort analysis. OBJECTIVE: To evaluate efficacy of proximal junction fracture (PJF) prevention in adult spinal deformity (ASD) using 2-level cement augmentation at the construct's proximal extent. SUMMARY OF BACKGROUND DATA: Prevention of PJF after thoracolumbar fusions is critical because they may result in neurological injury. Cement augmentation of constructs' proximal vertebrae is postulated to decrease PJF...
October 1, 2015: Spine
Justin K Scheer, Shayan Fakurnejad, Darryl Lau, Michael D Daubs, Jeffrey D Coe, Kenneth J Paonessa, Michael O LaGrone, Rodrigo A Amaral, Per D Trobisch, Jung-Hee Lee, Daniel Fabris-Monterumici, Neel Anand, Andrew K Cree, Robert A Hart, Lloyd A Hey, Christopher P Ames
STUDY DESIGN: An electronic survey administered to Scoliosis Research Society membership. OBJECTIVE: To characterize surgeon views regarding proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) management providing the framework in which a PJK/PJF classification system and treatment guidelines could be established. SUMMARY OF BACKGROUND DATA: PJK/PJF are common complications of adult spinal deformity surgery. To date, there is no consensus on PJK/PJF definitions, classification, and indications for revision surgery...
June 1, 2015: Spine
Seung-Jae Hyun, Lawrence G Lenke, Yong-Chan Kim, Linda A Koester, Kathy M Blanke
STUDY DESIGN: Retrospective matched-cohort comparative study. OBJECTIVE: Compare radiographical outcomes after the use of a standard 2-rod construct (2-RC) versus a multiple-rod construct (multi-RC) across 3-column osteotomy sites in a matched cohort with severe kyphosis and/or scoliosis with minimum 2-year follow-up. SUMMARY OF BACKGROUND DATA: Three-column osteotomies are used for treating severe spinal deformities, typically with a standard 2-RC across the highly unstable osteotomy site...
October 15, 2014: Spine
Darryl Lau, Aaron J Clark, Justin K Scheer, Michael D Daubs, Jeffrey D Coe, Kenneth J Paonessa, Michael O LaGrone, Michael D Kasten, Rodrigo A Amaral, Per D Trobisch, Jung-Hee Lee, Daniel Fabris-Monterumici, Neel Anand, Andrew K Cree, Robert A Hart, Lloyd A Hey, Christopher P Ames
STUDY DESIGN: Systematic review of literature. OBJECTIVE: To perform a comprehensive English language systematic literature review of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), concentrating on incidence, risk factors, health related quality of life impact, prevention strategy, and classification systems. SUMMARY OF BACKGROUND DATA: PJK and PJF are well described clinical pathologies and are a frequent cause of revision surgery...
December 1, 2014: Spine
Myung-Sang Moon, Sung-Soo Kim, Young-Wan Moon, Hanlim Moon, Sung-Sim Kim
STUDY DESIGN: Medical record-based survey. PURPOSE: To survey the overall incidence of the intra- and postoperative complications and sequelae, and to propose the preventive measures to reduce complications in the spinal tuberculosis surgery. OVERVIEW OF LITERATURE: There is no study focused on the surgery-related complications and sequelae, with some touching lightly on the clinical problems. METHODS: There were 901 patients in this study, including 92 paraplegics...
August 2014: Asian Spine Journal
Wei-Li Hsu, Chao-Yin Chen, Jau-Yih Tsauo, Rong-Sen Yang
Osteoporosis is a prevalent health concern among older adults and is associated with an increased risk of falls that incur fracture, injury, or mortality. Identifying the risk factors of falls within this population is essential for the development of effective regimes for fall prevention. Studies have shown that muscle quality and good posture alignments are critical for balance control in elderly individuals. People with osteoporosis often have muscle weakness and increased spine kyphosis leading to vertebral fractures and poor balance control, or even falls...
June 2014: Journal of the Formosan Medical Association, Taiwan Yi Zhi
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