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Adult kyphosis prevention

Michael M Safaee, Vedat Deviren, Cecilia Dalle Ore, Justin K Scheer, Darryl Lau, Joseph A Osorio, Fred Nicholls, Christopher P Ames
OBJECTIVE Proximal junctional kyphosis (PJK) is a well-recognized, yet incompletely defined, complication of adult spinal deformity surgery. There is no standardized definition for PJK, but most studies describe PJK as an increase in the proximal junctional angle (PJA) of greater than 10°-20°. Ligament augmentation is a novel strategy for PJK reduction that provides strength to the upper instrumented vertebra (UIV) and adjacent segments while also reducing junctional stress at those levels. METHODS In this study, ligament augmentation was used in a consecutive series of adult spinal deformity patients at a single institution...
February 23, 2018: Journal of Neurosurgery. Spine
Zheng Liu, Penghui Zhang, Hao Zeng, Zhengquan Xu, Xiyang Wang
DESIGN: This a retrospective study in single centre. OBJECTIVE: The objective of this retrospective clinical study is to compare the long-term clinical efficacy of posterior long-segment and short-segment fixation with single-stage transpedicular debridement and fusion for the treatment of thoracolumbar spinal tuberculosis in adults. METHODS: Sixty-six cases of thoracolumbar tuberculosis were treated by single-stage transpedicular debridement, bone graft fusion, and pedicle screw fixation...
February 11, 2018: International Orthopaedics
Vibhu K Viswanathan, Sunil Kukreja, Amy J Minnema, H Francis Farhadi
OBJECTIVE Proximal junctional kyphosis (PJK) can progress to proximal junctional failure (PJF), a widely recognized early and serious complication of multisegment spinal instrumentation for the treatment of adult spinal deformity (ASD). Sublaminar band placement has been suggested as a possible technique to prevent PJK and PJF but carries the theoretical possibility of a paradoxical increase in these complications as a result of the required muscle dissection and posterior ligamentous disruption. In this study, the authors prospectively assess the safety as well as the early clinical and radiological outcomes of sublaminar band insertion at the upper instrumented vertebra (UIV) plus 1 level (UIV+1)...
February 9, 2018: Journal of Neurosurgery. Spine
Sajedah M Hindi, Shuichi Sato, Guangyan Xiong, Kyle R Bohnert, Andrew A Gibb, Yann S Gallot, Joseph D McMillan, Bradford G Hill, Shizuka Uchida, Ashok Kumar
Skeletal muscle mass is regulated by a complex array of signaling pathways. TGF-β-activated kinase 1 (TAK1) is an important signaling protein, which regulates context-dependent activation of multiple intracellular pathways. However, the role of TAK1 in the regulation of skeletal muscle mass remains unknown. Here, we report that inducible inactivation of TAK1 causes severe muscle wasting, leading to kyphosis, in both young and adult mice.. Inactivation of TAK1 inhibits protein synthesis and induces proteolysis, potentially through upregulating the activity of the ubiquitin-proteasome system and autophagy...
February 8, 2018: JCI Insight
Caglar Yilgor, Nuray Sogunmez, Louis Boissiere, Yasemin Yavuz, Ibrahim Obeid, Frank Kleinstück, Francisco Javier Sánchez Pérez-Grueso, Emre Acaroglu, Sleiman Haddad, Anne F Mannion, Ferran Pellise, Ahmet Alanay
BACKGROUND: The restoration of normal sagittal alignment is a critical goal in adult spinal deformity surgery to achieve favorable outcomes and prevent mechanical complications. Schwab sagittal modifiers have been accepted as targets for appropriate alignment, but addressing these targets does not always prevent high mechanical complication or revision rates. This may be because the linear absolute numerical parameters do not cover the whole pelvic incidence spectrum and the distribution of lordosis, pelvic anteversion, and negative malalignment are not considered as potential causes of failure...
October 4, 2017: Journal of Bone and Joint Surgery. American Volume
Michael M Safaee, Joseph A Osorio, Kushagra Verma, Shay Bess, Christopher I Shaffrey, Justin S Smith, Robert Hart, Vedat Deviren, Christopher P Ames
BACKGROUND: Proximal junctional kyphosis (PJK) is a well-recognized complication in patients undergoing posterior instrumented fusion procedures for adult spinal deformity. Strategies that reduce rates of PJK have the potential to improve the safety of these operations and decrease cost by eliminating the need for revision surgery. OBJECTIVE: To present a set of surgical techniques that can decrease rates of PJK in adults undergoing surgery for spinal deformity...
October 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
Satoshi Nori, Akio Iwanami, Akimasa Yasuda, Narihito Nagoshi, Nobuyuki Fujita, Tomohiro Hikata, Mitsuru Yagi, Takashi Tsuji, Kota Watanabe, Suketaka Momoshima, Morio Matsumoto, Masaya Nakamura, Ken Ishii
OBJECTIVE A number of studies have reported that surgery for cervical intramedullary tumors via the posterior approach can result in postoperative sagittal malalignment of the cervical spine; however, the risk factors remain unclear. The purpose of this study was to investigate the changes in cervical spinal alignment after surgery for cervical intramedullary tumors in adults and to elucidate the risk factors for cervical spinal sagittal misalignment. METHODS Data for the period from April 2001 to December 2011 for all adults who had undergone surgery for cervical intramedullary spinal cord tumors at a single institution were retrospectively analyzed to determine the postoperative changes in cervical spine alignment...
November 2017: Journal of Neurosurgery. Spine
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: The study aimed 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
MINI: Proximal junctional kyphosis (PJK) is a common, yet incompletely understood, complication of surgery for adult spinal deformity. We analyzed 440 consecutive adult spinal deformity patients for trends in development of PJK and need for revision surgery. pelvic tilt and thoracic kyphosis were predictive for developing PJK, while radiographic evidence of proximal junctional failure was predictive for proceeding to revision. STUDY DESIGN: Retrospective review of prospectively collected data...
November 15, 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 <40 years old), middle aged (MA: 40-65 years old), and the elderly (ED >65 years old)...
September 1, 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...
December 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
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