Modification of Surgical Technique - One Way To Prevent Proximal Junctional Kyphosis (PJK) In Adolescent Idiopathic Scoliosis (AIS) Treated By Posterior Instrumentation And Fusion

Suresh Pillai

Volume : VIII, Issue : I, January - 2019

Modification of Surgical Technique - One Way To Prevent Proximal Junctional Kyphosis (PJK) In Adolescent Idiopathic Scoliosis (AIS) Treated By Posterior Instrumentation And Fusion

Suresh Pillai

Abstract :

PJK is a kyphotic deformity in the spinal motion segments immediately cephalad to the instrumented segments. The incidence ranges from 9–28% in the reported literature.

This can occur in different conditions Hypothesis

Resection of the posterior ligament complex between the upper instrumented and un instrumented vertea is proposed as one cause of PJK

Materials and Methods

A prospective study from 2007 to 2011 was done with a minimum follow up of 2 yrs. A modification of the procedure was done . The posterior ligament complex between the upper two instrumented verteae and the non instrumented vertea are retained.. Fusion is done till the UIV. 32/36 AIS patients underwent modification. Patients were assessed at regular intervals

Results

All the 32 patients who underwent this modification did not develop PJK.. 4 patients who did not undergo this modification developed increase in kyphosis.

Discussion

This study was done from 2007–2011. A recent article published by The Springer (( Curr Rev Muskuloskelet Med (2016)9:299–308, Robert. A . Hart etal) describes posterior ligament disruption has important role in the development of PJK and PJF. Reinforcing the posterior tension band may be effective in reducing the risk for developing PJK. Hart etal proposes mesilene tape augmentation between the UIV and UIV+1 inorder to create a functional tension band. Preserving the PLC is a biological way to preserve the posterior tension band and prevent development of PJK in AIS patients .

Conclusion

This modified procedure is one way to prevent PJK in AIS patients undergoing posterior instrumented correction.