Proximal junctional kyphosis (PJK) is a common complication following fusion for Adult Spinal Deformity. PJK and proximal junctional failure (PJF) may lead to pain, neurological injury, reoperation, and increased healthcare costs. Efforts to prevent PJK and PJF have aimed to preserve or reconstruct the posterior spinal tension band and/or modifying instrumentation to allow for more gradual transitions in stiffness at the cranial end of long spinal constructs. We describe placement of an interlaminar fixation construct at the upper instrumented vertebra which may decrease PJK/PJF severity, and is placed with little additional operative time and minimal posterior soft tissue trauma.
Proximal junctional failure (PJF) is one of the most devastating complications that develop after adult spinal deformity (ASD) surgery. Here, we report 2 rare cases of PJF accompanied by delayed infection after ASD surgery with a review of the relevant literatures. Late-onset infection is an infrequent complication despite acute postoperative infection is common after posterior spinal instrumentation and fusion. Among them, delayed onset pyogenic spondylitis of the adjacent vertebra to the instrumented vertebrae is an extremely rare phenomenon. We do not have a clear explanation for this pathology. Since the delayed infections developed not in the fused segments but in the adjacent vertebra, the cause of the first case can be speculated as stimulation of low-virulent organisms to fester and hematogenous seeding and that of the second case as metal fretting and a sterile inflammatory response causing hematogenous microbial seeding, respectively. Additional studies on this phenomenon are warranted to elucidate the pathogenesis of this complication.
Proximal Junctional Kyphosis and Proximal Junctional Failure Following Adult Spinal Deformity Surgery
