December 22, 2015
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Two-level cement augmentation may decrease the rate of acute proximal junctional fractures

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Researchers evaluated potential methods to prevent acute proximal junction fractures in patients with adult spinal deformity and found use of two-level cement augmentation was linked with a significant reduction in the incidence of proximal junction fractures and revision procedures.

Researchers retrospectively studied data on 51 patients with adult spinal deformity after thoracolumbar fusion from the pelvis to thoracolumbar junction with at least 6 months of follow-up. Health-related quality of life outcomes (HRQoL), demographics and radiograph parameters of deformity were compared for patients who underwent the following procedures: no cement; two-level cement augmentation at upper instrumented vertebra (UIV) and vertebra one level proximal to UIV (UIV+1); and cement at another location (other).

A total of 19 patients underwent two-level cement augmentation at UIV, 23 patients had no cement and nine patients underwent cement at another location.

Researchers noted two-level procedures without cement had a 19% revision rate for proximal junctional fractures (PJF) compared with a 0% revision rate for two-level procedures with cement. When adjusted for UIV, the risk of proximal junction fracture revision surgery increased by 13.1-times for the “other” category of patients. In addition, two-level cement procedures increased HRQoLs in all patients, while only back and leg pain significantly improved in non-two-level cement procedures, researchers wrote. – by Robert Linnehan

Disclosure: The researchers reported receiving funds from the National Center for Advancing Translational Sciences, NIH, through UCSF-CTSI (Grant Number UL1 TR00004).