222 - Prophylactic Vertebral Cement Augmentation at the Uppermost Instrumented Vertebra and Rostral Adjacent Vertebra for the Prevention of Proximal Junctional Failure following Long Segment Fusion for Adult Spinal Deformity

Abstract

BACKGROUND CONTEXT: Proximal junctional kyphosis (PJK) is a recognized postsurgical phenomenon after spinal fusion in both the treatment of adolescent idiopathic scoliosis (AIS) and adults after long segment instrumented fusion in adult spinal deformity (ASD). PJK occurs at the rostral junction between the fixed instrumented spinal segment and the mobile vertebral levels above. One surgical technique that may mitigate the development of PJK and proximal junctional failure (PJF) is the use of prophylactic vertebroplasty (PV) with polymethylmethacrylate (PMMA). The placement of PMMA in the UIV has two potential benefits: increasing pedicle screw pull-out strength at the UIV and increasing the overall construct stiffness. Fusion alone in a long segment construct has been thought to increase stress at the UIV+1. Increasing construct stiffness at the UIV level alone with cement augmentation has been thought to load the UIV+1 and vertebral body, augmenting the forces that contribute to PJK.