Effectiveness of percutaneous cement injection on proximal junctional failure after posterior lumbar interbody fusion: Preliminary study.

Abstract

Proximal junctional failure (PJF) is the greatest challenge after posterior lumbar interbody fusion (PLIF). The aim of this study was to evaluate the effectiveness of percutaneous cement injection (PCI) for PJF after PLIF patients requiring surgical revision.In this retrospective clinical study, we reviewed 7 patients requiring surgical revision for PJF after PLIF with 18 months follow-up. They received PCI at the collapsed vertebral body and supra-adjacent vertebra, with or without intervertebral disc intervention. The outcome measures were radiographic findings and revision surgery. Two different radiographic parameters (wedging rate (%) of the fractured vertebral body and local kyphosis angle) were used, and were performed before and immediately after PCI, and 18 month after the PCI.In our study, we showed that 5 of 7 patients who experienced PJF after PLIF did not receive any revision surgery after PCI. Immediately after cement injection, the anterior wedging rate (%) and the local kyphosis angle were significantly improved (P = .018, P = .028). The anterior wedging rates (%) and local kyphosis angle, at pre-PCI, immediate after PCI, and at final follow-up, were not significantly different between the non-revision surgery and revision surgery groups.Five of 7 patients who experienced PJF after PLIF did not receive revision surgery after PCI. Considering that general anesthesia and open surgery are high-risk procedures for geriatric patients, our results suggest that non-surgical PCI could be a viable alternative treatment option for PJF.SMC2017-01-011-001. Retrospectively registered 18 January 2017.