P86. Postoperative bracing does not improve the rate of proximal junctional kyphosis in adult spinal deformity

Abstract

BACKGROUND CONTEXT The development of proximal junctional kyphosis (PJK) is an ongoing issue in adult spinal deformity (ASD) patients following spine surgery, with an incidence reported to be as high as 61.7%. Approximately 47.4% of patients who develop PJK will require revision surgery within 6 months. Currently, there are no reports in the literature on the effects of postoperative bracing on the incidence of PJK. We sought to determine whether postoperative bracing results in decreased rates of PJK in ASD treated with open posterior instrumented fusion (PSF) greater than six levels. PURPOSE To determine whether postoperative bracing results in decreased rates of PJK in ASD patients treated with PSF greater than six levels. We hypothesized that postoperative bracing would result in lower rates of PJK. STUDY DESIGN/SETTING We performed a retrospective analysis of prospectively collected data comparing patients treated with a thoracic lumbar sacral orthosis (TLSO) postoperatively for 3 months vs no brace following PSF. PATIENT SAMPLE Consecutive cohort of ASD patients (n=112) from a single surgical spine practice who underwent PSF were included. OUTCOME MEASURES Clinical and functional outcomes assessed: Oswestry Disability Index (ODI) and Visual Analog Scale pain (VAS). Radiographic measures: spinopelvic parameters, thoracic kyphosis (T5-T12), junctional kyphosis (T10-L2), lumbar lordosis (T12-S1), sagittal and coronal alignment, and PJK angle with corresponding level. METHODS Clinical and radiographic data of 112 (78 braced and 34 non-braced) consecutive adult patients who underwent PSF (> 6 levels) for deformity correction were analyzed. Radiographic measurements were performed preoperatively and postoperatively at 6 weeks and 6 months. PJK was defined as more than 10 degrees of abnormal kyphotic angulation measured at the superior end plate of one adjacent vertebra above the upper instrumented vertebra (UIV), to the inferior endplate of the UIV. Chi-square test and ANCOVA were used to analyze data. Statistical significance was set at p≤0.05. RESULTS The baseline clinical and radiographic demographics between the two cohorts were similar. The incidence of PJK was not statistically different (p=0.98) between patients who were braced (n=13/34; 38.2%) versus those not braced (n=30/78; 38.5%) postoperatively. Women had five times greater odds of developing PJK than men [OR=5.44;(95%CI =1.51-19.64)]. There were no significant differences at 6 months follow-up between the braced and not braced groups in ODI, VAS, or radiographic features, with the exception of T10-L2 thoracolumbar kyphosis, which was 3.08 versus 7.95 degrees in the braced and non-braced groups, respectively (p=0.03). CONCLUSIONS There was no statistical difference in the incidence of PJK in the braced versus non-braced groups. Interestingly, thoracolumbar kyphosis was significantly decreased in ASD patients who were braced postoperatively. Further investigation is needed to determine if postoperative bracing is protective against excessive postoperative kyphosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.