Novel Distributed Loading Technique Using Multimaterial, Long-Segment Spinal Constructs to Prevent Proximal Junctional Pathology in Adult Spinal Deformity Correction—Operative Technique and Radiographic Findings

Proximal junctional kyphosis (PJK) and proximal junction failure are common and costly complications after long-segment adult spinal deformity (ASD) correction. Although much research has focused on the concept of “softening the landing” to prevent proximal junction pathologies, long-segment constru...

Full description

Saved in:
Bibliographic Details
Published in:World neurosurgery 2021-11, Vol.155, p.e264-e270
Main Authors: Tempel, Zachary J., Hlubek, Randall J., Kachmann, Michael C., Body, Alaina, Okonkwo, David O., Kanter, Adam S., Buchholz, Avery L., Krueger, Bryan M.
Format: Article
Language:English
Subjects:
Adjacent segment disease
Adult spinal deformity
Aged
Deformity correction
Distributed loading
Humans
Kyphosis - complications
Middle Aged
Neurosurgical Procedures - adverse effects
PJK
Postoperative Complications - pathology
Postoperative Complications - prevention & control
Postoperative Complications - surgery
Proximal junctional kyphosis
Retrospective Studies
Spinal Curvatures - surgery
Spine - pathology
Spine - surgery
Spine biomechanics
Young’s modulus
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c356t-c82ce10db2bdfd54cd4590651a6c02d4616f023ca65b93ddf186e9789ad3d26e3
cites cdi_FETCH-LOGICAL-c356t-c82ce10db2bdfd54cd4590651a6c02d4616f023ca65b93ddf186e9789ad3d26e3
container_end_page e270
container_issue
container_start_page e264
container_title World neurosurgery
container_volume 155
creator Tempel, Zachary J.
Hlubek, Randall J.
Kachmann, Michael C.
Body, Alaina
Okonkwo, David O.
Kanter, Adam S.
Buchholz, Avery L.
Krueger, Bryan M.
description Proximal junctional kyphosis (PJK) and proximal junction failure are common and costly complications after long-segment adult spinal deformity (ASD) correction. Although much research has focused on the concept of “softening the landing” to prevent proximal junction pathologies, long-segment constructs largely deviate from the force-deformation curve of the physiologic spine. Our novel distributed loading technique for ASD correction is described using multimaterial, long-segment constructs to create a biomechanically sound, yet physiologic, decremental stiffness toward the rostral end. Operative steps detail the custom-designed constructs of dual-headed pedicle screws and varied rod diameters and materials (cobalt chromium or titanium) for an initial 20 patients (mean 66.6 ± 4.8 years). Standing scoliosis films were obtained preoperatively and at regular intervals postoperatively to assess for PJK. No patient had evidence of PJK or proximal junction failure at latest radiographic follow-up (mean 17.9 months, range 13−25 months). Radiographic findings for sagittal vertical axis averaged 11.2 ± 5.6 cm preoperatively and 3.6 ± 2.3 cm postoperatively. Compared with preoperative parameters, postoperative reductions in pelvic incidence-lumbar lordosis mismatch averaged 28.7 ± 12.9 degrees, and sagittal vertical axis averaged 7.6 ± 5.2 cm while PJA was essentially unchanged. Preliminary results suggest that the distributed loading technique is promising for prevention of PJK with stiffness gradients that mimic the force-deformation curve of the physiologic posterior tension band. Our technique may optimize the degree of stress at the proximal junction without overwhelming the anterior column bony while remodeling and mature arthrodesis takes place.
doi_str_mv 10.1016/j.wneu.2021.08.052
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2563421596</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1878875021012225</els_id><sourcerecordid>2563421596</sourcerecordid><originalsourceid>FETCH-LOGICAL-c356t-c82ce10db2bdfd54cd4590651a6c02d4616f023ca65b93ddf186e9789ad3d26e3</originalsourceid><addsrcrecordid>eNp9kUFu1DAYhSMEolXpBVggL1mQYDuJJ5HYVFNaQAMd0XZtOfafjEeJHWxnYHY9BFfjApwEh2krVnhjW37v0_P_kuQlwRnBhL3dZt8NTBnFlGS4ynBJnyTHpFpUabVg9dPHc4mPklPvtziunBTVIn-eHOVFQSqGy-Pk1xe7gx6dax-cbqYACq2sUNp06AbkxuhvE6BbP98_T33QgwjgtOjfRJnp0mvoBjABXY_aiB4trYmcSQaPgkVrB7v5ce3sj2js0afJyKDtrFyLsLG97fZIG3SmIvqBcQ6tdYMO-0hzDv4aft_9vBrBiaB38E8uYRT6GsPazolxoyW60GaO7l8kz1rRezi930-S24v3N8sP6erq8uPybJXKvGQhlRWVQLBqaKNaVRZSFWWNWUkEk5iqghHWYppLwcqmzpVq49CgXlS1ULmiDPKT5PWBOzobA_nAB-0l9L0wYCfPacnygpKyZlFKD1LprPcOWj66OBS35wTzuVG-5XOjfG6U44rHRqPp1T1_agZQj5aH_qLg3UEA8Zc7DY57qcFIUHoeHVdW_4__B-KCuVY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2563421596</pqid></control><display><type>article</type><title>Novel Distributed Loading Technique Using Multimaterial, Long-Segment Spinal Constructs to Prevent Proximal Junctional Pathology in Adult Spinal Deformity Correction—Operative Technique and Radiographic Findings</title><source>Elsevier</source><creator>Tempel, Zachary J. ; Hlubek, Randall J. ; Kachmann, Michael C. ; Body, Alaina ; Okonkwo, David O. ; Kanter, Adam S. ; Buchholz, Avery L. ; Krueger, Bryan M.</creator><creatorcontrib>Tempel, Zachary J. ; Hlubek, Randall J. ; Kachmann, Michael C. ; Body, Alaina ; Okonkwo, David O. ; Kanter, Adam S. ; Buchholz, Avery L. ; Krueger, Bryan M.</creatorcontrib><description>Proximal junctional kyphosis (PJK) and proximal junction failure are common and costly complications after long-segment adult spinal deformity (ASD) correction. Although much research has focused on the concept of “softening the landing” to prevent proximal junction pathologies, long-segment constructs largely deviate from the force-deformation curve of the physiologic spine. Our novel distributed loading technique for ASD correction is described using multimaterial, long-segment constructs to create a biomechanically sound, yet physiologic, decremental stiffness toward the rostral end. Operative steps detail the custom-designed constructs of dual-headed pedicle screws and varied rod diameters and materials (cobalt chromium or titanium) for an initial 20 patients (mean 66.6 ± 4.8 years). Standing scoliosis films were obtained preoperatively and at regular intervals postoperatively to assess for PJK. No patient had evidence of PJK or proximal junction failure at latest radiographic follow-up (mean 17.9 months, range 13−25 months). Radiographic findings for sagittal vertical axis averaged 11.2 ± 5.6 cm preoperatively and 3.6 ± 2.3 cm postoperatively. Compared with preoperative parameters, postoperative reductions in pelvic incidence-lumbar lordosis mismatch averaged 28.7 ± 12.9 degrees, and sagittal vertical axis averaged 7.6 ± 5.2 cm while PJA was essentially unchanged. Preliminary results suggest that the distributed loading technique is promising for prevention of PJK with stiffness gradients that mimic the force-deformation curve of the physiologic posterior tension band. Our technique may optimize the degree of stress at the proximal junction without overwhelming the anterior column bony while remodeling and mature arthrodesis takes place.</description><identifier>ISSN: 1878-8750</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2021.08.052</identifier><identifier>PMID: 34418605</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adjacent segment disease ; Adult spinal deformity ; Aged ; Deformity correction ; Distributed loading ; Humans ; Kyphosis - complications ; Middle Aged ; Neurosurgical Procedures - adverse effects ; PJK ; Postoperative Complications - pathology ; Postoperative Complications - prevention &amp; control ; Postoperative Complications - surgery ; Proximal junctional kyphosis ; Retrospective Studies ; Spinal Curvatures - surgery ; Spine - pathology ; Spine - surgery ; Spine biomechanics ; Young’s modulus</subject><ispartof>World neurosurgery, 2021-11, Vol.155, p.e264-e270</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-c82ce10db2bdfd54cd4590651a6c02d4616f023ca65b93ddf186e9789ad3d26e3</citedby><cites>FETCH-LOGICAL-c356t-c82ce10db2bdfd54cd4590651a6c02d4616f023ca65b93ddf186e9789ad3d26e3</cites><orcidid>0000-0002-7444-2851</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34418605$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tempel, Zachary J.</creatorcontrib><creatorcontrib>Hlubek, Randall J.</creatorcontrib><creatorcontrib>Kachmann, Michael C.</creatorcontrib><creatorcontrib>Body, Alaina</creatorcontrib><creatorcontrib>Okonkwo, David O.</creatorcontrib><creatorcontrib>Kanter, Adam S.</creatorcontrib><creatorcontrib>Buchholz, Avery L.</creatorcontrib><creatorcontrib>Krueger, Bryan M.</creatorcontrib><title>Novel Distributed Loading Technique Using Multimaterial, Long-Segment Spinal Constructs to Prevent Proximal Junctional Pathology in Adult Spinal Deformity Correction—Operative Technique and Radiographic Findings</title><title>World neurosurgery</title><addtitle>World Neurosurg</addtitle><description>Proximal junctional kyphosis (PJK) and proximal junction failure are common and costly complications after long-segment adult spinal deformity (ASD) correction. Although much research has focused on the concept of “softening the landing” to prevent proximal junction pathologies, long-segment constructs largely deviate from the force-deformation curve of the physiologic spine. Our novel distributed loading technique for ASD correction is described using multimaterial, long-segment constructs to create a biomechanically sound, yet physiologic, decremental stiffness toward the rostral end. Operative steps detail the custom-designed constructs of dual-headed pedicle screws and varied rod diameters and materials (cobalt chromium or titanium) for an initial 20 patients (mean 66.6 ± 4.8 years). Standing scoliosis films were obtained preoperatively and at regular intervals postoperatively to assess for PJK. No patient had evidence of PJK or proximal junction failure at latest radiographic follow-up (mean 17.9 months, range 13−25 months). Radiographic findings for sagittal vertical axis averaged 11.2 ± 5.6 cm preoperatively and 3.6 ± 2.3 cm postoperatively. Compared with preoperative parameters, postoperative reductions in pelvic incidence-lumbar lordosis mismatch averaged 28.7 ± 12.9 degrees, and sagittal vertical axis averaged 7.6 ± 5.2 cm while PJA was essentially unchanged. Preliminary results suggest that the distributed loading technique is promising for prevention of PJK with stiffness gradients that mimic the force-deformation curve of the physiologic posterior tension band. Our technique may optimize the degree of stress at the proximal junction without overwhelming the anterior column bony while remodeling and mature arthrodesis takes place.</description><subject>Adjacent segment disease</subject><subject>Adult spinal deformity</subject><subject>Aged</subject><subject>Deformity correction</subject><subject>Distributed loading</subject><subject>Humans</subject><subject>Kyphosis - complications</subject><subject>Middle Aged</subject><subject>Neurosurgical Procedures - adverse effects</subject><subject>PJK</subject><subject>Postoperative Complications - pathology</subject><subject>Postoperative Complications - prevention &amp; control</subject><subject>Postoperative Complications - surgery</subject><subject>Proximal junctional kyphosis</subject><subject>Retrospective Studies</subject><subject>Spinal Curvatures - surgery</subject><subject>Spine - pathology</subject><subject>Spine - surgery</subject><subject>Spine biomechanics</subject><subject>Young’s modulus</subject><issn>1878-8750</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kUFu1DAYhSMEolXpBVggL1mQYDuJJ5HYVFNaQAMd0XZtOfafjEeJHWxnYHY9BFfjApwEh2krVnhjW37v0_P_kuQlwRnBhL3dZt8NTBnFlGS4ynBJnyTHpFpUabVg9dPHc4mPklPvtziunBTVIn-eHOVFQSqGy-Pk1xe7gx6dax-cbqYACq2sUNp06AbkxuhvE6BbP98_T33QgwjgtOjfRJnp0mvoBjABXY_aiB4trYmcSQaPgkVrB7v5ce3sj2js0afJyKDtrFyLsLG97fZIG3SmIvqBcQ6tdYMO-0hzDv4aft_9vBrBiaB38E8uYRT6GsPazolxoyW60GaO7l8kz1rRezi930-S24v3N8sP6erq8uPybJXKvGQhlRWVQLBqaKNaVRZSFWWNWUkEk5iqghHWYppLwcqmzpVq49CgXlS1ULmiDPKT5PWBOzobA_nAB-0l9L0wYCfPacnygpKyZlFKD1LprPcOWj66OBS35wTzuVG-5XOjfG6U44rHRqPp1T1_agZQj5aH_qLg3UEA8Zc7DY57qcFIUHoeHVdW_4__B-KCuVY</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Tempel, Zachary J.</creator><creator>Hlubek, Randall J.</creator><creator>Kachmann, Michael C.</creator><creator>Body, Alaina</creator><creator>Okonkwo, David O.</creator><creator>Kanter, Adam S.</creator><creator>Buchholz, Avery L.</creator><creator>Krueger, Bryan M.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7444-2851</orcidid></search><sort><creationdate>202111</creationdate><title>Novel Distributed Loading Technique Using Multimaterial, Long-Segment Spinal Constructs to Prevent Proximal Junctional Pathology in Adult Spinal Deformity Correction—Operative Technique and Radiographic Findings</title><author>Tempel, Zachary J. ; Hlubek, Randall J. ; Kachmann, Michael C. ; Body, Alaina ; Okonkwo, David O. ; Kanter, Adam S. ; Buchholz, Avery L. ; Krueger, Bryan M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-c82ce10db2bdfd54cd4590651a6c02d4616f023ca65b93ddf186e9789ad3d26e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adjacent segment disease</topic><topic>Adult spinal deformity</topic><topic>Aged</topic><topic>Deformity correction</topic><topic>Distributed loading</topic><topic>Humans</topic><topic>Kyphosis - complications</topic><topic>Middle Aged</topic><topic>Neurosurgical Procedures - adverse effects</topic><topic>PJK</topic><topic>Postoperative Complications - pathology</topic><topic>Postoperative Complications - prevention &amp; control</topic><topic>Postoperative Complications - surgery</topic><topic>Proximal junctional kyphosis</topic><topic>Retrospective Studies</topic><topic>Spinal Curvatures - surgery</topic><topic>Spine - pathology</topic><topic>Spine - surgery</topic><topic>Spine biomechanics</topic><topic>Young’s modulus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tempel, Zachary J.</creatorcontrib><creatorcontrib>Hlubek, Randall J.</creatorcontrib><creatorcontrib>Kachmann, Michael C.</creatorcontrib><creatorcontrib>Body, Alaina</creatorcontrib><creatorcontrib>Okonkwo, David O.</creatorcontrib><creatorcontrib>Kanter, Adam S.</creatorcontrib><creatorcontrib>Buchholz, Avery L.</creatorcontrib><creatorcontrib>Krueger, Bryan M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tempel, Zachary J.</au><au>Hlubek, Randall J.</au><au>Kachmann, Michael C.</au><au>Body, Alaina</au><au>Okonkwo, David O.</au><au>Kanter, Adam S.</au><au>Buchholz, Avery L.</au><au>Krueger, Bryan M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Novel Distributed Loading Technique Using Multimaterial, Long-Segment Spinal Constructs to Prevent Proximal Junctional Pathology in Adult Spinal Deformity Correction—Operative Technique and Radiographic Findings</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2021-11</date><risdate>2021</risdate><volume>155</volume><spage>e264</spage><epage>e270</epage><pages>e264-e270</pages><issn>1878-8750</issn><eissn>1878-8769</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Proximal junctional kyphosis (PJK) and proximal junction failure are common and costly complications after long-segment adult spinal deformity (ASD) correction. Although much research has focused on the concept of “softening the landing” to prevent proximal junction pathologies, long-segment constructs largely deviate from the force-deformation curve of the physiologic spine. Our novel distributed loading technique for ASD correction is described using multimaterial, long-segment constructs to create a biomechanically sound, yet physiologic, decremental stiffness toward the rostral end. Operative steps detail the custom-designed constructs of dual-headed pedicle screws and varied rod diameters and materials (cobalt chromium or titanium) for an initial 20 patients (mean 66.6 ± 4.8 years). Standing scoliosis films were obtained preoperatively and at regular intervals postoperatively to assess for PJK. No patient had evidence of PJK or proximal junction failure at latest radiographic follow-up (mean 17.9 months, range 13−25 months). Radiographic findings for sagittal vertical axis averaged 11.2 ± 5.6 cm preoperatively and 3.6 ± 2.3 cm postoperatively. Compared with preoperative parameters, postoperative reductions in pelvic incidence-lumbar lordosis mismatch averaged 28.7 ± 12.9 degrees, and sagittal vertical axis averaged 7.6 ± 5.2 cm while PJA was essentially unchanged. Preliminary results suggest that the distributed loading technique is promising for prevention of PJK with stiffness gradients that mimic the force-deformation curve of the physiologic posterior tension band. Our technique may optimize the degree of stress at the proximal junction without overwhelming the anterior column bony while remodeling and mature arthrodesis takes place.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>34418605</pmid><doi>10.1016/j.wneu.2021.08.052</doi><orcidid>https://orcid.org/0000-0002-7444-2851</orcidid></addata></record>
fulltext fulltext
identifier ISSN: 1878-8750
ispartof World neurosurgery, 2021-11, Vol.155, p.e264-e270
issn 1878-8750
1878-8769
language eng
recordid cdi_proquest_miscellaneous_2563421596
source Elsevier
subjects Adjacent segment disease
Adult spinal deformity
Aged
Deformity correction
Distributed loading
Humans
Kyphosis - complications
Middle Aged
Neurosurgical Procedures - adverse effects
PJK
Postoperative Complications - pathology
Postoperative Complications - prevention & control
Postoperative Complications - surgery
Proximal junctional kyphosis
Retrospective Studies
Spinal Curvatures - surgery
Spine - pathology
Spine - surgery
Spine biomechanics
Young’s modulus
title Novel Distributed Loading Technique Using Multimaterial, Long-Segment Spinal Constructs to Prevent Proximal Junctional Pathology in Adult Spinal Deformity Correction—Operative Technique and Radiographic Findings
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-22T09%3A28%3A24IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Novel%20Distributed%20Loading%20Technique%20Using%20Multimaterial,%20Long-Segment%20Spinal%20Constructs%20to%20Prevent%20Proximal%20Junctional%20Pathology%20in%20Adult%20Spinal%20Deformity%20Correction%E2%80%94Operative%20Technique%20and%20Radiographic%20Findings&rft.jtitle=World%20neurosurgery&rft.au=Tempel,%20Zachary%20J.&rft.date=2021-11&rft.volume=155&rft.spage=e264&rft.epage=e270&rft.pages=e264-e270&rft.issn=1878-8750&rft.eissn=1878-8769&rft_id=info:doi/10.1016/j.wneu.2021.08.052&rft_dat=%3Cproquest_cross%3E2563421596%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c356t-c82ce10db2bdfd54cd4590651a6c02d4616f023ca65b93ddf186e9789ad3d26e3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2563421596&rft_id=info:pmid/34418605&rfr_iscdi=true