Prevention of proximal junctional kyphosis & failure using sublaminar bands in a hybrid construct in pediatric kyphosis deformity

Abstract

Purpose: The purpose of this study was to evaluate short term proximal junctional kyphosis and failure (PJK/ PJF) rates and clinical outcomes in patients who underwent posterior spinal fusion (PSF) and deformity correction using sublaminar bands in a hybrid construct. Methods: This is a retrospective review of pediatric spinal deformity cases performed by a single surgeon from January 2008 to December 2012. One hundred thirty-six pediatric deformity patient charts were reviewed for inclusion into the study. All 136 patients reviewed had been operatively managed for a spinal deformity and were younger than 18 years of age. Our study's inclusion criteria comprised patients with a kyphosis greater than 608, the use of sublaminar polyester bands in a hybrid surgical construct, and a minimum of 2 years of follow-up. Of the 136 spinal deformity cases reviewed, 17 cases met our inclusion criteria. No cases were excluded because of technical difficulty of band placement or for not using a hybrid construct with sublaminar bands (as it was the primary surgeon's principal construct of choice). PJK was defined as proximal junction sagittal Cobb angle (PJA) of at least 108 greater than the preoperative measurement. This was assessed by comparison of preoperative and postoperative radiographs. Our hypothesis was that PSF performed with our technique would have a lower rate of PJK than previously reported with other methods of fixation. Results: The range of the preoperative kyphosis was 628-1118, and postoperative kyphosis was 128-558. There was one case of PJK (5.8%) and no cases of PJF. Conclusion: This study on short term outcomes of PSF using sublaminar bands in a hybrid technique for treatment of kyphosis demonstrated a lower rate of PJK than has been reported in prior studies. This technique protects the fixation within the upper instrumented vertebrae of long segment PSFs.