Echt Murray, Ranson William, Steinberger Jeremy, Yassari Reza, Cho Samuel K
2013Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
5925Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Global Spine J. 2021 Jun;11(5):792-801. doi: 10.1177/2192568220939902. Epub 2020 Aug 4.
Systematic review.
Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are well-known complications after long-segment fusions in the thoracolumbar spine of osteoporotic patients. Recent advances in anti-resorptive and anabolic medications, instrumentation, surgical technique, and cement augmentation have all aided in the avoidance of junctional kyphosis. In this article, current literature on the prevention of PJK and PJF in the osteoporotic spine is reviewed.
A systematic literature review was conducted using the PubMed/MEDLINE and Embase databases in order to search for the current preventive treatment methods for PJK and PJF published in the literature (1985 to present). Inclusion criteria included (1) published in English, (2) at least 1-year mean and median follow-up, (3) preoperative diagnosis of osteoporosis, (4) at least 3 levels instrumented, and (5) studies of medical treatment or surgical techniques for prevention of junctional kyphosis.
The review of the literature yielded 7 studies with low levels of evidence ranging from level II to IV. Treatment strategies reviewed addressed prophylaxis against ligamentous failure, adjacent vertebral compression fracture, and/or bone-implant interface failure. This includes studies on the effect of osteoporosis medication, cement augmentation, multi-rod constructs, and posterior-tension band supplementation. The role of perioperative teriparatide therapy maintains the highest level of evidence.
Perioperative teriparatide therapy represents the strongest evidence for preventive treatment, and further clinical trials are warranted. Use of cement augmentation, sublaminar tethers, and multi-rod constructs have low or insufficient evidence for recommendations. Future guidelines for adult spinal deformity correction may consider bone mineral density-adjusted alignment goals.
系统评价。
近端交界性后凸畸形（PJK）和近端交界性失败（PJF）是骨质疏松患者胸腰椎长节段融合术后众所周知的并发症。抗吸收和促合成药物、内固定器械、手术技术以及骨水泥强化等方面的最新进展均有助于避免交界性后凸畸形。本文对目前关于骨质疏松性脊柱中预防PJK和PJF的文献进行综述。
使用PubMed/MEDLINE和Embase数据库进行系统的文献综述，以检索文献中发表的关于PJK和PJF的当前预防性治疗方法（1985年至今）。纳入标准包括：（1）英文发表；（2）平均和中位随访至少1年；（3）术前诊断为骨质疏松症；（4）至少3个节段进行内固定；（5）关于预防交界性后凸畸形的药物治疗或手术技术的研究。
文献综述产生了7项证据水平较低的研究，证据水平从II级到IV级。所综述的治疗策略涉及预防韧带失败、相邻椎体压缩骨折和/或骨-植入物界面失败。这包括关于骨质疏松药物、骨水泥强化、多棒结构和后张力带补充作用的研究。围手术期特立帕肽治疗的作用保持了最高的证据水平。
围手术期特立帕肽治疗是预防性治疗的最有力证据，有必要进行进一步的临床试验。骨水泥强化、椎板下牵索和多棒结构的使用证据不足或不充分，无法给出推荐。未来成人脊柱畸形矫正指南可能会考虑根据骨密度调整对线目标。
