Texakalidis Pavlos, Matsoukas Stavros, Krushelnytskyy Mykhaylo, Swong Kevin, El Tecle Najib, Koski Tyler R, Dahdaleh Nader S
Department of Neurosurgery, Northwestern Memorial Hospital, Chicago, IL.
Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Spine (Phila Pa 1976). 2025 Jul 1;50(13):932-939. doi: 10.1097/BRS.0000000000005299. Epub 2025 Feb 14.
Systematic review and meta-analysis.
To evaluate the impact of posterior ligamentous augmentation (PLA) on proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in adult spinal deformity (ASD) surgery.
Adult spinal deformity (ASD) surgery is frequently complicated by PJK and PJF, with reported rates ranging from 17% to 61.7%. Techniques such as PLA, which involves spinous process or sublaminar tethering at the upper instrumented vertebra (UIV) +1 or +2, have been investigated as potential methods to mitigate these complications.
A systematic literature review and meta-analysis was performed according to the PRISMA guidelines. Most studies defined PJK as an increase of ≥10° or ≥20° in the sagittal Cobb angle from UIV to UIV+2 compared with preoperative measurements. PJF was defined as PJK necessitating revision surgery.
Eight comparative studies comprising 1333 patients (PLA: 579; no PLA: 754) were included. The mean age ranged from 55 to 68.6 years across studies, with a mean follow-up period of 17.6 to 31.2 months. There were no significant differences between the PLA and no PLA groups in terms of age (MD: 2.53; 95% CI: -0.28 to 5.34, I2 : 64.8%), BMI (MD: 1.03; 95% CI: -0.87 to 2.93, I2 : 69%), or sagittal vertical axis (SVA) preoperatively (MD: 3.92; 95% CI: -1.90 to 9.75, I2 : 73.1%) and postoperatively (MD: -1.54; 95% CI: -4.10 to 1.01, I2 : 56.2%). However, the PLA group demonstrated significantly lower odds of developing PJK compared with the no PLA group (PLA: 25.8%; no PLA: 28.8%; OR: 0.54; 95% CI: 0.34-0.85, I2 : 37.4%). Furthermore, PLA was associated with significantly lower odds of PJF (PLA: 3.3%; no PLA: 12.3%; OR: 0.23; 95% CI: 0.12-0.47, I2 : 17.9%).
PLA in ASD surgery is associated with reduced odds of developing PJK and PJF over a follow-up period of 17.6 to 31.2 months.
系统评价与荟萃分析。
评估后韧带增强术（PLA）对成人脊柱畸形（ASD）手术中近端交界性后凸（PJK）和近端交界性失败（PJF）的影响。
成人脊柱畸形（ASD）手术常并发PJK和PJF，报道发生率为17%至61.7%。诸如PLA（涉及在上端椎（UIV）+1或+2处进行棘突或椎板下固定）等技术已被研究作为减轻这些并发症的潜在方法。
根据PRISMA指南进行系统的文献综述和荟萃分析。大多数研究将PJK定义为与术前测量相比，从UIV到UIV +2矢状面Cobb角增加≥10°或≥20°。PJF定义为需要翻修手术的PJK。
纳入8项比较研究，共1333例患者（PLA组：579例；非PLA组：754例）。各研究中患者平均年龄为55至68.6岁，平均随访期为17.6至31.2个月。PLA组和非PLA组在年龄（MD：2.53；95%CI：-0.28至5.34，I²：64.8%）、体重指数（MD：1.03；95%CI：-0.87至2.93，I²：69%）或术前矢状垂直轴（SVA）（MD：3.92；95%CI：-1.90至9.75，I²：73.1%）及术后（MD：-1.54；95%CI：-4.10至1.01，I²：56.2%）方面均无显著差异。然而，与非PLA组相比，PLA组发生PJK的几率显著更低（PLA组：25.8%；非PLA组：28.8%；OR：0.54；95%CI：0.34 - 0.85，I²：37.4%）。此外，PLA与PJF几率显著降低相关（PLA组：3.3%；非PLA组：12.3%；OR：0.23；95%CI：0.12 - 0.47，I²：17.9%）。
在17.6至31.2个月的随访期内，ASD手术中的PLA与发生PJK和PJF的几率降低相关。
