Tanaka Masato, Moschos Savvas, Jein Chen B, Verma Aman, Rezk Sharaf E H Mohammed A
Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, JPN.
Department of Orthopedic Surgery, Okayama University Hospital, Okayama, JPN.
Cureus. 2025 Jul 12;17(7):e87802. doi: 10.7759/cureus.87802. eCollection 2025 Jul.
Distal junctional kyphosis (DJK) or the adding-on phenomenon is one of the most challenging complications following long fusion for adolescent idiopathic scoliosis (AIS) or adult spinal deformity (ASD). Among these complications, distal junctional failure (DJF) is defined as a condition requiring revision surgery due to severe symptoms such as intense low back pain, myelopathy, and difficulty in standing and walking. Three patients developed severe lower back pain due to DJF, and two patients underwent revision surgery with a new technique. Surgical outcomes, surgical time, intraoperative blood loss, and operative complications were evaluated. Two patients underwent revision surgery with a novel method for revising distal screw loosening without excessive distal extension. There was no complication, and two patients had solid bony fusion at a two-year follow-up. The revision surgery for type 1 DJK can be challenging because the conventional pedicle screw technique is not feasible for the lower instrumented vertebra, and a more extended distal fusion is required. The adoption of O-arm-guided transdiscal screw fixation has significant clinical implications. This technique also increases accuracy in screw placement, mitigating the risks associated with traditional revision methods and preserving motion segments.
远端交界性后凸畸形（DJK）或附加现象是青少年特发性脊柱侧凸（AIS）或成人脊柱畸形（ASD）长节段融合术后最具挑战性的并发症之一。在这些并发症中，远端交界性失败（DJF）被定义为由于严重症状（如剧烈腰痛、脊髓病以及站立和行走困难）而需要翻修手术的一种情况。3例患者因DJF出现严重下腰痛，2例患者采用新技术接受了翻修手术。对手术结果、手术时间、术中出血量和手术并发症进行了评估。2例患者采用一种新方法进行翻修手术，该方法用于纠正远端螺钉松动而不过度向远端延伸。未出现并发症，2例患者在两年随访时获得了坚固的骨融合。1型DJK的翻修手术可能具有挑战性，因为传统的椎弓根螺钉技术对于最下端固定椎体不可行，并且需要更广泛的远端融合。采用O型臂引导下经椎间盘螺钉固定具有重要的临床意义。该技术还提高了螺钉置入的准确性，降低了与传统翻修方法相关的风险，并保留了活动节段。
